Statewide effort tackles postpartum depression and perinatal mood disorders

The Michigan Health & Hospital Association (MHA) is leading a statewide effort to expand care for new mothers struggling with postpartum depression and other perinatal mood disorders. 

“For mothers, depression rates continue to increase,” says Lauren LaPine-Ray, MHA vice president of policy and rural health. “Making sure we have real support for behavioral-health services in this state is somewhere we urgently need to see change and investment.”

Acting as a convener, MHA helps hospitals share best practices and implement programs designed to identify, treat, and prevent these conditions. The initiative aims to improve outcomes for mothers and families while supporting hospitals in building sustainable, evidence-based mental-health services.

“We see ourselves not as trying to change the work or duplicate it, but rather bringing together hospitals that are doing similar things or want to start a new program inspired by another community,” LaPine-Ray says. “By tracking this work over time, we hope to show positive change and real impact for patients and communities across the state.”

Rather than dictating which programs hospitals should adopt, LaPine-Ray explains that MHA equips members with guidance and resources so they can make informed decisions. The approach gives hospitals the tools to develop initiatives that reflect their community’s unique needs and priorities while learning from peers across the state.

“We viewed our role as equipping all our members with good information so they can make the best decisions for their communities,” she says.

Mother & Baby Day Program provides full continuum of care

Pine Rest Christian Mental Health Services is one MHA collaborator in expanding perinatal mental-health care. Jenna Strodtbeck, director of clinical practice for hospital and acute services at Pine Rest, helped shape the organization’s perinatal mood disorder (PMD) program, the Mother & Baby Day Program into the leading model it is today. Strodtbeck now works with MHA to help other hospitals adopt similar screening tools and services.

“We recognized there were barriers that kept mothers from accessing care such as child care, nursing needs, and separation from their new baby,” Strodtbeck says. “The model has broadened to a full continuum to include inpatient, outpatient psychiatry, and therapy.”

The Mother & Baby Day Program supports both mother and baby with a full continuum of care, from intensive inpatient treatment to partial hospitalization and outpatient therapy. The program offers specialized nursing care, psychiatric evaluation, therapy sessions, and the option for mothers to participate alongside their newborns in a structured environment, promoting bonding and continuity of care.

Strodtbeck emphasizes that combining standardized screening with strong leadership support ensures patients are identified early and connected to care before symptoms worsen.

“The most transferable aspects of Pine Rest’s program include specialized leadership, a multidisciplinary team structure, training model, safety protocols, screening workflows, and a quality improvement process,” she says. “Individual hospitals will want to explore their community needs, supports, and payors to determine the level of service they provide and how they staff and structure their program.”

Measuring early outcomes is an important part of evaluating perinatal mental health programs. Hospitals can track success through increased screenings and treatment for perinatal mood and anxiety disorders, as well as by monitoring referral networks to specialized care.

“We also look for growth in referral networks, which signals that hospitals and providers are becoming more confident in caring for these patients,” Strodtbeck says.

Preventive program cuts postpartum depression by 50%

Michigan State University also works alongside MHA to emphasize the need for more tailored resources for new and expectant parents through its ROSE (Reach Out, Stay Strong, Essentials) program. The program complements hospital-based services by offering a low-cost, evidence-based prenatal and postpartum curriculum to prevent postpartum depression. Multiple randomized trials have shown ROSE can prevent roughly half of postpartum depression cases. 

ROSE teaches expectant parents to identify stressors, build support networks, and practice asking for help. Dr. Jennifer Johnson, MSU professor of OB-GYN and psychiatry, partners with MHA to expand ROSE across the state and guide hospitals implementing the program.

“From our implementation trial through MSU, we found that over 40% of agencies could get ROSE up and running with strong initial implementation, adding quarterly or monthly support when needed,” Johnson says. “The cost of preventing a single case of depression saves about $32,000, making it highly cost-effective compared with the $2,000 to $4,000 cost of implementation.”

Johnson notes that offering ROSE universally rather than selectively is often simpler, particularly in clinics serving marginalized populations. A national study is now randomizing more than 2,000 mothers to examine universal versus selective implementation and inform scaling strategies.

“By and large, it’s easier for most settings to offer ROSE to everyone rather than pick and choose, especially in clinics serving marginalized populations, including undocumented mothers,” Johnson says. “Our study hopes to identify the impact of universal versus selective implementation, which helps us understand how to scale the program effectively.”

The program’s proven outcomes also help hospitals use limited mental-health resources more efficiently, allowing psychiatrists and providers to focus on higher-acuity cases.

“It’s rare to have something that prevents half of cases of postpartum depression and costs so little,” she notes. “By preventing these cases, we save scarce perinatal mental health resources, such as doctors who can prescribe effectively to pregnant and postpartum moms, making the whole system more efficient.”

Overcoming Medicaid and SNAP policies that threaten success

Despite these efforts, systemic challenges remain. Funding gaps, workforce shortages, and policy limitations make it difficult for hospitals to sustain comprehensive care, particularly for vulnerable populations. Johnson warns that cuts to Medicaid and other federal programs could restrict access and strain hospital systems.

“It’s more about the whole system than the program itself,” she says. “With coming cuts to Medicaid, SNAP, and other federal health and human services, not only will people lack care and access, but the systems themselves won’t be able to sustain certain services, which affects everyone.”

LaPine-Ray notes that reimbursement policies further complicate access.

“Intensive outpatient programs are reimbursed only on the commercial side, not through Medicaid,” she says. “That really limits which patients can access these services unless hospitals absorb the cost as charity care.”

Collaborative efforts have been supported in part by a two-year grant from the Michigan Health Endowment Fund, which allowed hospitals to launch initiatives, access guidance, and establish evaluation systems. MHA is now helping hospitals embed these programs into ongoing operations to ensure sustainability.

“Our intent throughout this work is to implement programs that are financially sustainable, and we know our nonprofit hospitals are eager to focus their community-benefit investments in these areas,” LaPine-Ray says. “If our hospitals can spend the next two years figuring out how to implement these programs, they’ll be much more likely to continue them once the grant funding runs out.”

Data collection will play a critical role in evaluating success. MHA is partnering with Public Policy Associates to establish common evaluation metrics, paired with decades of inpatient and outpatient hospital data to track improvements and identify gaps. LaPine-Ray notes that data submission on programs like ROSE and Pine Rest’s PMD program began in December, giving hospitals an early view of challenges and outcomes and helping guide long-term improvements.

More information on MHA’s efforts and a list of participating hospitals can be found at mha.org. 

Lisa LaPlante photo by Doug Coombe.
Photo of infant with book by Tommy Allen.
Dr. Johnson photo courtesy subject.
Other photos by Blondfox and Olly via Pexels.com.

The MI Mental Health series highlights the opportunities that Michigan’s children, teens and adults of all ages have to find the mental health help they need, when and where they need it. It is made possible with funding from the Community Mental Health Association of Michigan, Center for Health and Research Transformation, Genesee Health System, Mental Health Foundation of West Michigan, North Country CMH, Northern Lakes CMH Authority, OnPoint, Sanilac County CMH, St. Clair County CMH, Summit Pointe, and Washtenaw County CMH.

*Fact Sheet: Maternal Mental Health
**Interventions for Perinatal Depression and Anxiety in Fathers: A Mini-Review