美国国家公共电台 NPR Lawmakers Weigh Pros And Cons Of Mandatory Screening For Postpartum Depression（在线收听）

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Lawmakers in California are about to start debating a bill that would make doctors screen pregnant women and new mothers for mental health problems. Many doctors do not like this idea. From member station KQED in San Francisco, April Dembosky has this story.

APRIL DEMBOSKY, BYLINE: Right now, a lot of doctors are afraid to screen new moms for depression.

MALINI NIJAGAL: What do you do with the answers?

MELANIE THOMAS: What do we do with the positive screen?

LAURA SIROTT: What are you going to do with these people who screen positive?

DEMBOSKY: Those are the questions doctors Malini Nijagal, Melanie Thomas and Laura Sirott are asking. Where do you send these women? Studies show that of new moms who screen positive for depression, 78 percent don't get any mental health treatment. OBGYN Laura Sirott says she's heard the range of reasons why from her patients.

SIROTT: Ooh, they don't take my insurance, or my insurance pays for three visits. I can't take time off of work to go to those visits. It's a three-month wait to get into that person.

DEMBOSKY: And Sirott says it's hard to find a psychiatrist who is trained and willing to prescribe medication to pregnant or breastfeeding women.

SIROTT: It's very frustrating to ask patients about a problem and then not have any way to solve that problem.

DEMBOSKY: But moms are frustrated, too. After the baby comes, no one asks about them anymore. Wendy Root Askew struggled for years to get pregnant, and when she finally did, her anxiety got worse. She couldn't stop worrying.

WENDY ROOT ASKEW: And then after I had my son, I would have these dreams where someone would come to the door, and they would knock on the door, and they would say, well, you know, we're just going to wait two weeks to see if you get to keep your baby or not. And it really impacted my ability to bond with him.

DEMBOSKY: She likes the bill because it goes beyond the mandated screening. It requires health insurance companies to help moms find a therapist.

ROOT ASKEW: Just like we have case management programs for patients who have diabetes or sleep issues or back pain, a case management program requires the insurance company to take some ownership of making sure that their patients are getting the treatment that they need to be healthy.

DEMBOSKY: Doctors still have their objections. They could be disciplined for not doing it, and screening takes time. Sometimes you ask a mom how she's sleeping, and she's in tears for the next 30 minutes. Dr. Sirott says the system isn't set up for this.

SIROTT: Currently, I get $6 for screening a patient. By the time I put it on the piece of paper and print it, it's not worth it.

DEMBOSKY: And it's not clear it's worth it to the patients either. Four other states have tried mandated screening, and a study showed it didn't result in more women getting treatment. Even with California's extra requirements on insurance companies, women could still face high copays or limits on therapy sessions. But supporters of the bill say doctors need to start somewhere. Mountain View psychiatrist Nirmaljit Dhami says screening is the first step in recognizing the full scope of the problem.

NIRMALJIT DHAMI: I often tell them that if you don't know that somebody is suicidal, it doesn't mean that their suicidality will go away, you know, if you don't ask. The risk is the same.

DEMBOSKY: The state Legislature is set to begin debate on the bill next month. For NPR News, I'm April Dembosky in San Francisco.