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January 1, 2016

A lifespan of mental health services for women

Department of Psychiatry – January 2016 - View Full PDF

Sarah Nagle-Yang, MD

Associate Residency Training Director, Psychiatry; Co-Program Director, Women’s Mental Health Services, UH Case Medical Center; Assistant Professor, Department of Psychiatry, Case Western Reserve University School of Medicine

Jaina Amin, MD

Associate Residency Training Director, Psychiatry; Co-Program Director, Women’s Mental Health Services, UH Case Medical Center; Assistant Professor, Department of Psychiatry, Case Western Reserve University School of Medicine

University Hospitals Case Medical Center Department of Psychiatry has a rich history in the field of maternal mental health, including pioneering some of the nation’s first clinical research into infant attachment and family-centered care by Miriam B. Rosenthal, MD. Building on that history, in late 2014, the department re-launched an innovative, collaborative clinical and education partnership with the Department of Obstetrics and Gynecology at UH MacDonald Women’s Hospital.

The Women’s Mental Health Program offers a multidisciplinary approach to comprehensive mental health support for women throughout their lives, with particular expertise in the prenatal, postnatal and menopausal periods.

“Nearly every psychiatrist in traditional practice has found themselves with a pregnant patient and been confronted with conflicting research and few options for subspecialty expertise in reproductive psychiatry,” says Sarah Nagle-Yang, MD, Co-Director of the Women’s Mental Health Program. “Our goal is to provide a multifaceted service that reaches women across their life span when and where they need additional mental health support, no matter the circumstances.”

The program is co-directed by Dr. Nagle-Yang and Jaina Amin, MD, a colleague in reproductive psychiatry. The team also includes OB-GYN Lulu Zhao, MD, who is also Assistant Professor, Obstetrics and Gynecology, Case Western Reserve University School of Medicine, who has subspecialty training in mental health Additionally, the program operates in close collaboration with a physician who specializes in addiction, as well as several psychologists within the Departments of Psychiatry and Obstetrics and Gynecology.

On the outpatient side, Drs. Amin and Nagle-Yang hold an integrated clinic within a high-risk OB-GYN practice, which allows them to see the patient for mental health care in the same office where she has her prenatal visits, thus reducing the stigma of seeking mental health services for the expectant mother and increasing the likelihood that she will feel comfortable accessing the available support. 

In addition, the pair are embedded in two community mental health centers that offer perinatal programs—Connections: Health Wellness Advocacy Center and Ohio Guidestone.

For inpatients, the team offers a specialty consultative service for all obstetrical admissions at UH MacDonald Women’s Hospital, and participates in regular rounds on the unit to offer interdisciplinary feedback and guidance to obstetrics staff as needed. Maternal mental health services are also available for mothers in the neonatal intensive care unit (NICU). Dr. Nagle-Yang has published several studies on this topic, the most recent appearing in the journal Acta Paediatrica in 2013. That study defined the characteristics of mothers who benefit from on-site psychiatric services during any NICU hospitalization. 

To help combat the shortage of subspecialty expertise and lack of access to subspecialty care for women across the United States, the Women’s Mental Health Program seeks to better familiarize young doctors with the unique challenges of reproductive psychiatry through national advocacy and local education efforts. The aim is two-fold: to help general practice psychiatrists learn how to more effectively support and treat female patients at all stages of life, especially around pregnancy; and to train and educate a new cadre of reproductive psychiatry subspecialists. In 2015, the American Journal of Psychiatry featured a commentary co-authored by Dr. Nagle-Yang highlighting the importance of an increased focus on reproductive psychiatry for the next generation of psychiatrists. 

The Women’s Mental Health Program seeks to engage psychiatry residents in the service’s activities, both through liaison rounds and elective opportunities in outpatient settings. The goal is to introduce the unique aspects of this subspecialty to a larger population of aspiring psychiatrists. In 2016, the team will offer a new fellowship training track in women’s mental health as part of the Community Public Psychiatry Fellowship within the Department of Psychiatry. The fellowship will be one of only 10 of its kind in the country, and the only such dual-track fellowship for Women’s Mental Health and Community Psychiatry.

Dr. Nagle-Yang adds, “Providing comprehensive care to mothers during this pivotal time in their lives provides women with the care they deserve at all stages of life, and also supports the entire family structure. The research shows that a happy mother is a tremendous first step towards a healthy baby. We owe it to these families to reach as many mothers in need as possible, and this program is designed to continue those efforts, and grow them, well into the future.”

To learn more about the Women’s Mental Health Services program at University Hospitals, please contact Dr. Nagle-Yang at Sarah.Nagle-Yang@UHhospitals.org or Dr. Jaina Amin at Jaina.Amin@UHhospitals.org

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