Low barrier perinatal psychiatric care for patients with substance use disorder: meeting patients across the perinatal continuum where they are

Abstract

Pregnant and postpartum patients with substance use disorders (SUD) often have other co-occurring mental health disorders. Complications of substance use and mental health conditions, such as overdose and suicide, are a significant contributor to maternal morbidity and mortality. For individuals dually diagnosed with SUD and other mental health disorders, the perinatal period can be both a motivating and a vulnerable period for care. Barriers to optimal care include, but are not limited to, lack of screening, lack of referrals for care, a limited number of psychiatric providers available to care for pregnant patients, and stigma around mental health and addiction care in pregnancy. In this review, we discuss approaches to low-barrier perinatal psychiatric care for women with SUD to promote engagement in care. We review (1) appropriate psychiatric assessment and diagnostic work-up; (2) treatment planning incorporating shared-decision making, non-punitive and culturally sensitive patient-centred care, and principles of harm reduction with a focus on psychopharmacology, and (3) the benefits of an integrated and collaborative multidisciplinary care model for this subpopulation of vulnerable patients.

Keywords:

• Perinatal psychiatry
• women's mental health
• perinatal addiction
• perinatal substance use disorder
• reproductive psychiatry
• low barrier care women's psychiatry
• addiction in pregnancy
• substance use disorder in pregnancy
• postpartum mental health

Acknowledgement

We would like to thank Erin Castle Work for her technical help and assistance with this paper.

Disclosure statement

Edwin R. Raffi, MD, MPH is the Chief Medical Officer of Column Health Clinics.

Jessica Grey, MD: has no financial disclosures.

Nkechi Conteh, MD: has no financial disclosures

Martha Kane, PhD: has no financial disclosures

Lee S. Cohen, MD: Research Support: National Pregnancy Registry for Atypical Antipsychotics: Alkermes Biopharmaceuticals; AstraZeneca Pharmaceuticals; Forest/Actavis Pharmaceuticals; Ortho-McNeil Janssen Pharmaceuticals, Inc.; Otsuka Pharmaceuticals; Sunovion Pharmaceuticals, Inc.; Teva Pharmaceuticals; Johnson and Johnson Other Research Support: Brain & Behaviour Research Foundation; JayMac Pharmaceuticals; National Institute on Aging; National Institutes of Health; National Institute of Mental Health; SAGE Therapeutics; Takeda/Lundbeck Pharmaceuticals Advisory/Consulting: Alkermes Biopharmaceuticals (through MGH Clinical Trials Network Initiative); JDS Therapeutics LLC; Praxis Precision Medicines, Inc. (through MGH Clinical Trials Network Initiative).

Davida M Schiff, MD: National Institute on Drug Abuse, Substance Abuse and Mental Health Services Administration, and the Department of Justice.

No potential conflict of interest was reported by the author(s).