Photo of Dr. Sheila Marcus

This Q&A is an excerpt from the Second Wave Michigan article by Estelle Slootmaker titled “Special report: COVID-19’s silver linings for mental health care in Michigan”

This interview has been edited for length and clarity.

Q: Why is it important that we focus mental health efforts on children and teens?

A: We are beginning to discover what was a substantial problem in the state of Michigan before the pandemic has become a tsunami of need during and following the pandemic. About 20% of children and adolescents will have some sort of mental health issue, depression, anxiety, ADHD, autism, trauma, OCD, and a whole host of issues. That has increased during the pandemic. The data now is something like 40% of adolescents report mood and anxiety symptoms during and following the pandemic.

In places where there exist child-mental-health-trained or child psychiatrists, the wait times are anywhere between four and six months. The vast majority of the counties in the state of Michigan don’t have any trained children’s psychiatrists. So there’s no wait time because there’s no line to wait in. In those cases, generally, children are being cared for by pediatricians, family medicine physicians, or nurse practitioners.

Q: What kinds of mental health challenges does MC3 help pregnant women and new mothers overcome?

A: The most common complication of pregnancy is postpartum or pregnancy-related depression. The postpartum period is often a time when women who have bipolar illness have their first episodes. The other big issue in pregnancy and postpartum is trauma. So many women are victimized during their pregnancies. In the case of women with domestic violence histories, there often are uses of substances including marijuana and alcohol, sometimes opiates.

We’re very mindful that when we’re caring for pregnant moms, we also have to care for the babies, even during the pregnancy. If we have a victimized, traumatized, substance-abusing, depressed mom, simply treating the mom’s disorders will be insufficient. You have to make sure that mom and baby get into infant mental health services to give mom the skills that she needs to form a healthy attachment relationship to the infant. We sometimes call this ‘the dance of early childhood,’ moms looking at babies, babies looking back at moms, and falling in love with one another.

Q: What role can primary care providers play in meeting the mental health needs of these women and their infants?

A: Many obstetricians are doing a screening for depression, anxiety, and trauma during pregnancy. They’re more likely than anybody to pick up on signs and symptoms of some of these disorders. They may have followed the mom in other pregnancies and have a sense of whether there have been other issues. In family medicine [practices], doctors are following moms during pregnancy and postpartum as well as their children. They’re really connected to the family, sometimes for many generations.

Q: How is MC3 engaging these PCPs?

A: Our role is to support and scaffold the primary care docs in caring for the children that are already in their panels for primary care. After they’ve called us once or twice, they realize that we’re here to support them and here to validate that the work that they’re doing is incredibly difficult — not chastising them for not being able to do things that they weren’t trained to do.

We also do “brown bags,” clinical case consultations, where a group gets together and presents a case or two to discuss cases over lunch. We have a variety of recorded modules available to practitioners on a whole host of topics like depression, anxiety, eating disorders, LGBTQ issues, and suicide. We’ve begun a specific suicide prevention and safety planning [module], which we’re delivering to 60 or 70 practitioners several times a year. Since COVID, there are now billing codes that allow them to bill for consultations, report writing, tests, or multidisciplinary meetings that happened on the same day as a [patient] visit.