The Hackett Center Newsletter, October 2024

Welcome to the fall edition of The Hackett Center Newsletter. In this issue, we focus on women’s mental health. While mental health is well-recognized as a critical component of overall wellbeing, scientists, clinicians, and community leaders are only beginning to understand and respond to the unique and complex physiological, psychological, and social factors affecting women’s mental health. This newsletter highlights our Greater Houston Maternal Behavioral Health Roundtables that convene local experts passionate about improvements in this space and the outstanding work of Houston’s Network of Behavioral Health Providers (NBHP). We close this edition with a personal story from Jessica Rohr, PhD, Senior Fellow for Maternal Behavioral Health at The Hackett Center.

I am thrilled to lead The Hackett Center in improving women’s mental health throughout the lifespan in Houston and beyond. Thank you for giving your time to learn more.

The Hackett Center and its parent institution, the Meadows Institute, have launched a women’s behavioral health initiative. Our work focuses on elevating behavioral health prevention, intervention, and support during critical periods throughout a woman’s life course, namely during early childhood, adolescence, pregnancy, parenthood, and perimenopause and menopause, which we believe will advance health and wellbeing for all individuals. Our women’s behavioral health work includes an educational webinar series and related topical and timely issue briefs about women’s behavioral health. These briefs emphasize the importance of addressing women’s mental health through a comprehensive, systems-based, multi-faceted approach and summarize the recommendations from our speakers on the webinars for stronger practices and policies.

We’re thrilled to share the first issue brief, “Women’s Mental Health Across the Life Course”, in this issue of The Hackett Center News. Below is an excerpt, and you can find the full issue brief on our website, along with the corresponding webinar.

Women’s Mental Health Across the Life Course
Mental health is a critical aspect of overall well-being, and women experience life events and transitions throughout the life course that can impact their mental health. Poor mental health among women has far-reaching consequences that extend beyond individual well-being. Undiagnosed, underdiagnosed, and untreated mental health needs can negatively impact family dynamics, productivity, and economic stability, ultimately affecting entire communities. Societal expectations and the normalization of certain emotional struggles can contribute to the oversight of women’s mental health conditions, and this becomes even more evident for certain populations, including women of color.

Significant mental health disparities exist between men and women.₂ For example, high school girls are more than twice as likely to experience poor mental health compared to high school boys,₃ and women are twice as likely as men to experience depression in their lifetime.4 Additionally, women are more likely to experience anxiety disorders, eating disorders, and post-traumatic stress disorder (PTSD) than men._4,5,6,7,8 Even when attempting to access care, women meet a fragmented mental health system and encounter providers who have little to no training in women’s behavioral health. This problem is two-fold—a lack of available education and training opportunities for clinicians in women’s behavioral health and a gap in scientific research involving women. This deficit in training and in the involvement of women in clinical trials limits provider capacity to effectively address women’s mental health and furthers disparities in outcomes for women.

Read the rest of this brief here.

Footnotes

1. Yu S. (2018). Uncovering the hidden impacts of inequality on mental health: a global study. Translational psychiatry, 8(1), 98. https://doi.org/10.1038/s41398-018-0148-0
2. Centers for Disease Control and Prevention. Youth Risk Behavior Survey Data Summary and Trends Report 2011-2021. https://www.cdc.gov/healthyyouth/data/yrbs/yrbs_data_summary_and_trends.htm
3. Brody, D. J., Pratt, L. A., & Hughes, J. P. (2018). Prevalence of Depression Among Adults Aged 20 and Over: United States, 2013-2016. NCHS data brief, (303), 1–8. https://pubmed.ncbi.nlm.nih.gov/29638213/
4. GBD 2019 Diseases and Injuries Collaborators (2020). Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 396(10258), 1204–1222. https://doi.org/10.1016/S0140-6736(20)30925-9
5. Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of general psychiatry, 52(12), 1048–1060. https://doi.org/10.1001/archpsyc.1995.03950240066012
6. Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of general psychiatry, 62(6), 593– 602. https://doi.org/10.1001/archpsyc.62.6.593
7. Halbeisen, G., Braks, K., Huber, T. J., & Paslakis, G. (2022). Gender Differences in Treatment Outcomes for Eating Disorders: A Case-Matched, Retrospective Pre-Post Comparison. Nutrients, 14(11), 2240. https://doi.org/10.3390/nu14112240
8. Pereda, N., Guilera, G., Forns, M., & Gómez-Benito, J. (2009). The prevalence of child sexual abuse in community and student samples: a meta-analysis. Clinical psychology review, 29(4), 328–338. https://doi.org/10.1016/j.cpr.2009.02.007

Existing mental health systems are siloed and do not maximize the potential of relational health to improve maternal and child health outcomes. It is critical to take a cross-sector, multi-disciplinary approach to integrate mental health into prenatal and postpartum settings across the continuum of care. The Hackett Center continues to partner with Texas Health Institute, March of Dimes, and Mental Health America Greater Houston to convene the region’s first Maternal Behavioral Health Roundtable and uplift maternal mental health in Greater Houston. This core team is supported by our Roundtable Advisory Committee, representing Baylor College of Medicine, the Texas Department of State Health Services, the Network of Behavioral Health Providers, First3Years Texas, and the Houston Health Foundation. Roundtable participants gain a better understanding of the barriers and assets in the mental health ecosystem and identify and act on aligned priorities. The goals and structure of the Roundtables continue to evolve in response to participant input and emergent opportunities.

The April 2024 Roundtable convened over 50 community professionals, including community health workers, doulas, lactation consultants, peer support specialists, and others working directly with families, for a listening session to uplift challenges and opportunities affecting behavioral health in the Houston community. Key themes were that 1) There is a need for a robust, accessible, and unified system of trusted peer supports; 2) Community work is required to make real change; 3) Highlighting voices of lived experiences is crucial to buy-in; 4) Systems that provide care to individuals are siloed; and 5) Healthcare isn’t meeting the needs of parents.

The May 2024 Roundtable convened 50 professionals for an event titled Numbers Tell a Story: Research & Data in Maternal Mental Health. Attendees heard qualitative themes from the April Listening Session with community professionals, learned about the history of women’s exclusion from research and opportunities for improvement, listened to a case study of a DSHS landscape scan of maternal behavioral health resources in rural counties surrounding Harris County, and heard findings and implications of HCPH’s latest maternal child health report for Harris County.

To learn more about the Roundtables, please contact [email protected].

The Hackett Center is honored to work alongside and in partnership with the talented team at Houston’s The Network of Behavioral Health Providers (NBHP), which serves as a forum for Houston’s leading mental health and substance use service providers to come together and make progress on issues of common concern. Founded in 2004, NBHP is now 48 members strong. Those members represent public agencies and non-profit and for-profit organizations offering care along the full spectrum of behavioral health services from prevention to crisis intervention. Collectively, NBHP members serve over 250,000 participants annually and provide meaningful job opportunities for more than 5,000 behavioral health professionals with a total economic impact of more than $655M in behavioral health service provision.

NBHP has been a strong ally in The Hackett Center’s maternal behavioral health work. One of their signature projects, the Harris County Pathways Community HUB (HC PCH), is an evidence-based care coordination model focused on addressing the non-medical drivers of health for multiple populations including those who are pregnant or up to 12 months postpartum with behavioral health risk factors. The model provides individualized support for participants as they take concrete steps to complete an open ‘pathway’ towards research-based success in multiple areas including behavioral health and wellness, healthcare, postpartum care, education, housing, and food stability. LaToya Shields, Director of the Harris County PCH Project, serves on the Advisory Committee for the Greater Houston Maternal Behavioral Health Roundtables and brings her decades of experience in promoting health equity and public health approaches to the work of the Roundtable and its members.

Since its inception in November of 2022, Harris County PCH has demonstrated positive outcomes for pregnancy, birth, and behavioral health that far exceed those expected for the population served. In 2023 alone, 80% of pregnant participants carried their pregnancies to full term, and 85% of the babies born to these participants had a healthy birth weight. Since the project began, 85% of pregnant participants have carried their pregnancies to full term, and 90% of the babies born to them have had a healthy birth weight. Additionally, 71% of all pregnant participants successfully completed substance use pathways meaning that they met a series of milestones for treatment and recovery. Over 87% of all pregnant participants who completed the program showed lower Edinburgh Postnatal Depression Scale (EPDS) scores at discharge compared to enrollment. Finally, 95% of all opened postpartum pathways were closed successfully and within 84 days of pregnancy, aligning with industry standard Healthcare Effectiveness Data and Information Set (HEDIS) measures. This high-touch, Community Health Worker-based pay-for-performance model is driven by data and compassionate, skilled care. We are grateful that NBHP and Harris County PCH are demonstrating what is possible through partnerships that coordinate networks of providers to better serve participants’ unique needs.