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Mandated perinatal mental health screening in California: a mixed-methods exploration
Rebecca Woofter1,2, Kortney Floyd James3,4, Rashmi Rao5
1Rutgers School of Public Health, Department of Health Behavior, Society, and Policy, Rutgers University, Piscataway, New Jersey, 08854, United States.
Insights
California's perinatal mental health screening mandate improved screening rates but did not fully address patient access to mental healthcare. OBGYNs reported continued barriers for patients seeking mental health services post-screening.
Area of Science:
- Perinatal mental health
- Healthcare policy
- Obstetrics and Gynecology
Background:
- California mandated perinatal mental health screenings in 2019.
- This policy aimed to improve identification of mental health symptoms during prenatal and postpartum care.
Purpose of the Study:
- To evaluate perinatal mental health screening rates after the California mandate.
- To understand OBGYN perspectives on screening effectiveness and patient outcomes.
Main Methods:
- Analysis of electronic medical records for 11,763 patients (2019-2023).
- Interviews with OBGYNs regarding screening practices and patient access to care.
Main Results:
- Screening rates increased from 2019 to 2023.
- By 2023, screening documentation reached 80% prenatal, 69% postpartum, and 57% for both.
- OBGYNs reported consistent screening but persistent patient barriers to mental healthcare access.
Conclusions:
- The mandate improved screening rates incrementally.
- Screening alone did not significantly enhance patient access to necessary mental healthcare.
- Further interventions are needed to address barriers in perinatal mental healthcare access.
Introduction:
As of 2019, California requires healthcare providers to screen patients for mental health symptoms during prenatal care and postpartum care. This study examined perinatal mental health screening rates and perspectives of OBGYNs on screening outcomes following this mandate.
Methods:
We analyzed electronic medical records data for patients who delivered in one California health system between 2019 and 2023 to assess prenatal and postpartum mental health screenings (N = 11 763). We also interviewed OBGYNs in the health system in 2023 about their perceptions of screening practice and patient outcomes since the mandate was implemented.
Results:
Both prenatal and postpartum screening rates increased between 2019 and 2023; however, by 2023, only 80% of patients had documented screenings in prenatal care, 69% in postpartum care, and 57% in both time periods. In interviews, OBGYNs noted that while the mandate led to more consistent screening, they emphasized that patients continued to face substantial barriers to mental healthcare.
Conclusion:
This study suggests that while the California perinatal mental health screening mandate led to incremental improvements in screening rates in the years following implementation, not all patients were screened within the study period. Further, OBGYNs indicated that screening alone did not substantially help patients access mental healthcare.
