News in Postpartum Depression – UNC opens nation’s first Perinatal Psychiatry Inpatient Unit!

Samantha Meltzer-Brody, MD

On August 15, 2011, UNC’s newly renovated Perinatal Mood Disorders Inpatient Unit admitted its first patient. So noted Emmy Award winning journalist and news anchor Sara Lee Kessler, who has followed PPD issues in the nation for many years. “Do you think every state should have this?” she asked me (an obvious rhetorical question) – Just listen to the community of moms who have suffered, researchers, advocacy organizations, bloggers, clinicians, families and healthcare policy makers whose experiences and work are deeply validated by the opening of this center.

To those of us who have followed maternal mental health for years, the center’s opening is cause for great celebration. The significance of a specialized, well-equipped in-patient unit staffed by experienced and dedicated professionals represents an unprecedented milestone in maternal mental health…. a response commensurate to both the specialized needs of this patient population and the acuity of these concerning, but highly treatable disorders.

Samantha Meltzer-Brody, MD, MPH , Director of the UNC Perinatal Psychiatry Program, spoke about the clinical and programmatic road to this seminal moment. She noted that specialty services for women needing in-patient treatment for perinatal mood disorders have long been lacking. “Often”, states Dr. Meltzer-Brody, “they had been dissatisfied with psychiatric inpatient experiences which offered no specialized maternal services or appropriate facilities for their needs, especially to receive infant visits. We had initially attempted to house mothers needing inpatient treatment in our geropsychiatry unit as an interim solution. We needed to demonstrate that a specialized in-patient unit would be fiscally viable before we could open a dedicated facility.”

Throughout the past few years, Dr. Meltzer-Brody and her staff were treating rising numbers of mothers in their renown outpatient program. With increasing patient populations and a staff including experienced practitionersChris Raines RN, Elizabeth Bullard, MD and Director of Psychiatric Nursing Eileen Spahl, all of whom possess the clinical expertise to evaluate and determine the specialized therapies and services needed, the time seemed right to move forward with their dream facility.

Says Ms. Raines, “Our goal is to empower women and help them begin to understand this disorder and decrease the stigma surrounding depression and anxiety. By providing a caring and compassionate environment with providers who understand what helps and what does not help, we hope to give these women and their families the ability to heal and possibly grow through the difficulties of these disorders”.

In addition to compelling data and patient feedback overwhelmingly indicating the need for this comprehensive unit, Dr. Melzer-Brody is quick to credit a pro-woman’s mental health initiative among the leadership at UNC as a major factor in the center’s development. David Rubinow, MD, Chairman of the Department of Psychiatry and Director, UNC Center for Women’s Mood Disorders, helped to spearhead and maintain support among UNC administrators who whole-heartedly endorse the new facility.

Along with undeniable statistics of PMAD incidence and lack of available in-patient psychiatric specialty treatment, the growing level of national attention to this issue – which affects mothers and their infants with severely negative consequences if untreated – created additional impetus which has found its way into state and federal laws. The creation of UNC’s Perinatal Psychiatry In-Patient Unit offers a national model for replication by facilities who pride themselves on serving women and infant mental health. UNC can be very proud of taking the lead in this ground breaking achievement.

The new unit has its own entrance and is completely free-standing. The treatment team is comprised of highly trained doctors, nurses, psychologists, midwives, social workers, and other therapists who work together to create individualized treatment plans. Included is comprehensive assessment and treatment, medication stabilization when needed and a vast range of individual and group therapies as appropriate.

Dr. Meltzer Brody acknowledges that caution is required to avoid inadvertent implication that might stigmatize a specific diagnosis or individual woman’s mental health issue. As with psychiatric disorders in the general population, it is symptom acuity which ultimately determine in-patient placement. For example, a woman suffering from the extremely rare postpartum psychosis would initially be admitted to the unit which treats psychosis. Once stabilized, she would then be moved to the in-patient perinatal program.

With five dedicated beds (two of which can be easily partitioned to another unit if needed), the new perinatal psychiatry unit offers the following services:

• Protected sleep times
• Extended visiting hours to maximize positive mother-baby interaction
• Gliders for pumping and nursing in patient rooms
• Hospital-grade breast pumps, refrigeration and freezer storage
• Lactation consultants
• Specialty trained nursing and other staff
• Group therapies including art, relaxation, behavioral, and psycho-education
• Biofeedback therapy
• Mother-infant attachment therapy
• Family and partner assisted interpersonal psychotherapy
• Therapeutic yoga geared for pregnancy and postpartum women
• Nutrition consultation
• Obstetrics and Gynecology Consultation
• Spiritual support from hospital chaplains with expertise in the perinatal period
• Discharge planning and transition to outpatient either in the UNC Perinatal Psychiatry Outpatient program or in the patient’s community

Dr. Meltzer-Brody’s hope is that “other facilities/hospitals around the country will be inspired to open similarly dedicated in-patient perinatal psychiatry programs within their own institutions”. Her wish is certainly one echoed by all who support new mothers and understand the need to balance a healing in-patient stay with services which support the maternal child bond in a non-stigmatizing environment.

I look forward to attending the Grand Opening of this already operational facility which will be held on September 15, 2011. Congratulations to Dr. Meltzer-Brody and her associates for their perseverance in the national birth of this essential treatment component. To find out more about the program, please click here.

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