MHAMD

Mental Health Association of Maryland

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Talking to your child about the St Mary’s school shooting

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The nation’s attention is now focused on Maryland as the home of the most recent school shooting. Today, at least three students were injured at Great Mills High School in St. Mary’s County.

As the story continues to evolve in the media, parents are faced with the difficult decision of what to say to our kids.

The reality is that there is no one way to have this conversation and we don’t always even have to have the conversation. What we say, when we say it and how we say it depends on our child’s age, maturity level and temperament. And, as parents, we also have to think about what our child may hear from the news, from older siblings or neighbors, and from their friends.

Most national experts agree that children under 8 should be shielded from the story unless they are directly impacted by it or exposed to the aftermath. Here are a few thoughts about addressing the topic with older students.

  • First, process your own emotions before you talk with your child. As a parent, this is scary and we may feel vulnerable, angry or have other strong reactions.
  • Plan what you want to say to your child, thinking specifically about what you want them to take away from the conversation.
  • Reassure your child by highlighting what the school and the people in the school do to keep students safe. As details unfold, consider telling the stories of the heroes.
  • Address images as well as words if your child has seen photos or video in news coverage. Balance the scary photos with positive images of safety officers, school officials and other heroes who help keep students safe.
  • For elementary school students, keep the story brief — just a sentence or two about what happened — and then take your cues from your child’s questions. Note your child may ask questions right away, or may come back to you after having some time to think about what they’ve learned.
  • For middle and high school students, start by asking what they’ve already heard. In today’s quick news and social media culture, odds are that they’ve already heard about the situation. Let them share their thoughts and feelings with you, and use the conversation as an opportunity to share your values and thoughts on the topic. And, consider discussing potential solutions or actions. You may even want to connect the conversation to the “walk outs” and “step ups” that many students participated in or heard about earlier this month.
  • Recognize that students of all ages will process the news in their own way and in their own time. A student who is already anxious, who worries about school or who has experienced trauma may feel greater anxiety, need more time to talk and require extra reassurance about their own safety.

Sadly, our nation’s recent history of school shootings have led to the development of extensive guides on how to talk to children and youth about school violence. Here are a few additional resources to guide your conversation including information developed by Maryland’s Children’s Mental Health Matters Campaign*:

CMHM Fact Sheet on Wellbeing & Resiliency
https://www.childrensmentalhealthmatters.org/wp-content/uploads/2017/10/Resiliency.pdf

CMHM Fact Sheet on Trauma
https://www.childrensmentalhealthmatters.org/wp-content/uploads/2017/10/Trauma.pdf

CHMH Fact Sheet on Traumas (Spanish)
https://www.childrensmentalhealthmatters.org/wp-content/uploads/2014/04/Trauma_ES.pdf

http://www.nasponline.org/resources-and-publications/resources/school-safety-and-crisis/talking-to-children-about-violence-tips-for-parents-and-teachers

http://www.apa.org/helpcenter/talking-to-children.aspx

https://www.healthychildren.org/English/healthy-living/emotional-wellness/Building-Resilience/Pages/How-to-Support-Your-Childs-Resilience-in-a-Time-of-Crisis.aspx

At the end of the day, no one knows your child better than you. Review the resources that are out there, make your own decision and do what’s best for your child.

 

*The Children’s Mental Health Matters! Campaign is a collaboration of the Mental Health Association of Maryland (MHAMD) and the Maryland Coalition of Families (MCF) supported by the Maryland Department of Health – Behavioral Health Administration. The Campaign goal, with partners across the state, is to raise public awareness of the importance of children’s mental health. For more information, please visit www.ChildrensMentalHealthMatters.org.

Posted in: Community Engagement

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Millman Parity Report

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At the urging of MHAMD and others, the Maryland General Assembly and the Maryland Insurance Administration have taken important steps in recent years to ensure the proper implementation of the federal Mental Health Parity and Addiction Equity Act. Unfortunately, according to the findings in a groundbreaking new national report, there is still much work to be done. This is the message MHAMD shared at a briefing on January 30 for members of a key legislative committee.

According to an independent report by the Milliman Group, Maryland is among the worst states for access to affordable in-network behavioral health (mental health and substance use disorder) services. The national actuarial firm analyzed three years of insurer claims data from 2013 to 2015, covering approximately 42 million Americans in all 50 states and Washington, D.C.

The data demonstrates that insurers in Maryland are much more likely to provide in-network care for physical health services compared to mental health and substance use treatment services. This limits access to care and results in higher out-of-pocket costs that can make treatment unaffordable, even for those with insurance.

Among the key findings:

  • In 2015, Maryland consumers were nearly 1,000 percent more likely to go out-of-network for behavioral health office visits compared to primary care visits. That’s nearly twice the national average, and third worst in the nation.
  • Marylanders were 700 percent more likely in 2015 to utilize out-of-network facilities for inpatient behavioral health care compared to those accessing inpatient treatment for physical health care.

The study also uncovered a troubling disparity in reimbursement rates for the professionals treating individuals with behavioral health needs as compared to those providers delivering physical health treatment. In 2015, mental health and substance use treatment providers were paid over 27 percent less than other providers for the very same office visits billed using identical or similar payment codes. This disincentives medical professionals from entering the behavioral health field, exacerbating an existing workforce shortage and further limiting access to care for Marylanders in need.

MHAMD is proud of the work we’ve done in recent years to implement the critically important federal parity law, and we are appreciative of our ongoing partnerships with members of the Maryland General Assembly, the Maryland Insurance Administration and stakeholders in the behavioral health community. Together, we have passed laws and created regulations designed to improve treatment options and availability for individuals with mental health and substance use disorders. We still have a long way to go, but MHAMD will keep working to ensure Marylanders with behavioral health needs have access to treatment when and where needed.

Posted in: Maryland Parity

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MHAMD honored by Mayor Pugh during Mental Illness Awareness Week

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Baltimore City Mayor Catherine Pugh honored the Mental Health Association of Maryland and other advocates this week as part of Mental Illness Awareness Week (MIAW). MHAMD was recognized for our 100+ years of advocacy to ensure that the one in five Marylanders living with mental health problems have access to high-quality services, resources and information. Thank you, Mayor Pugh, for helping to increase awareness to such an important issue.

An annual part of MIAW is National Depression Screening Day. Major depression affects about 16 million American adults each year, and brief screenings are the quickest way to determine if you or a loved one should connect with a mental health professional- to get a checkup from your neck up.  You can take a free, anonymous and confidential screening on our website. You’ll see your results immediately and receive recommendations and links to resources. Please note that the screenings provided are educational and not diagnostic, but can help you determine if your recent thoughts or behaviors may be associated with depression, a common, treatable mental health issue.

Additionally, Maryland has a statewide crisis hotline that can be reached day or night to provide support, guidance, and assistance to those in need. That number is 1-800-422-0009 and they can direct you to resources and providers in your community. Please reach out if you think you or a loved one can benefit from this service.

Mental Illness Awareness Week

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Proposed Regulations a Win for Behavioral Health Consumers

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Network Adequacy Part V: Proposed Regulations a Win for Behavioral Health Consumers

You may remember from Part IV of our Network Adequacy series that the Maryland General Assembly passed landmark legislation in 2016 requiring that health insurance plans in the state have adequate numbers of providers in their networks to ensure that behavioral health consumers can access timely care. This legislation, enacted after years of advocacy with state regulators and decision-makers, required the Maryland Insurance Administration (MIA) to promulgate new regulations by 2018 to implement the law for plans beginning in 2019.

We are excited to share that the proposed regulations are a huge win for privately-insured behavioral health consumers. Throughout the past year, the MIA held public hearings on various topics relevant to network adequacy. MHAMD and other healthcare consumer advocacy organizations worked together to submit comments and testimony with a singular message: privately insured Marylanders deserve timely access to care and the only way to ensure that is by holding the insurers accountable to meet appointment wait time standards. The MIA agreed; the proposed regulations not only include geographic standards (travel distances), but they also include some of the strongest appointment wait time standards in the country.

While the regulations aren’t perfect and they aren’t yet final, they provide strong network adequacy requirements and consumer protections. The regulations require insurance carriers:

  • Have enough providers within a geographic area to ensure that consumers can access appointments within:
    • 10 days for non-urgent behavioral health care
    • 15 days for primary care
    • 72 hours for emergency behavioral health care
  • Have providers within a specific distance of a member’s home or workplace depending on their geographic area:
    • 10 miles for urban areas
    • 25 miles for suburban
    • 60 miles for rural areas
  • Have one mental health and one substance use disorder provider for every 2000 members, and
  • Make available an executive summary explaining how they reached network sufficiency

MHAMD joined a number of our partner organizations in submitting comments to point out a few of the concerns remaining, mainly that insurers can apply for a waiver of the requirements and that there is no limit to the number of times they can apply for the waiver. We hope the MIA addresses these concerns and upholds all the strong protections in the final regulations, which should be published later this fall. Check back on the blog or subscribe to our email list for updates.

Network Adequacy Series Posts

Network Adequacy Series, Part IV: We need your help to ensure strong insurance networks

Network Adequacy Series, Part III: What Maryland advocates are doing

Network Adequacy Series, Part II: What are state and federal regulators doing about it?

Network Adequacy Series, Part I: What is all the fuss?

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Five ways you can get involved during Mental Health Awareness Month

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Mental Health Awareness Month GraphicMental Health America declared May as Mental Health Awareness Month in 1949 to spread awareness about mental health and reduce stigma around mental illness and substance use so that individuals feel more comfortable reaching out for help, finding information about mental illness and finding the right treatment. Fighting stigma can seem like a hefty task, so MHAMD pulled together a list of ways that you can spread awareness among people you know, show support for your friends and family, and contribute to the effort to end stigma. And, what better time to help than during Mental Health Awareness Month? These are a few ways that you can spread awareness this month.

Learn more about mental health with online resources during Mental Health Awareness Month

Online resources are a great way to easily share information about how to spot potential mental health issues arising in people you know and learn about how many people live with mental health conditions. Here’s a round-up of useful resources that can be found online:

  • This year’s Mental Health Month theme, Risky Business, explores habits and behaviors that increase the risk of developing or exacerbating mental illnesses, or could be signs of mental health problems­ themselves. Topics include risky sex, prescription drug misuse and internet addiction. You can order copies of these fact sheets on MHAMD’s publications form or on our downloadable publications page.
  • The Jed Foundation’s Mental Health Resource Center shares information about dealing with topics ranging from what to do if someone you know may be having suicidal thoughts to tips for managing your own stress and anxiety. The Jed Foundation focuses on mental health awareness among teens and young adults.
  • Healthy New Moms offers resources for pregnant women and new moms to learn more about postpartum mood and anxiety disorder and where to find help. Order hard-copy resources or download at healthynewmoms.org.
  • The National Alliance on Mental Illness’s Fact Sheet Library covers a range of mental health topics on one page.
  • The Children’s Mental Health Matters! Campaign, co-coordinated by MHAMD and the Maryland Coalition of Families, offers numerous resources for families and educators to help address potential mental health issues arising in children and teens.
  • MHAMD offers a free, anonymous and confidential mental health screening for individuals who are concerned that they may be experiencing mental health complications. Brief screenings are a quick way to determine whether you or someone you care about should connect with a mental health professional.

Take action on mental health advocacy issues and current legislation

Awareness helps end the stigma associated with mental health and substance use disorders, but it also helps to influence the public policies surrounding access to care for individuals experiencing mental health disorders. Find advocacy networks that you can join now to stay up to day on current state and federal legislation and ways you can let your representatives know your opinion. MHAMD’s Legislative Network will keep you involved in all the mental health policy developments happening in Annapolis during the legislative session.

Connect with us on social media

Social media is a powerful tool for getting information out there to a larger audience. MHAMD and Mental Health America have Mental Health Awareness month graphics that you can easily share on your social media profiles. And, follow and like our social media profiles for new information!

Here are some shareable graphics you can use this month:

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Become a member of MHAMD

When you become a member of MHAMD, you create opportunities for individuals to learn how mental illness affects their neighbors, family members and friends. And, you create ways for people to find resources and help when they most need it. Join MHAMD during Mental Health Awareness Month to show your support for the one in five living with mental health and substance use problems.

Start conversations

Making others comfortable with talking about their mental health experiences creates a more accepting and inclusive environment that encourages people to ask for the help they may need. If you know someone who you think may be struggling, make it a point to offer your support if they want to share.

Posted in: Community Engagement

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The Hummingbird Study investigates treatment for postpartum depression

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postpartum depression new momAbout The Hummingbird Study

The Johns Hopkins Women’s Mood Disorders Center is one of the several sites participating in The Hummingbird Study, a new clinical research trial with Sage Therapeutics to study postpartum depression. The Hummingbird Study’s purpose is to evaluate the safety and effectiveness of an investigational medication in women with moderate to severe postpartum depression. The research study lasts about 37 days and includes a screening visit, a 3-day, in-patient hospital stay and four follow-up visits. The Women’s Mood Disorder Center is actively recruiting new moms, up to six months postpartum, to participate.

Postpartum depression in new moms

According to the National Institute of Mental Health, postpartum depression is a biological complication of pregnancy. During pregnancy, levels of certain hormones rise and then rapidly fall after giving birth. However, in some women, these hormone shifts may contribute to postpartum depression. Research indicates that between 15 and 20% of new moms struggle with postpartum depression.

The Mental Health Association of Maryland’s Healthy New Mom’s Campaign is interested in the outcomes of the Hummingbird Study, happening across the country. The preliminary results from the project have been very positive and we are hopeful for more informative data as the trial adds more subjects.

Learn more about the Hummingbird Study at www.thehummingbirdstudy.com. For more information about postpartum mood and anxiety disorders, visit www.healthynewmoms.org. To learn more about MHAMD’s Healthy New Moms Campaign and our outreach across the state, please visit, www.healthynewmoms.org.

Posted in: Community Education & Training

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School Nurses Certify in Youth Mental Health First Aid

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Howard County Public Schools trained 120 nurses and other health staff in Youth Mental Health First Aid ® in the last few months. These health professionals are now better prepared to recognize the risk factors and signs of mental health problems in youth and have additional resources to provide help.

Why school health professionals?

School health professionals are a particularly crucial audience to reach with Mental Health First Aid, according to Lea Ann Browning-McNee of the Mental Health Association of Maryland (MHAMD). “They are often the first to see patterns in students, to have discussions about both physical and emotional pain, and may feel like a ‘safe’ adult for a student to confide in.”

Donna Mazyck, executive director of the National Association of School Nurses agrees, told NPR last year that “School nurses are the detectives in that school. They’re the eyes and ears of public health.”

Youth Mental Health First Aid, an internationally-recognized certification, helps school health professionals expand their skill set – enhancing their hearing and vision so to speak, as participants learn to assess what they hear from a student and what changes they may see in a student’s behavior. In addition, the course focuses on what to do to help students, whether it’s simply serving as a supportive listener, helping a student learn strategies for managing stress or connecting a family to school or community-based evaluation, treatment or support services.

“Howard County Public Schools joins other districts, such as Charles and Harford County, who have also trained health staff,” says Jennifer Treger, director of the Mental Health First Aid Maryland program at MHAMD. “We are lucky that Maryland is part of a federal grant that supports training for educators and school health professionals, as well as coaches, administrators and others who engage with students.”

Teaching Youth Mental Health First Aid through the MD-AWARE program

MHAMD coordinates the school-based trainings in partnership with the Maryland State Department of Education’s MD-AWARE, part of the “Now Is the Time” federal grant program administered by the Substance Abuse and Mental Health Services Administration. Mental Health First Aid training is available to schools and their partners across the state, and MHAMD is set to train another 100+ school health professionals in late summer as part of the state’s School Heath Interdisciplinary Program conference.

Kerrie Wagaman, RN, MSN, coordinator of health services for Howard County Public Schools, says “The Mental Health First Aid Course provided the staff of registered nurses and health assistants extra resources to continue keeping our students safe.”

More than 23,000 Marylanders are certified as Mental Health First Aiders. To learn how you can bring Youth Mental Health First Aid to your school, visit www.mhfamaryland.org.

Posted in: Community Education & Training

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Maryland General Assembly passes HOPE Act improving behavioral health services

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Keep The Door Open Behavioral Health Rally Annapolis

The Maryland General Assembly passed the Heroin and Opioid Prevention Effort (HOPE) Act of 2017 (SB967/HB1329), today, a comprehensive behavioral health measure aimed at expanding treatment options for those with mental health and substance use disorders and allocating more resources to reducing opioid dependency in Maryland. MHAMD and the Maryland Behavioral Health Coalition worked with legislators throughout the session to refine various provisions of the HOPE Act. The act includes Keep the Door Open Act provisions to properly resource community mental health and substance use providers.

Within its wide range of provisions, the HOPE Act:

  • Requires specified increases in funding for community behavioral health services (Keep the Door Open Act). Payments to providers increase by 3.5% in each of the next two fiscal years, and by 3% the following year. The bill also requires that the Behavioral Health Administration and Medicaid, in consultation with stakeholders, conduct a rate-setting study for community behavioral health services and implement a payment system based on the findings. The study must be completed by September 20, 2019.
  • Requires the establishment of behavioral health crisis treatment centers consistent with forthcoming recommendations from the Maryland Behavioral Health Advisory Council, and requires at least one crisis center be established by June 1, 2018.
  • Makes expansion and promotion of the statewide 24/7 crisis hotline a statutory requirement, and requires hotline staff to be trained to screen callers for mental health and substance use disorder needs, conduct risk assessment for overdoses and suicides, and connect callers to appropriate behavioral health resources and supports.
  • Repeals a requirement that an individual be trained in overdose identification before receiving the overdose-reversal medication naloxone from a pharmacist.
  • Requires hospitals to have protocols for discharging patients treated for a drug overdose or identified as having a substance use disorder. The protocols may include coordination with peer recovery counselors, connection to a community-based treatment, a prescription, etc.
  • Requires development of a plan for increasing substance use disorder treatment in jails and prisons.

Measures like the HOPE Act pass with the continued support of behavioral health activists like you. Between rallying in Annapolis for expanded behavioral health services, testifying in legislative hearings and calling and emailing legislators, your voices were heard by Maryland legislators.

For more information, view MHAMD’s Legislative Wrap-Up and Final Bill List. Send MHAMD’s Legislative Updates straight to your inbox by signing up for our mailing lists.

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Consumer Quality Team Interviews Mental Health Consumers at Clifton Perkins Hospital

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For the first time, the Consumer Quality Team of Maryland (CQT) interviewed mental health consumers about their experiences at Clifton T. Perkins Hospital Center in Jessup, Maryland. With the addition of this hospital in January, CQT now visits all five state inpatient facilities.

Demand among patients for interviews with CQT was high, and during the course of the three-day interview process, consumers from all ten units of the hospital met with Team members to express their thoughts about the quality of mental health treatment at Perkins.

Overall, the consumers were satisfied with the services they received at Perkins. Numerous compliments were paid to the group leaders, especially the woman who leads the Tai Chi class. Consumers also praised the doctors and treatment teams, and applauded the opportunities for employment across different sectors in the hospital.

Many consumers also expressed concerns about the quality and quantity of the food served. Another reoccurring theme discussed was the way line-staff speaks to them. It was voiced that the staff could receive extra training, or be re-trained, on sensitivity and respectfulness.The interviewers reviewed their findings with the hospital’s new CEO, John Robison, and his clinical staff, who were attentive and engaged as they listened to information from the patients. The staff offered feedback and took copious notes as they were briefed on the consumers’ interviews. John Robison was appreciative of all the information, including the constructive criticism and was fast to act on it. Before the third day of interviews, dietary staff had already met with each unit to discuss the concerns about the food, and it was understood that Mr. Robison was working on a plan to improve the line staff’s communication.

CQT plans to visit Clifton T. Perkins Hospital Center again in April to hear more updates and comments from consumers after their initial visit.

Learn more about the Consumer Quality Team of Maryland here.

Posted in: Services Oversight

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Maryland Maternal Mental Health Task Force sends findings to Governor Larry Hogan

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Mother researching maternal mental health disorders
The Task Force to Study Maternal Mental Health has submitted its recommendations for improving prevention and care for perinatal mood and anxiety disorders (PMADs) in Maryland to Governor Larry Hogan and the Maryland General Assembly. The Assembly passed legislation in 2015 to establish the Task Force, assigning the group with identifying vulnerable populations and risk factors for PMADs and making recommendations on legislation, policy initiatives and budgetary priorities to address and improve unmet maternal mental health needs in Maryland. Read the full report here.

One in seven women experience depression during pregnancy or in the first 12 months after delivery, and more than 400,000 infants every year are born to mothers with depression, making perinatal depression the most underdiagnosed and untreated obstetric complication in the United States. Perinatal mood and anxiety disorders (PMADs) are treatable once recognized, yet 50 percent of all mothers who experience these disorders are never identified.

Through a total of 15 recommendations, the Task Force urged the state to:

  • Improve early identification and treatment of PMADs through increased screening, treatment resources and expanded provider education,
  • Enhance peer support programs for mothers, coupled with public education initiatives aimed at increasing awareness about PMADs, and
  • Expanded maternal mental health services for pregnant women and new moms.

Improve early identification, treatment resources and provider education

Screening and identification of PMADs greatly improve the likelihood of a quick recovery for mothers, supports healthy child development and offers long-term health care cost savings. Women typically visit their obstetrician and gynecologist during pregnancy and visit a pediatrician for infant check-ups more often than other health professionals, so these providers are in an ideal position to screen for PMADs. The Task Force recommends requiring mental health screenings for women during pregnancy and throughout the first year postpartum suggests offering maternal mental health information and resources for care to mothers and families.

In addition to screening, the Task Force recommends developing free maternal mental health CME/CEU training for providers to ensure improved clinical outcomes for mothers and continued support beyond the initial screening. The Task Force also advises expanding the psychiatric consultation programs provided through the Maryland Behavioral Health Integration in Pediatric Primary Care (BHIPP) to assist providers in addressing the emotional and mental health needs of their pregnant and postpartum patients.

Develop peer support and public education programs for mothers

Peer support programs allow individuals who lived with mental health disorders to use their experiences to help others guide their own recoveries, and have been proven to reduce symptoms and hospitalization, increase social support and improve well-being. The Task Force recommends that Maryland expands resources for peer support programs to enable more specialized and comprehensive support for new and expectant mothers. The Task Force report uses the Massachusetts program MotherWoman as an example of a comprehensive peer support program for pregnant women and new moms. To supplement peer support programs and to reduce the stigma associated with PMADs, the Task Force proposes creating centralized, multicultural public education materials and resources for patients and families to more easily find information. The MHAMD Healthy New Moms campaign is an existing public education campaign that provides materials and information to pregnant women and new moms.

Expand maternal mental health services for pregnant women and new moms

The Task Force recommends establishing specialized maternal mental health programs to best meet the needs of mothers experiencing PMADs and proposes coordination of treatment for substance use disorders (SUDs) and maternal mental health. Methods for coordinating treatment include screening for SUDs throughout the pregnancy, improving post-partum follow-up and ensuring SUD treatment providers incorporate both prenatal care and mental health care into their treatment plans.

The Task Force recommendations facilitate a path toward more comprehensive support and treatment for women who are experiencing PMADs, reduce stigma associated with maternal mental health conditions and a greater level of oversight for Maryland to continue improving its maternal mental health services.

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