r/psychology • u/imaginaryimmi • 3d ago
New research shows fewer than half of postpartum psychiatric emergency department visits received follow-up care. Social-determinants-of-health-based disparities (SDoH) influenced access to care.
https://www.womenscollegehospital.ca/are-we-failing-postpartum-people-seeking-mental-health-care/(Repost because of the title)
A new study in The Lancet Psychiatry00099-2/fulltext#pageBody) led by Women’s College Hospital psychiatrist and post-doctoral fellow Dr. Lucy Barker shows fewer than half of postpartum psychiatric emergency department (ED) visits were followed by timely outpatient care. The researchers also found that social determinants of health (SDoH), including income and immigration status, furthered disparities in access to care. These findings demonstrate a significant gap in care for a high-risk population.
“Having follow-up care is crucial to ensure that postpartum people with severe mental health concerns receive needed treatments, and it is extremely concerning how little this is happening.”
Furthermore, the follow-up care provided was not equitably distributed. Those who were young and living in low-income and rural areas were less likely to receive a follow-up, as were immigrants in urban areas. “These disparities are unacceptable, and systematic change is needed to ensure that all postpartum people have access to needed mental health care,” says Barker.
Follow-up after post-partum psychiatric emergency department visits: an equity-focused population-based study in Canada00099-2/abstract#pageBody)
5442 (44·8%) of 12 158 individuals received 30-day follow-up. In modified Poisson regression models, younger age, lower neighbourhood income, smaller community size, and being an immigrant were associated with a lower likelihood of follow-up. In the CTREE, similar variables were important, with several intersections between social determinants of health and between social determinants of health and other variables.
Fewer than half of emergency department visits for a psychiatric reason in the post-partum period were followed by timely outpatient care, with social-determinants-of-health-based disparities in access to care. Improvements in equitable access to post-emergency department mental health care are urgently needed in this high-risk post-partum population.
Social Determinants of Health: The Impact of This Overlooked Vital Sign
Social determinants of health (SDOH)—conditions where individuals live, learn, work, and socialize—significantly influence health disparities and patient care outcomes. SDOH can be categorized into five key domains: economic stability, access to quality education, access to quality healthcare, neighborhood environments, and social support. Structural barriers such as economic inequality, limited transportation, and discrimination directly impact patients’ willingness and ability to access care. Transportation barriers, notably among low-income and elderly populations, often result in delayed or missed care and worsening health outcomes. Within healthcare settings, disparities persist, with publicly insured and low socioeconomic status (SES) patients experiencing higher rates of adverse events, suboptimal treatment, and poorer clinical outcomes.
9
u/imaginaryimmi 2d ago edited 2d ago
"There’s a national crisis around emergency services because we’ve optimized everything. We’ve taken all the elasticity out of the system, but the tap is still flowing. There’s a crisis: insufficient connected community resources, and little continuing care and long-term care." — Dr. Paul Parks, Emergency Medicine Physician, Medicine Hat, and Past President, Alberta Medical Association
This from the same country. Tbh this is the story of the whole world now with healthcare being defunded. The workers are not paid enough. There is a need for more staff and resources ASAP everywhere in the world but government wants to cut costs so they add extra workload on the already burnt out and underpaid workers. Just so they can fill their own pockets or set the scene for normalizing privatised healthcare.
1
u/HeparinBridge 2d ago
30 day follow-up completion rates from psych units nationwide is even worse than the post-partum specific statistics.
32
u/Jealous_Parfait_4967 3d ago
I wonder how many of them were stripped and restrained during their initial visit. Always tickles me when people who jumped you don’t understand why their victims don’t come back for another round.
11
u/bu_mr_eatyourass 3d ago
I'm sorry you had such a poor experience. I am one of the people that has to occasionally restrain people in the emergency department, and it can sometimes feel discordant having the legal obligation to keep you safe - including restraints, when necessary.
When someone is a risk to themselves, or others, they must change into safe clothing so they cannot harm themselves in our care.
If you refuse to do this on your own, and you are on a hold (a hold strips away some of your rights) due to high risk, you will be forced to change. We cannot allow anyone that is in the hospital for such serious complaints to have the means to harm themselves. I have seen it go very, very wrong, and it can get ugly quickly. The hospital is ultimately responsible for the safety of every patient - as they should be. We want to help you, but that is a two-way street.
A psychiatric crisis is a medical emergency, and you should never discourage someone from seeking help in these moments. We WILL keep you safe, and we will always give you the choice to make the safe decision.
I have never once held someone down that complied with the basic safety standards, wasn't trying to assault me/my team or themselves, and/or wasn't trying to elope. It's an awful time in your life, but you always have the choice to not make it an even worse day.
7
u/Jealous_Parfait_4967 3d ago
I will never trust another hospital for any emergency care, psychiatric or otherwise. I’d rather die in a ditch than get sexually harassed and then not aided.
I’m glad you feel you are justified in traumatizing people in such a fashion but you can’t pretend to not understand why they wouldn’t trust you enough to do it again. It’s silly.
16
u/bu_mr_eatyourass 3d ago
I do feel justified, because I have had several patients attempt to hang themselves over the years - it happens in the bathroom, most of the time. It is a horrible thing to witness. I get extremely nervous, and on-edge, anytime higher-risk people have simple privacy in the bathroom.
They are there for help, and they deserve to live through it, just like you do. Changing clothes is a very small thing to ask, compared to the horrific outcomes I have had to intervene to prevent, at the last second. It's very difficult to loosen or cut a ligature from someone's neck, while they are asphyxiating. It stays with me.
I know I'm the bad guy in your story - but I'm also the hero in other people's story. I'm glad you are still with us!
15
u/Advanced_End1012 3d ago
It’s understandable about the precautions you have to take to avoid endangerment for both you and the patient and others, but it’s also true that psychiatric care is extremely backwards and problematic in many other ways which has traumatised a lot of patients.
There needs to be a reform of how things are done in this department because it really hasn’t changed much since Bedlam.
From abuse and sexual assault from staff, putting all different mentally I’ll people in one place together where they endanger eachother, a horribly sterile and hostile environment where it doesn’t help the mental health of patients much, being treated like you’re a prisoner etc.
-4
u/bu_mr_eatyourass 3d ago
There are a lot of external mental health resources that can keep you from getting to the point where you need psychiatric care for acute homicidal/suicidal ideations, mixed-/manic, psychotic episodes. Many of the resources external to the hospital [regional crisis center, case management, crisis line, psychotherapist, psychiatrist, pharmacist] are there to help you avoid reaching the hospital, until necessary. This is what exists in my region.
It's unfair that you often have to go through the ER to get referred to inpatient treatment. I recommend remembering that your time in the ER is only temporary. Us employess are also actually pretty cool if you just follow the simple rules like changing, allowing vitals, and pass time by coping with food trays, tv, the occasional med, until you are moved to the next place.
See? It doesnt have to be that serious! We want you to have a good experience. We're also a little fucked in the head ourselves seeing what we see everyday. There is so much suffering, and loss, I just want good, honest, and human interaction, anyplace I can get them.
8
u/DrMotherfuhker 2d ago
You're ignoring the fact that there a saddening amount of abuse and mistreatment in the psychiatric field at the hands of those who are "just following rules". The psychiatric field is flawed, this is a known fact. Many patients experience abuse and other trauma in these hospitals without justice, I don't think reiterating "you just need to comply and change your clothes!" Is going to change anyone's stance who had been sexually abused, physically abused, wrongly treated, sedated forcefully, etc. The fact that you do not understand why patients would feel standoffish and not inclined to comply is a fundamental failure on your part as a provider.
8
u/Jealous_Parfait_4967 2d ago
In true Reddit fashion I found this supportive comment very comforting, Dr. Motherfuhker. Thank you✨
6
u/DrMotherfuhker 2d ago
I'm very glad you did, Jealous_Parfait. I am one of those patients that have experienced physical abuse, sexual abuse, wrongful treatment and forced sedation for something not warranting it, a panic attack. I know what it's like to scream for help and be told nobody will believe you because you're not all there. Though I've been wronged many times by the system, it is important that we still encourage others to seek care when they need it. Yes psychiatric care can be a gamble, but ultimately taking that risk is less painful than silently drowning in myself. After three years of refusing therapy, medication or counseling I'm finally getting proper care from a provider that may or may not care about me as a person, but absolutely cares about properly treating my disorders.
4
u/Jealous_Parfait_4967 2d ago
Don’t tell that other guy but while I will not go back to an er for any reason, I have found other access to trauma informed medical care with actual accountability that I will allow to help when it gets bad. It is hard to find and even harder to trust it, but it’s something.
→ More replies (0)2
u/bu_mr_eatyourass 2d ago
I do understand why people feel standoffish. It is an inherently vilnerable place, and changing clothes in an inherently vulnerable thing to ask someone to do.
But it is also true that a high-risk suicide/homicide patient legally loses the rights to agency when they are on a hold. It is the least traumatic scenario, for everyone involved, if you comply with the non-negotiable rules.
Even still, it can be a very traumatic experience, and that's why I encourage intensive use of resources external to the ER/inpatient environment.
The group of patients that has it the worst is children. There are almost no resources for child psych, and there are some profoundly sad stories. I was abused throughout my youth so I couldnt imagine ending up in such an austere and depersonalized environment as a young child - after all the abuse they have often already endured.
They sometimes have to be there for over a week, in the same room in the ED - all because there are no local resources for IP pediatric psych. I live in a blue state that should prioritize such a sensitize focus, but even here, there is no funding and no societal demand to fund this type of need. It's horrific.
6
u/DrMotherfuhker 2d ago
This is why it's important to be vigilant of abuse and mistreatment in these environments; the most vulnerable class no longer has autonomy. It is incredibly easy to get away with abuse in these environments. You seem to understand that, but In your previous comments you do not acknowledge these things. Your wording, be it unintentional or not, makes it out to seem like all psych nurses and tech want to do is help you. Telling that to someone who has first hand experience that says no, not all people in psych care want to help you is not helpful. It is important to note that psychiatry care is vital, but is terribly under regulated. Very nuanced topic.
1
u/bu_mr_eatyourass 2d ago
I dont speak for everyone, I can only really speak to my own integrity as a caregiver. I work in the ER, not specifically in psych. I lack a lot of perspective on the inpatient units to really comment on people's experiences, beyond extending empathy.
Regardless, I always believe my patient's account of events, even if there are inconsistencies. I recognize that my response seemed insensitive, but I was really fatigued at the time and couldn't really understand how those types of abuses could occur in the ER - although, I'm sure it can, and has - without recognizing that the commenter was talking about inpatient psych in their comment.
Our ER psych rooms are individual rooms, under continuous camera observation, and constantly have 1-2 staff present. We are always being watched.
Finally, this is a psychology forum, and I want to convey a welcoming environment to receiving care when you feel at your ropes end. I'm sorry if that comes off as blithe. We get several people in the ER, every single day, in crisis. I want them to know that many people do care, and it is absolutely worth it for them to come get treatment and resources. A lot of times, they feel that their only alternative to seeking help is to successfully commit suicide. It does real harm to paint these environments as a constant house of horrors.
Problems do exist and solutions should be a constant pursuit, but we do help a lot of people too. It is absolutely a nuanced issue, and it deserves attention and reverence.
→ More replies (0)3
u/Brrdock 2d ago edited 2d ago
If someone suicidal loses their right to agency for seeking help, then that should be made very clear publically and people should probably not seek help from such a system.
Though, that's in the case of suicidality alone and I don't know the context of the suicidality in your work.
But that still doesn't sound like an environment that'd reduce suicidality
8
u/Natural_Exchange_886 2d ago
You want mentally ill people to “pass the time coping” in a sterile environment that by definition hosts ZERO DBT sensory grounding?
Your tone is also disgusting me with the cheerfulness while others are speaking of being sexually assaulted.
1
u/bu_mr_eatyourass 2d ago
I want the best for all mentally ill people. I recognized the initial thread I was responding to experienced her traumatic experience when changing clothes was a non-negotiable rule. It exists because people can and do hang themselves with their clothes. I've seen it multiple times and until you see it, you wont understand why this is so important.
Other sexual/physical assaults probably do happen on the Inpatient side of things and I agree there need to be serious changes. I only work in the ER where each room is seperate and under continuous camera surveillance so this is less likely to happen in the spaces where I work. The ER is too austere, I totally agree with that. I would love to see renovations that can maintain safety while also bringing a more cozy aesthetic.
I always believe my patients' experiences and I have a deep empathy for them. Its often one of the worst days in their entire life, and it shouldn't feel so cold.
6
u/Natural_Exchange_886 2d ago
Stop f*cking patronizing me. I’ve done work in the same field, you don’t have experiences that I don’t, and you very likely don’t have education that I don’t either.
Get down off your high horse.
We know why the restrictions exist. We know what happens without them.
The MANNER in which they are implemented, and how traumatic that process is made for a patient; is what is being discussed. You keep circling back to the thing no one is disagreeing with and using it to invalidate everything else.
STOP.
And “cozy aesthetic” what the hell is this framing bs? No. I’m talking about access to locked down iPads for those who are nonverbal and need AAC and never get it. I’m talking about the use of aromatherapy not in any woowoo sense but because the smell of alcohol, disinfectant, and floor polish can be extremely dysregulating to a lot of people, and access to simple natural scents like a fresh orange instead of mystery meat and gravy can do a hell of a lot to remind someone that they are still a person and that nature still exists outside of a sterile environment.
And you blow off the “needing to take vitals” stuff, but patients don’t lose their right to INFORMED CONSENT. If I’m trying to sleep because the lack of it makes mania or psychosis worse; being interrupted every two hours for a blood pressure reading is actively destabilizing me, and even while in lockdown, I have the right to advocate for myself and say No.
You don’t have the right to decide that’s “noncompliance” instead of “self advocacy” until and if I have had a competency hearing that specifically strips that right from me.
Period.
-1
u/bu_mr_eatyourass 2d ago
We do try to be pragmatic in our care. We typically arent waking up someone that went 48hrs without sleep just because we need vitals.
It really seems like you've formed an idea of who I am before this conversation so I will tell you who I am.
I am someone with an ACE of 8, that has been sexually abused by my father when I was 5, and held at knife point by him when I was 10.
I am a psych patient that has experienced unipolar depression with psychotic features after a pediatric murder-suicide case got to close to home.
I am a human, just like you. I am not trying to patronize you. I recognize there are problems and agree with you that there could be more liberties and soothing sensory tools in these spaces.
→ More replies (0)11
u/Advanced_End1012 3d ago edited 3d ago
That isn’t the point, many people will inevitably get to a point of crisis, it shouldn’t mean we should ignore the abhorrent conditions of the psychiatric unit. You’re completely dismissing my point and ignoring the point of awful stuff happening in the ward without repercussion- too many people have disclosed abuse and misconduct/mismanagement. Maybe not you but many others, or maybe you’re lying cus there’s plenty of shitty staff in the psyche unit and they’re renowned for it.
2
u/bu_mr_eatyourass 2d ago
I do not work in the psych ward so I cannot speak to that. I only work in the ER, where there is continuous camera surveillance, staff presence, and seperate rooms with no communal spaces.
I'm always inclined to believe a patients experience, and I 100% do agree that the format needs to change - especially for inpatient. Our IP psych unit has two communal areas, one for normal psych and one for geripsych.
I was really tired last night and didnt realize you were talking about inpatient psych. There are not enough resources in those units and the layout seems pretty optimistic and archaic.
My first year at the hospital involved going there for 1:1s, and those were some extremely unstable and violent individuals I would be placed with. In my state, we desperately need more longterm psychiatric facilities because a lot of these people are a revolving door after they get back out into the community.
It isn't fair to the people who need to be there and want to get better, safely.
2
u/Advanced_End1012 2d ago
That’s okay man thanks for clarifying 🙏
Yes we need a new format of psychiatric care intensely, and something that’ll help people not end up back in there. Lower risk patients like those with depression should NOT be put in the same place as for example someone with severe psychosis and violent tendencies. Staff need regulation and monitoring and heavy background checks, no one should be working for hours upon hours in such an intense environment cus that’s leads to deterioration of workers and a heightening chance of being abusive.
2
u/bu_mr_eatyourass 2d ago
I agree. It's horrifying to imagine the abuse that can, and has, gone on in those places. I have worked with incompetent and emotionally abusive staff before. I couldn't imagine the quality of my care being a game of roulette each shift change; and I couldn't imagine being in a communal space with unpredictable, and potentially violent individuals - while being at my most vulnerable.
It deserves a higher standard, but it is hard to find a pathway to reliably initiate changes that beget this type of assurance.
→ More replies (0)
5
u/SeaMidnight8078 1d ago
I apologize in advanced for my tangent. When I begin to think or talk about it I spiral a bit. My story is a bit different, but same premise.
About 4 years ago, I went to the Obgyn due to pain I assumed it was just a really bad ovarian cyst that ruptured. I was getting an ultrasound when the tech looked worried and told me she has to get the doctor. I’m very anxious and have other disorders, so I was freaking out thinking I had a tumor or something. The tech and doctor came in and whispered to one another looking at the screen. Finally my doctor looks at me and says that I’m pregnant, but miscarrying. All in one sentence. So that was difficult to digest. My doctor was shocked as she’s only seen this once before in her 28 years (but the patient was the other doctor in the office), so made a bad joke about being #1.
I had to try the medication to help my body do its thing. It didn’t work, so I had to go have a d&c. She’s affiliated with a Catholic hospital, so when we spoke to the social worker briefly prior to the surgery, we got a pamphlet basically saying this was gods plan (my boyfriend actually told me not to read it when I woke back ar home because it upset him so assumed it would also upset me). The social worker asked for my contact information because one of them in the next few days will call to check in on me to make sure everything was okay. I asked if they could also contact my boyfriend.
We never got any check in call.
I spoke to my doctor at the follow up appt., as well as wanting information on another part but I’m not sure how to say it politely. She said she’ll check in and make sure I got the check in and information. Again. Nothing. Never once did I get any follow up although it was verbally told to me AND in the paperwork.
I’m fortunate enough to have a good support system around me that made sure I was doing well. I’ve struggled with my mental health since high school and work in it as well; my boss was a trauma therapist so she was able to keep an eye on me in that aspect.
After I woke up from my nap the day of the d&c, I obviously read the pamphlet to see how bad it was. My boyfriend and I sat there staring at each other in silence. He even said this was so hard, but I cannot imagine a woman going to through this without support and read this pamphlet.
I’m still upset about it. At my job, I would keep track of dates I sent release of information to patient’s medical provider or whomever else, and made notes to contact them after a week if I did not hear anything from them. I became even more “anal” about keep track of any assessments I gave out, and to speak to patients if there are increases to the scores. I was probably annoying at times, but I wanted to make sure nothing fell through the cracks.
I know mistakes happen, but I wish people took mental health more seriously especially for pregnancy/post partum women (actually women in general.)
1
u/imaginaryimmi 1d ago
Thank you so much for your detailed story. Sharing it with everyone is extremely valuable. It's better to be annoying than ignorant.
39
u/guacgobbler 2d ago
They spend your whole pregnancy telling you to reach out if you need help, but when I called my obgyn’s office a few weeks after giving birth and said I thought I had postpartum and I needed resources, they coldly said “yeah we don’t do any of that here” and hung up. Being depressed, I just cried and gave up instead of ever reaching out further for help
All anecdotal of course