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For Clinicians

Episode 37: Perinatal Mental Health Among AAPI Moms

Dr. Bob Boland, Dr. Kerry Horrell, Dr. Nausheen Noor, Dr. Rose Yang
Dr. Bob Boland  00:02
Welcome to the mind guys podcast brought to you by the Menninger Clinic, a national leader in mental health care. We're your hosts, Dr. Bob Boland
Dr. Kerry Horrell  00:11
and Dr. Kerry Horrell. twice monthly, we dive into mental health topics that fascinate us as clinical professionals,
Dr. Kerry Horrell  00:18
and we explore those unexpected dilemmas that arise while treating patients. Join us for all of this, plus the latest research and perspectives from the minds of distinguished colleagues near and far. Let's dive in
Dr. Bob Boland  00:43
so now we have two people to introduce today. So who do you want introduce
Dr. Kerry Horrell  00:47
Oh, okay, well, I'll just start top of the list. Okay. First of all, let's say these are both psychologists, colleagues of ours here at the
Dr. Bob Boland  00:55
horse so excited to have we've been wanting them for a while. This was a demand
Dr. Kerry Horrell  01:00
or episode that took the longest to schedule. But we'll start with Dr. Nausheen Noor,  Dr.  Noor is a staff psychologist here at the clinic. Her clinical and research interests include women's mental health, trauma, personality disorders, she became passionate about women's mental health during her time as a community mental health provider in Karachi, Pakistan, where she provided services to women who are struggling with a host of issues, including postpartum depression, domestic violence and traumatic stress. And through her work, she strives to destigmatize and advocate for mental health and wellness in the Asian American community. Welcome Dr.Noor . Do you want to say hi, so people know which one is your voice?
Dr. Nausheen Noor  01:37
Thank you, Kerry. Yes. Hi, this is me. Dr. Noor.
Dr. Bob Boland  01:41
All right. So I'll do Dr. Rose Yang. Dr. Rose Yang is a staff psychologist for the adult division coordinator and she is the adult division coordinator and the faculty leader and liaison for Diversity, Equity and Inclusion at the Menninger Clinic. She's deeply passionate about cultural diversity issues and postpartum mental health. As a mom of two she recognizes the breadth of challenges and triumphs that come with motherhood. And I like that. Yeah. And she often looks for opportunities to provide education support for other moms and their families. So were we talking about the Asian American community today, mental health, and particularly perinatal health,is that fair to say?
Dr. Rose Yang  02:19
yeah, it's fair to say Hi, Dr. Yang,  super glad to be here. Welcome
Dr. Bob Boland  02:23
to both are so glad to finally have you
Dr. Kerry Horrell  02:25
on I know, okay, a long time coming.
Dr. Bob Boland  02:27
Yeah. All right. Let's get started. So, you know, for starters, so can you both describe your careers? And you know, just tell us how you got interested in Asian American and Pacific Island health,
Dr. Kerry Horrell  02:36
which we probably will move forward calling AAPI. Yeah, happy. Happy Asian American Pacific Islander? Yes. Yes. Rose, you want to kick us off?
Dr. Rose Yang  02:46
Yeah. So it's really interesting. Like my career trajectory. I actually was, initially I was like, I'm going to be a forensic psychologist, and I know all my practicums and all my externships. I did it all in forensics. And then I realized that I don't think I'm cut out to work in a prison setting. And so I decided, I did my fellowship at Menninger and have stayed at the Menninger Clinic ever since. I really got interested in sort of like D and I issues and APPI mental health, really, from the get go of fellowship, and then onwards, and particularly getting interested in sort of perinatal mental health, actually, because we had a couple of psychiatrists, and psychologists here who are really interested in that, and they kind of hold me on board, and I became very invested in it. Then I had my first kiddo, and I realized, wow, being a mom is a trip, and so therefore, I really got interested in what it's like to be a mom, the challenges that come with it, and the cultural sort of ramifications in my family and the ways that I found them to be also really supportive. And so that's how I really got interested initially. And I'm still passionate about it today.
Dr. Bob Boland  03:54
Oh, and Dr. Noor.
Dr. Nausheen Noor  03:56
Yeah. So as Kerry you were describing I, originally from Pakistan, and my interest in women's health started in my community mental health position. I had my master's in clinical psychology at that time from Pakistan. And but when I was sitting with these women, and hearing about all these stories on domestic violence or traumatic stress, I had no clue what to do, except to just sit and listen. And so that's when I knew I needed more training. I need to study more, learn more about interventions and do more research. So that brought me here to United States and I got my PhD here from University of Houston. I did like a host of different practicums. But none of them really centered on women. There isn't really, there wasn't an opportunity to just focus on immigrant women, specifically South Asian women. So I just did all these different kinds of trainings, learning about trauma, learning about eating disorders, and so different fields. And then I did my fellowship here at the Menninger Clinic as well and left and came back and Rose mentioned to me, Dr. Yang mentioned to me that you know, would you be interested in doing some more multicultural work together, some DEI work together. You know, as a mom of two even I've struggled quite a bit with being a mother of two kids. But the I think the extra layer that comes is also being the immigrant and being far from my family and not having that support system, especially during the pandemic. So that's another place where I became more passionate about it and kind of understood it in a different way than before.
Dr. Kerry Horrell  05:23
As we alluded to, we're gonna get into some of the stuff around motherhood and the intersection of perinatal health slash motherhood slash APPI women, but to maybe stay at like just some of the basics for a second, I think, like in the field of psychiatry and psychology we talk about or like there is, you know, groups and communities in the within the field that talk about APPI health. But I wonder if we do want to think about this is an incredibly diverse group of people. And it's not like any intersecting identities, it's really hard to find that balance between we want to think about the trends we're seeing, so that we can tailor treatments and care specifically to a community, while also balancing just the reality that every single human we interact with is this unique, complex group. So can I just want to acknowledge that before I ask this question, but but in general, as you think about like, issues, particularly psychiatric mental health, really issues like what are some of the common issues that are impacting the APPI community?
Dr. Rose Yang  06:20
Well, I think aside from mental health, I think the first thing is this idea of the model minority that I want to talk about, yes, because our community is not a monolith. And I think I really think there's quite a bit of debate right now, and sort of discussing whether we should be separating these groups of people rather than kind of lumping them all under the APPI umbrella. And I think that's a really good debate to have, because something that's really come up is this idea of the model minority that was coined in I think it was like, because like, 1966. It's really that old, yeah, yeah, it came out. And somebody wrote in the forget his name, but he wrote in a New York Times article talking about a Japanese success story and kind of talking about how, even despite World War Two and be in concentration camps, national, we're not calling them concentration camps within the United States, but that Japanese individuals and Asian individuals really kind of rose from the dust and were able to overcome their struggles and be very successful. I think the intention was good in that, but what it really does is it erases some of the struggles that that the individuals have, because the reality is, it's such a wide umbrella, you have Southeast Asians, you have East Asians, you have Pacific Islanders and Native Hawaiian individuals. And it's, it's such a wide geographical area as well. And so really, by saying kind of APPI individuals or model minorities, sort of what the stereotype of, you know, they're well educated, they make money there, they you know, don't put up a fuss, they're pretty passive in politics, that's one of the one of the stereotypes as well. And you know, they all come from good families with two parent homes like that really sort of erases the struggles of a lot of individuals who do not have these advantages who are coming here, escaping trauma, coming here as sort of refugees being displaced persons. And so I think that's one of the issues that has really come up for me instead of of my work around, sort of D&I Work and APPI work, you're not sure. I don't know if you have additional thoughts around that. But that's something that I've come up against,
Dr. Nausheen Noor  08:24
I think you covered about everything in there. But I just wanted to speak to Kerry what you mentioned about the diversity. So yes, as diverse as we are, but there are also so many, you know, geographically were scattered like, I don't know how Hawaiian and Pacific Islander and, and Pakistan are Pakistanis are lumped in the same umbrella under the same umbrella. It doesn't make that sense. And then the diversity in terms of the languages that are spoken, the religions that are practiced, the different groups that exist. I mean, it is just so diverse, that if we were to speak, even if Rose and I would just speak, we can have completely different presentations on just one group versus the other. Right. Yes. The the problem with that term, although it simplifies things, and thank God, there is a term for us. And we're not just others on the demographic form, but it does it does erase a lot of the nuances.
Dr. Bob Boland  09:16
Yeah. What's a fair percentage of the world's population? Majority, though? Yeah, it is hard to imagine how we can group it together.
Dr. Rose Yang  09:24
Yeah. And actually to that piece, too. I think they were doing some research around this. And they were saying at the rate in which the APPI the population is growing by like 2060, or something like that we would be sort of the largest minority population in the United States.
Dr. Bob Boland  09:39
I think it's been the fastest growing. Yeah, absolutely. So we know that APPI individuals were particularly affected during the pandemic, right. And how do you think this affected their mental health? Is that something you remember about but there's a lot of a lot of anti Asian sentiment, essentially?
Yeah, they were due to the socio political climate at that time. There were a lot of hate crimes. Like COVID was called like the Asian flu. So there were there were a lot of hate crimes at that time against the APPI population. And there was an increase in symptoms of depression and anxiety and physical ailments at that time. And it also impacted perinatal depression. But fewer women were reporting at that time, and we'll get, we'll get to that later. But women were affected disproportionately, at that time.
Dr. Kerry Horrell  10:24
Do we jump into this part of it? Do you? Well, actually, it was, yeah, Rose, do you have other things that you would like to comment on when you're COVID. And, again, I, I do just want to say I really felt the juxtaposition between is just saying, really, this group is not a monolith. And we just can't draw, like a bunch of pieces. And I'm like, now how are people? Affected by, you know, our generations? pandemic? How did that happen? But I do. I do. I mean, I, again, it's like, I think it's a delicate balance between like, a, like, you're saying, like, having a name for a group and thinking about and, you know, I know, in our all three of, you know, for Nausheen and Rosa and I, we were kind of the the group that just started our Diversity Forum here at the clinic. And so for years, you know, we've been in close contact about some of these conversations and finding a, we have to put names and words to our experiences as intersecting identities so that we can tailor our mental health treatments that we are not just modeling everything after one type of person. And again, it's so hard to Yes, when these boxes. So again, just wanting to say that I felt that, that jump between those questions, but Rose, I wonder, did you have anything that you wanted to say about COVID? And just again, what you've noticed?
Dr. Rose Yang  11:40
Well, I think that's actually a really good point, because I think about COVID. And the hate crimes and the reportings under reporting, quite frankly, of sort of hate crimes. It is also one of those things where society really lumped Asian people together as one, right. I mean, it was called, you know, the China virus. Right. Yeah. You know, we think about the Coronavirus was called the China virus or some of the rhetoric around that, that that machine was referring to, people didn't really care where somebody came from, what their ethnicity was, what their background was, they kind of lumped them all, or thinking about some of the hate crimes that we're talking about. People lumped, everybody that looked maybe particularly Asian in their minds was seen as coming from China or as potentially a carrier or sick with, you know, COVID 19. So I think that really does highlight kind of that point there, though, which is, even though there's so many groups, and there's so many different ethnicities and cultures within the APPI population in this in this alone, we were lumped as one ways, right? So I think that to that point, yes.
Dr. Kerry Horrell  12:41
So okay, this thing about perinatal health, I'm realizing I don't know that I know which distinct or not distinct boundary Peri Natal, I
Dr. Bob Boland  12:53
don't mean, like
Dr. Kerry Horrell  12:54
fishing around and not say that incompetent, but I don't actually know what that means. Neonatal is before they're born, then putting to duty and apparently, it'll be like,
Dr. Bob Boland  13:02
after obviously after birth. Okay,
Dr. Kerry Horrell  13:05
well, so no, no, if I'm wrong, can we can we, as again, I guess we needed to inch towards this intersection, perinatal help for
Dr. Kerry Horrell  13:13
APPI women.
Dr. Kerry Horrell  13:14
Let's Can we start with what is the perinatal? Yes. So what is that
Dr. Nausheen Noor  13:19
you want to take? Yeah, sure.
Dr. Rose Yang  13:21
So what we have here and what we're really talking about is like during pregnancy, during the birthing process, and postpartum up to about a year postpartum, later, right, because I when I think about perinatal, I also think of later even though that might be not the sort of the operational definition, and I like the word perinatal, because it really kind of highlights how the entire process of so like pregnancy Oh, actually getting pregnant, a pregnancy of the birthing process and postpartum has so many emotions associated with it, and so many reactions associated with it. Whereas sometimes when we when we use the term, sort of like postpartum depression, right, the focus is so much on Well, after giving birth, Mom becomes depressed or dad, you know, becomes depressed, right. And the reality is oftentimes, which we're not really doing very well is, you know, the individual is starting to feel those symptoms of say anxiety or depression or having some of those obsessive thoughts even before the baby was born. Right. And if there's a kind of jumping ahead, but if there's a way that we could really like screen for that and sort of intervene earlier on, I mean, that's better off for mom baby in the family. So that's kind of my thought
Dr. Kerry Horrell  14:32
really, really quick too. We did not put this in your bio but you are certified in perinatal mental health, like this is a some this is like in your you know, Rose Yang, PhD, and then there's three more letters.
Yes, yes, I'm certified and I don't even remember my exactly my three letters.
Dr. Kerry Horrell  14:50
If I'm recalling your email bio, I think it's P M H. C. dash c? Yes. Very he's got it right rosemary, clearly email. Got it. Correct. Yeah, and that means you're Perry, you're certified in perinatal mental health.
Dr. Rose Yang  15:03
Yes. So you can get that certification. It's through Postpartum Support International. Just a plug for one of our other psychologists here. Dr. Taylor Neff is also certified. Very cool. So just wanted to point that out. But yeah, it's a I am, sir.
Dr. Bob Boland  15:18
So are we talking more about sort of the exacerbation of like, mental disorders during the perinatal period? Are there unique things that come up during that period that we should be aware of?
Dr. Kerry Horrell  15:28
And he also tags on? Or both? Or both?
Dr. Nausheen Noor  15:31
Yeah, I think that combination for sure, there are some people who have not had a history of any depression and anxiety who will experience those during the perinatal period, and those who had before will have an it will be more exacerbated, right?
Dr. Kerry Horrell  15:45
Like, because I'm thinking, it's not only that you might be more psychiatrically vulnerable to getting depression or anxiety, because of hormonal changes and other stuff. But you're also psycho socially entering into parenthood, you're changing your identity for many people, meaning you have your you have this new identity of parent, your own world of how you have learned to get your needs met kind of shifts on its axis, I imagine. So I can imagine like, there's also like, psychosocial stressors, looks like I again, I'm just I'm spitballing. This is not my area of expertise. So it's not clear. But I could imagine that you have the psychiatric vulnerabilities that have already been there, the hormonal changes, slash, just sleep and all these things that change around this time period, then meets I, you know,
Dr. Nausheen Noor  16:30
yeah, and thank you for that guy. And the differences, like all of us will struggle with any kind of transition, right? And that struggle is okay. It's it's a normal reaction to that extraordinary circumstance that you're going through. But in when we're talking about these symptoms, becoming to the point that if you need professional help, that's when they're really getting in the way of your functioning, like, you know, you may be having struggles, but you can deal with them, you have support systems in place that help you cope through it, or you're struggling so much that no matter how supportive your people are around you, you're still going to struggle, and you need that extra help. So that's the difference that I want. I wanted to mention before. Yeah, I personally
Dr. Kerry Horrell  17:12
don't struggle with change. It's easy, and I love it, as anyone close to me would know, well, that would make you know, I'm teasing. That's a huge change. So yeah, I can only imagine like the change of like developed like, again, even on a personal note, like my own like choices of thinking, Okay, I would like to have children in the next few years. It's just like, even in the thinking stage, which I don't know if that counts under perinatal, of all the deciding about I mean, it's just like, I'm under the umbrella, surely, at this point, I
think but also like when we're going through fertility treatment. Yeah,
Dr. Kerry Horrell  17:43
that's what I was thinking was that it is also that
Dr. Nausheen Noor  17:45
I went through some fertility treatments during my time. And I remember sitting in a waiting area and reading this at the fertility specialist that women who are going through fertility treatments have as much stress and depression, as women who are at the end of life, like are going through a trauma treatment. So this distress is pretty
Dr. Kerry Horrell  18:05
that was like in a brochure in the waiting room. Exactly. That sounds a little bleak, validating, but also a little bleak.
Dr. Nausheen Noor  18:12
And it's one of those advertisements, right? Like to talk you out of smoking, they'll show you some hidekous pictures of lungs. It was one of those things, but but just talking about fertility.
Dr. Bob Boland  18:26
Well, it is it is stressful.
Dr. Kerry Horrell  18:28
Yeah. Well, so maybe we can think a little bit about again, I'm kind of imagining our conversation as like we're getting closer and closer to how these two areas of both of your interests intersect. So a maybe one more question just broadly about what you two have studied and learned about the perinatal period is our like, what are the major barriers that come up for women during this time? And again, we've kind of covered that, but wonder if there's any other thoughts about
Dr. Rose Yang  18:53
that piece? Specifically mental health barriers or just like barriers in general? Yeah,
Dr. Kerry Horrell  18:58
both mental health I'd think specifically of like getting getting help getting care.
Dr. Rose Yang  19:02
I think a big part of it is honestly screening. I mean, I don't think here we do a very good job of screening for mental health symptoms for women who are pregnant and postpartum. I mean, I think one example of this too, is and when we think about sort of our typical OB GYN visits, right.
Dr. Bob Boland  19:22
When you say here, what do you mean by I mean, like the United States, okay. I like to think here.
Dr. Rose Yang  19:29
No, no, no, I just mean, like in the United States, because if we think about sort of your your OB visits, the primary focus is to make sure mom, you know, mom is physically healthy baby is physically healthy, and we're good to go. But there really is very, very limited screening here. It's kind of like, as long as you're good. These appointments are really quite short, like growth is good, all right, and you're out. And if you think postpartum, even though you're going in for postpartum checkups, they're tracking and make sure there's no infection. You know, they check to make sure like my C section was fine, and they were checking to make sure that you know, I'm like, physically healthy. But I don't even remember any questions being asked to me around the car are you doing like, how are you feeling?
Dr. Kerry Horrell  20:10
Are you okay?
Dr. Rose Yang  20:12
Are you okay? Yeah, and I want to be like, I'm not okay, I'm not okay, right now.
Dr. Kerry Horrell  20:16
And it's bad. It's.
Dr. Rose Yang  20:20
And, you know, the only screeners we got, actually was that my pediatricians alright. And even that, even though I love my pediatrician, it was done in such a sort of, like this kind of practical manner, they gave you a sheet where you had to fill out sort of like your symptoms, how are you feeling? Or do you have any desire to hurt yourself? Are you having, you know, low mood? Are you crying all the time? They left the room. And then they took the paper, and they never talked to me about it again.
Dr. Kerry Horrell  20:47
And that was I mean, I sit similar. I mean, I wasn't in just a normal PCP checkup moment. And I remember the nurse being like, handle these are weird questions, but just I have to ask them, but like, Are you depressed? And I was like, what a setup. You teed that up? So Well, for me to say anything besides right? No, let's move on from that. And I actually, this was classic me, I gave that nurse feedback. I was like, Hey, I'm a psychologist. And I just want you to know, like, that is, there's just no way anyone's going to say yes to that question. If you are genuinely interested in, you know, finding that out, but it right. It's like, even when the screeners are there, think there's just at times, like, just another thing that we have to just get the answers for, and we don't want to bother people.
Dr. Rose Yang  21:29
Right. Right. And I think that's Oh, god. Okay. Well, I was just saying, I think, you know, it's not that they're the only ones that should be aware of it. But I think a lot of women can't necessarily tell like how much of this is normal anxiety, normal depression based with, you know, their bodies changing, their roles are going to be changing there, there have to really be, you know, thinking about what their future is going to look like with a new baby in the house. And how much of it might actually be problematic, and is something that we need to sort of intervene. And so if women are not necessarily aware, and nobody else is checking on them to being, you know, to see if they're struggling, you know, we're really, you know, we're really in a position in which women are very vulnerable during that time. Yeah. So
Dr. Kerry Horrell  22:11
let's let's hop into about APPI women and their perinatal health. And I'm thinking specific barriers, specific experiences that again, you to have come to, in your own research and work, identify.
Dr. Nausheen Noor  22:27
Yeah, so it would be some of the same things that Rose we're talking about, but also, like, the way the the illnesses manifest, and the way we describe them, will be very different than how mainstream American culture would describe that. So I remember going to the doctor with my mom, and the doctor asking her about, like, are you legs hurting? And she didn't say, yes, they're hurting. She said, It feels like a rod is jammed in my leg. Right? It's a very, like, physical way of describing that kind of
Dr. Bob Boland  22:58
rods was jammed. Awful. Mine's better. Yeah,
Dr. Nausheen Noor  23:01
so it's like a lot of pain. But instead of saying, I'm in a lot of pain, it's a very visual description. But even with physic, like even your thinking of psychological convinced, like feeling depressed and sad and feeling anxious, it's a stereotype and mostly APPI women would be more likely to respond to like more physical measures, like it feels like My chest hurts a lot. My shoulders hurt a lot. Like, you know, more psychosomatic versus just psychological. And that's just, again, as I said, it's a stereotype. Not all people, all APPI people would say it, though. But there when you're thinking about thinking of immigrants, when you're thinking for a second generation APPI women, it would be very similar to that. So again, some women might just get missed on our screeners because they're not endorsing their psych psychological symptoms in exactly the same way that they're being measured by people who have normed it on mostly Caucasian women.
Dr. Bob Boland  23:52
So it's just not culturally sensitive, essentially.
Exactly. Yeah. And then there's this fear of like this shame on like, How can I be sad, I should be grateful I have this beautiful baby, how can I and this I think is real for all women. But, you know, this is what I really wanted. Everybody told me this wonderful baby shower, and now they've all forgotten about me that that's how it's supposed to be, I should just be happy and grateful and move on. So how can I be sad right now? So that kind of shame. Also, like silences a lot of people and people get missed then.
Dr. Rose Yang  24:24
Yeah, I think one thing that comes up too, when we're thinking about the struggles, in particular that APPI women have is around sort of acculturation and gaps in the family system that so for example, one thing that I think about when we're talking about acculturation gaps, oftentimes we're talking about a single family unit where maybe the parents immigrated here when they were in their late 20s, early 30s. And maybe they had a baby here or the child would emigrated when they were like one or two or three, right? And so what you'll notice in those families there are there going to be sort of acculturation gaps because their level of acculturation between the parents and the child are going to be different. So their value systems are going to be different, right? The way they acclimate to the environment, the way that you know, the, the social circles that they run in are going to be different. So what you'll see oftentimes, and I noticed this, even from a personal experience, and with some of my friends as well is around postpartum for women, the expectations from maybe their elders, their mother in law, for example, right around what the woman is supposed to do. So in China, for example, and this is not uncommon in other Asian countries, you have this idea of setting the month, where you essentially kind of seclude yourself postpartum where everybody comes in and takes care of the baby, and you brings you all the food, and you kind of lay in bed, you're supposed to rest for a month, which in theory sounds really, really nice, right? But for a lot of, for a lot of women who that wasn't the culture that that you know, that they're more familiar with, they don't want to stay inside for a month, that actually increases their symptoms of feeling depressed, like feeling like they're not getting back to their lives. And so sometimes what you'll see in these family systems is some conflict around maybe elders or other family members saying no, like, you need to follow this cultural custom in order to stay healthy and to get healthy. And maybe the woman and the husband don't want to do that, because it feels, it feels very suffocating. It feels very paralyzing. But that can create tension for the family system, right? So you really notice this in some families where there are sort of mixed generations with different levels of culturation. That's one thing I want to point out to,
Dr. Bob Boland  26:26
to take us to like what we should be doing about this, both when we're evaluating people, and when we want to help them, what should what advice do you have
Dr. Kerry Horrell  26:34
is this, you know, the reminder, our podcast is pretty geared towards people who are in the mental health field, early in helping professions. And so yeah, just you know, as you think about what are some of the best practices or even just tips, interventions, what comes to mind? I
Dr. Rose Yang  26:48
think this is what it be for, like the mental health field in general, even though you just said it's primarily for people. But it's, I mean, I'm harping on this. But going back to screening, as I think we don't have enough individuals who are doing the screening process and checking in with women on how they're doing throughout the entire perinatal process. And so, you know, again, historically, it's kind of been, you know, maybe OB GYN, so we'll do it, maybe pediatricians will do it. But the idea is, we really need to kind of rethink this and establish a culture where, you know, your physician's assistants are doing it, the nurses are checking in with you. If you have a doula if you have a midwife? Are there certain measures that they can use to see like, how are you doing emotionally? Right? What's going on with you? Are we able to look at and assess for signs of mania if you have a history of bipolar disorder, because that can be very a cluster of like a common, so to speak, flare up when going through sort of the perinatal process for women, right, because that's one thing I really think about is what we could do is really educate, you know, sort of different providers on how to kind of check in with women. And at the ACOG website, actually, they have say that what is that the American College of Obstetricians and Gynecologists? Yes, they're on their website, they actually have a lot of resources. They literally give you screeners that you can give to your patients. And they're like, you can just print them and download them. And you can give them in your office and give, you know, to check in to see how women are doing.  But to Kerry's
Dr. Bob Boland  28:17
point, I guess you have to mean it. Right. Right. Yeah.
Dr. Nausheen Noor  28:21
Like here, are you filling out the box? Yes. And also like to have those screeners available in different languages, okay, now to do have maybe interpreters there who who administered those screeners that would take a lot more work and manpower to do it. But what an investment that would be in terms of improving women's mental health and Perinatal health and when you're improving that it impacts the whole family. So having those those systems in place, especially the screening, yes, I agree with Rose, like it starts from the very beginning and having it again, at that time, they're typically not going to a therapist or counselor, or a social worker, they're more going to they're OBs, then they're going to their pediatricians, right? They're taking care of the baby, but they're missing out on themselves. So those people need to be checking in much more with the mom, then see if people in the mental health field would be doing in terms of access.
Dr. Kerry Horrell  29:16
Yeah. Because it just does have me thinking about the kind of protocols that are in place for Hey, when your body has gone through pregnancy, physically, here are things that could be red flags afterwards that there's a problem. It's like and then just the way that stigma just rushes in when it's like you've just gone through pregnancy and there might be changes in your hormones and stuff that goes on in your brain that then this is the red flag that there's a problem just gets so much like messier and it just doesn't feel as like again, it's talked about the experience of it. And I wonder actually one of my thoughts around this is I wonder if this is a almost like a systemic nose goes situation of like, Oh, I'm and OB that's not really my lane. Well, I'm this and this that's not really my lane either. I'm the pediatrician that's not my lane, and sort of this experience of like, who ends up being the hanging up the
Dr. Nausheen Noor  30:10
Yeah. But I think there is some recognition that this is their lane as much as it's ours, because otherwise those screeners wouldn't be there. I think it shouldn't happen. Yeah, yeah, I think I think there has been enough discourse, which might be very little, but enough to see the impact of poor perinatal health, which is why we are getting those screeners even though there are those are checkboxes. So maybe the next checkbox can be to, to look at those trainers closely and to have a conversation with with the patient, right. So slowly, and gradually, we can, I think, make that impact. If we just and normalizing, Kerry, to your point, like these changes, it could be hormonal, and some of these changes are going to happen. So really normalizing that that conversation as well, not just like having like a party, that there's going to be a baby, you know,
Dr. Rose Yang  31:02
I think as mental health providers too, is that there's so I feel like there's there's certain topics that we may be uncomfortable with. And I think if we don't feel like we're trained in the area of sort of like perinatal mental health, we may not ask these questions. And so I think one thing when I think about is sort of accessing mental health care is as a therapist or as like a counselor, to be somewhat versed and some of these conversations and how to bring them up, right, validating the experience of the women, validating the experience of the family system. Yes. Because I also think about you know, when we think about postpartum depression, specifically for like men, and how that shows up in men differently, then it comes out more as irritability, it comes out more as like anger, rage, problems with sleep. And so you know, we may not we may miss that. And we may not recognize that they're also struggling and that's impacting, you know, the competencies, you
Dr. Bob Boland  31:52
bring them up in a way because he said a couple of times, and I think most people, for whatever reason, don't even think of postpartum depression as a male problem.
Dr. Kerry Horrell  31:59
I don't even know that I've thought of postpartum depression for men being a thing that exists now. That's just depression. Yeah, like, I don't actually know that I've ever heard that phrase, if I'm being honest.
Dr. Rose Yang  32:12
Yeah, no, it's, um, they I mean, I think there's the studies right now show it's like one out of 10 men, but they think that's a really underestimate of like, how many men are actually impacted because of like them being willing to speak up and although there's symptoms look different
Dr. Bob Boland  32:26
changes to like, I still haven't lost the weight from my kids.
Dr. Kerry Horrell  32:29
Oh. Nausheen's point. One thing is, you know, when screeners and really the way we gather information, and even just decidedly collectively hold information, the let's say, you are a mom, or a dad, and you have a new baby, and you're not sleeping, your sleep schedules all thrown off. As you know, I mean, gosh, one of our very first episodes with Michelle Patriquin, when when we talked about sleep, like we just don't understand, like, now, leap is like one of the vital bedrocks of mental health. And this has got to be a time where sleep gets wonky. And then on top of that, again, you have shifts in your identity, how you're thinking about your life, about cycles of workload, workload, things are just so different. And then all of a sudden, you're like, Well, gosh, I'm crying all the time. And I'm feeling stressed. And I, maybe I'm feeling all this tightness in my chest and my shoulders. And surely a good amount of people are must think to themselves, well, this is just normal. This is what being a parent is like, to have a really hard time understanding or knowing or having, again, support and space to be like, well, we've actually hit a point where now things are of psychiatric concern, where you probably benefit from help. And again, I'm getting in class, I'm just thinking about the kind of stigma that that must exist around. Oh, you know, you shouldn't feel this way. That's all you know, many, many people. I think the majority of people have children like so I can just listen.
Dr. Nausheen Noor  33:52
And then then another barrier there is with all this, this litany of things that you carry, just listed, who has the time now to go to a psychiatrist when I have this laundry list of things to do as a new mom in the car. Right? Right. And so the only place I'll go to is the pediatrician because I really care about my baby, my mental health can suffer. So again, like I'm harping on this too, but that point of contact is just so so so wider to screen and identify and, and provide some direction, right? They're not there to treat. They're just they're screening and providing that direction.
Dr. Kerry Horrell  34:29
Well, I think that as a community here at Menninger, we've very much benefited from the CEs and presentations and things that you have done around this topic and we super appreciate you coming on to the podcast to share with that.
Dr. Bob Boland  34:42
Word what for once again, we have a lot of clinicians listening, what advice would you give, what do you
Dr. Kerry Horrell  34:47
leave? What are you gonna leave?
Dr. Rose Yang  34:48
Leave them with the actual screening, but I guess I'm on a roll on this You're big on screening.  Lactation specialists. They are so key and they're oftentimes in pediatrician offices if we can get those into the rolls to do some of that screening because of course now mom wants you know, baby, it's about baby, right you want to be able to latch. If we can get those individuals who screen and do it successfully, I think we would have more women come in for mental health services. That's my last thought. I
Dr. Kerry Horrell  35:14
love that
Dr. Nausheen Noor  35:15
for mental health professionals when we're doing taking histories, especially for women to to ask specifically about that period of time when they had babies or during when they were pregnant and how things worked for them. And maybe the Depression started then or maybe it was exacerbated then but I don't know how much people are actually investigating that even in our field.
Dr. Kerry Horrell  35:34
Yeah, you two are rockstars thank you so much for coming on.
Dr. Rose Yang  35:37
Thanks for having us.
Dr. Nausheen Noor  35:38
Thank you for having us.
Dr. Kerry Horrell  35:40
You've been listening to the mind dive podcast. We've been your hosts. I'm Dr. Kerry Horrell
Dr. Bob Boland  35:44
Dr. Bob Boland. Thanks for
Dr. Kerry Horrell  35:49
the mind dive podcast is presented by the Menninger Clinic. If you're curious about the professional experiences of mental health clinicians, make sure to subscribe wherever you listen.
Dr. Bob Boland  35:58
For more episodes like this, visit www dot Menninger To submit
Dr. Kerry Horrell  36:03
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