H. R. 20
IN THE SENATE OF THE UNITED STATES
October 16, 2007
Received; read twice and referred to the Committee on Health, Education, Labor, and Pensions
To provide for research on, and services for individuals with, postpartum depression and psychosis.
This Act may be cited as the
Melanie Blocker-Stokes Postpartum
Depression Research and Care Act.
The Congress finds as follows:
Postpartum depression is a devastating mood disorder which strikes many women during and after pregnancy.
changes are common and can be broken into three subgroups:
blues, which is an extremely common and the less severe form of
postpartum depression; postpartum mood and anxiety disorders, which are more
severe than baby blues and can occur during pregnancy and anytime within the
first year of the infant’s birth; and postpartum psychosis, which is the most
extreme form of postpartum depression and can occur during pregnancy and up to
12 months after delivery.
blues is characterized by mood swings, feelings of being overwhelmed,
tearfulness, irritability, poor sleep, mood changes, and a sense of
The symptoms of postpartum mood and anxiety disorders are the worsening and the continuation of the baby blues beyond the first days or weeks after delivery.
The symptoms of postpartum psychosis include losing touch with reality, distorted thinking, delusions, auditory hallucinations, paranoia, hyperactivity, and rapid speech or mania.
Each year over 400,000 women suffer from postpartum mood changes, with baby blues afflicting up to 80 percent of new mothers; postpartum mood and anxiety disorders impairing around 10 to 20 percent of new mothers; and postpartum psychosis striking 1 in 1,000 new mothers.
Postpartum depression is a treatable disorder if promptly diagnosed by a trained provider and attended to with a personalized regimen of care including social support, therapy, medication, and when necessary hospitalization.
All too often postpartum depression goes undiagnosed or untreated due to the social stigma surrounding depression and mental illness, the myth of motherhood, the new mother’s inability to self-diagnose her condition, the new mother’s shame or embarrassment over discussing her depression so near to the birth of her child, the lack of understanding in society and the medical community of the complexity of postpartum depression, and economic pressures placed on hospitals and providers.
Untreated, postpartum depression can lead to further depression, substance abuse, loss of employment, divorce and further social alienation, self-destructive behavior, or even suicide.
Untreated, postpartum depression impacts society through its effect on the infant’s physical and psychological development, child abuse, neglect, or death of the infant or other siblings, and the disruption of the family.
Research on postpartum depression and psychosis
Expansion and intensification of activities
The Secretary of Health and Human Services, acting
through the Director of the National Institutes of Health and the Director of
the National Institute of Mental Health (in this title referred to as the
Institute), is encouraged to continue aggressive work on
postpartum depression and postpartum psychosis.
Coordination With Other Institutes
The Director of the Institute should continue to coordinate activities of the Director under subsection (a) with similar activities conducted by the other national research institutes and agencies of the National Institutes of Health to the extent that such Institutes and agencies have responsibilities that are related to postpartum conditions.
Programs for Postpartum Conditions
In carrying out subsection (a), the Director of the Institute is encouraged to continue research to expand the understanding of the causes of, and to find a cure for, postpartum conditions. Activities under such subsection shall include conducting and supporting the following:
Basic research concerning the etiology and causes of the conditions.
Epidemiological studies to address the frequency and natural history of the conditions and the differences among racial and ethnic groups with respect to the conditions.
The development of improved screening and diagnostic techniques.
Clinical research for the development and evaluation of new treatments, including new biological agents.
Information and education programs for health care professionals and the public.
National public awareness campaign
The Director of the National Institutes of Health and the Administrator of the Health Resources and Services Administration are encouraged to carry out a coordinated national campaign to increase the awareness and knowledge of postpartum depression and postpartum psychosis.
Public service announcements
Activities under the national campaign under subsection (a) may include public service announcements through television, radio, and other means.
Section 403(a)(5) of the Public Health Service Act (42 U.S.C. 283(a)(5)) is amended—
by redesignating subparagraph (L) as subparagraph (M); and
by inserting after subparagraph (K) the following:
Longitudinal study of relative mental health consequences for women of resolving a pregnancy
Sense of Congress
It is the sense of Congress that the Director of the Institute may conduct a nationally representative longitudinal study (during the period of fiscal years 2008 through 2018) of the relative mental health consequences for women of resolving a pregnancy (intended and unintended) in various ways, including carrying the pregnancy to term and parenting the child, carrying the pregnancy to term and placing the child for adoption, miscarriage, and having an abortion. This study may assess the incidence, timing, magnitude, and duration of the immediate and long-term mental health consequences (positive or negative) of these pregnancy outcomes.
Beginning not later than 3 years after the date of the enactment of this Act, and periodically thereafter for the duration of the study under subsection (a), the Director of the Institute should prepare and submit to the Congress reports on the findings of the study.
Delivery of services regarding postpartum depression and psychosis
Establishment of program of grants
The Secretary of Health and Human Services (in this title
referred to as the
Secretary) should in accordance with this
title make grants to provide for projects for the establishment, operation, and
coordination of effective and cost-efficient systems for the delivery of
essential services to individuals with postpartum depression or postpartum
psychosis (referred to in this section as a
condition) and their families.
Recipients of Grants
A grant under subsection (a) may be made to an entity only if the entity is a public or nonprofit private entity, which may include a State or local government; a public or nonprofit private hospital, community-based organization, hospice, ambulatory care facility, community health center, migrant health center, or homeless health center; or any other appropriate public or nonprofit private entity.
To the extent practicable and appropriate, the Secretary shall ensure that projects under subsection (a) provide services for the diagnosis and management of postpartum conditions. Activities that the Secretary may authorize for such projects may also include the following:
Delivering or enhancing outpatient and home-based health and support services, including case management, screening, and comprehensive treatment services for individuals with or at risk for postpartum conditions; and delivering or enhancing support services for their families.
Delivering or enhancing inpatient care management services that ensure the well-being of the mother and family and the future development of the infant.
Improving the quality, availability, and organization of health care and support services (including transportation services, attendant care, homemaker services, day or respite care, and providing counseling on financial assistance and insurance) for individuals with postpartum conditions and support services for their families.
Integration With Other Programs
To the extent practicable and appropriate, the Secretary should integrate the program under this title with other grant programs carried out by the Secretary, including the program under section 330 of the Public Health Service Act.
A grant may be made under section 201 only if the applicant involved makes the following agreements:
Not more than 5 percent of the grant will be used for administration, accounting, reporting, and program oversight functions.
The grant will be used to supplement and not supplant funds from other sources related to the treatment of postpartum conditions.
The applicant will abide by any limitations deemed appropriate by the Secretary on any charges to individuals receiving services pursuant to the grant. As deemed appropriate by the Secretary, such limitations on charges may vary based on the financial circumstances of the individual receiving services.
The grant will not be expended to make payment for services authorized under section 201(a) to the extent that payment has been made, or can reasonably be expected to be made, with respect to such services—
under any State compensation program, under an insurance policy, or under any Federal or State health benefits program; or
by an entity that provides health services on a prepaid basis.
The applicant will, at each site at which the applicant provides services under section 201(a), post a conspicuous notice informing individuals who receive the services of any Federal policies that apply to the applicant with respect to the imposition of charges on such individuals.
The Secretary may provide technical assistance to assist entities in complying with the requirements of this title in order to make such entities eligible to receive grants under section 201.
Authorization of appropriations
To carry out this Act and the amendments made by this Act, there are authorized to be appropriated—
$3,000,000 for fiscal year 2008; and
such sums as may be necessary for fiscal years 2009 and 2010.
Passed the House of Representatives October 15, 2007.
Lorraine C. Miller,