Guest editorial--Reproductive mental health, Part 1

Over the past 20 years, the evolution of reproductive psychiatry as a subspecialty within adult psychiatry has been dramatic. Psychiatrists have come a long way in understanding mental illnesses in pregnant and postpartum women since Hippocrates first described them in 5 AD. Several reproductive psychiatry programs are now in operation throughout the world, and 2 years ago the First World Congress on Women’s Mental Health was held in Berlin. This was a milestone in recognizing and understanding the significance of mental health issues pertaining to women. 

The Provincial British Columbia Reproductive Mental Health (BCRMH) program had its auspicious beginnings in a tiny office at the old Grace Hospital in 1982. Despite its humble start, the program has evolved over the past 2 decades into a flagship provincial program, unique in Canada. Service is provided by six psychiatrists, one PhD psychologist, two counseling psychologists, one dietitian, two nurse clinicians, three research assistants, a provincial coordinator, and four clinical clerks. Program staff members are grateful to the BC Ministry of Health and the Provincial Health Services Authority for encouraging the program’s expansion, acknowledging the services provided, and helping improve the health care of mentally ill perinatal women in BC.

The program offers a variety of services at two sites: BC Women’s Hospital and St. Paul’s Hospital. Last year, more than 3000 patients were seen in the BCRMH outpatient program, and the inpatient consultation at the two hospitals were busy and active. 

Reproductive psychiatrists provide 24-hour on-call services at BC Women’s, where a “swing bed” allows the baby to room with the mother. This is a novel service, as it provides psychiatric care to women in an obstetrical setting. Counselors in the program specialize in offering marital therapy, cognitive behavioral therapy, interpersonal therapy, and innovative forms of group therapy. 

Recently, the BCRMH has added a clinical stream for women with concurrant mental health and substance use disorders. The PMS program, which was established as part of the BCRMH program in 1992, continues to rely on a multidisciplinary team approach, where pharmacotherapy, psychotherapy, and dietary counseling are integrated. 

The program’s provincial outreach component currently serves five regions in BC, and has been involved in trainer education, workshops, and surveys. Through teleconferencing, the provincial steering committee meets once a month to appraise community needs. Consumers have a strong voice in policy making. Public forums are offered regularly throughout the Lower Mainland. 

The BCRMH program is also affiliated with the Division of Adult Psychiatry in the Department of Psychiatry at the University of British Columbia. It provides educational opportunities for UBC’s medical students, psychiatry residents, and family practice residents. As well, the program attracts residents and fellows nationally and internationally. The program thrives on utilizing expertise from various disciplines, including nursing, psychology, social work, and art therapy. For the past 10 years, the reproductive psychiatrists have offered a well-received course through the American Psychiatric Association. 

The research activities of the program deserve special mention. The research group is now collaborating with groups in Canada and the United States to conduct ongoing prospective studies in the area of maternal-infant health. Pioneering work in the use of bright light therapy in postpartum women is being undertaken, while research in the area of group therapy for postpartum women has already proven this approach to be economical and time effective. Research is also underway regarding premenstrual dysphoric disorder and mood disorders related to perimenopause. Although more needs to be done in terms of education and research to bring women’s mental health to the forefront and to integrate it into mainstream psychiatry, much progress has been made. 

In this first of a two-part theme issue about reproductive mental health, we describe psychiatric disorders that can affect women during pregnancy and the postpartum period. In the April issue we will discuss pharmacological and nonpharmacological treatments for the pregnant, lactating, and postpartum patient. 

—Shaila Misri, MD, FRCPC
Clinical Professor, Psychiatry and Obstetrics and Gynaecology,
University of British Columbia
Medical Director, Reproductive Mental Health, BC Women’s Hospital and St. Paul’s Hospital