Good morning all.

I'm uh Julie Williams Johnson, Clear of the Board of Legislative Committee on Health.

Today is May 6th, and we'll take attendance to officially start, marking myself as present.

Committee Vice Chair Barr.

Legislative Memorial.

Present.

Legislative Uli and Chairman Gashi.

We are officially opened at 1105 and the month of May is many things.

Many, many things.

I keep updating my direct of my evenings to an appropriate if there are.

It is a mental health awareness month, and it is national postpartum week this week, and maternal mental health awareness week.

And today is National Maternal Mental Health Day.

And we are very fortunate to have Dr.

Louis Susser, who's an assistant professor of clinical psychiatry and program director of New York Presbyterians.

Dr.

Amler, please move mute yourself.

Thank you.

And of course, we have Ellen Blanken and Young.

Who is with New York Presbyterian with us as well today?

We're lucky to have both of them.

And of course, we have our commissioners, Commissioner Michael Orth of the Community Mental Health Department and Dr.

Sherulia Handler, Commissioner of our Health Department.

Thank you everyone for being with us today.

We've sat at this table many a time talking about the inequity of maternal health, especially women of color and um and uh the um uh what health benefits, um lead policies, they all don't recognize the full uh weight of what uh women go through uh pre during and post-pregnancy.

So I'm gonna shut my mouth and um turn the mic over to you, Dr.

Susser, so you can become smarter.

That's wonderful.

So thank you so much for recognizing maternal mental health week.

Um I thought it could be helpful today for me to shine some light on the importance of treatment of maternal mental health today.

You know, over the last decade, there's been so much more awareness of the importance of mental health in pregnancy and postpartum.

Um there's been it's important to identify postpartum depression, depression in pregnancy, other psychiatric disorders across the perineal period, and that's reduced stigma, and so women are much more likely to be willing um to fare to clinicians to to look for perineal depression, but there's still a lot of stigma again um related to the treatment, um, different treatment, whether it's medication, psychotherapy, and so I wanted to focus on treatment today so that we could we could recognize this more, talk about it more, and reduce this stigma that women face when they're trying to access so many women who present to me, share their fears of how society will see it if they find out that they're in psychotherapy and medication, what their partners might think, what family members might think, what other clinicians might think.

And so I wanted to go over how I approach treatment to psychiatric illness in pregnancy and post-party, how I discuss it with women and how I frame it so that they really can make that informed decision about what treatment they think would be best for their health and for their pregnancy and offspring as well.

And so you know it's really a risk-risk comparison, the risks of the treatment versus the risk of the illness when they're not on the treatment that works best.

And this is similarly the way you would see treatment of any medical condition in pregnancy or during breastfeeding was part of.

But often, unfortunately, because of stigma, we see treatment of psychiatric disorders differently, and we should it should be framed the same way.

And we should it should be framed the same way.

The way that you might approach gestational diabetes from lifestyle interventions to to insulin when indicated, uh, or UTI in pregnancy.

But unfortunately, in society, we still see psychiatric illness different.

A woman who might come in concerned about the new medication when other interventions haven't been in pregnancy, may have a lot of fear about taking a well-studied antidepressant in pregnancy or for example a severe depression, but then not have concerns about the other medications she's taking for other medical conditions and other areas of medicine.

And so this is why it's so important to understand how to frame it for a woman so she really can decide for herself what would be best for her health.

And so and oh on that slide, I'm sorry.

And so, you know, many women will come to me prior to pregnancy, wanting to figure out what plan would be best in the perinatal period and say, you know, they they've had multiple severe episodes of depression, but they don't want to be on the medication that's really keeping them well in pregnancy or or continuing whatever treatment plan have been working so well for them because um you know they do anything to not have an exposure for the fetus.

Um they'll endure any suffering, they'll say, or they might come in to see me in pregnancy in a severe depressive episode, um, struggling at work, struggling to eat well, struggling to care for their other children, really suffering, um, and say, you know, they'll do anything, they'll endure any symptoms to not have an exposure from the fetus.

Or maybe another example I see is a woman um you know who has decided that what she wants to do is stay on on the current plan, current medication, let's say um in pregnancy because she's doing well and she had suffered so much in the past off of it, and then she sees another provider who doesn't mean to do this, but might say, well, you know, this medication is well studied in pregnancy, but you know, why be that?

Why have that exposure?

And all of those cases, what the person, either the perinatal individual or the clinician is looking at is the risk of the treatment, the risk of the medication, for example, but in comparison to no exposure.

But if a woman is on a medication or a medication that's needed to keep her well or to get her well and to be healthy, similar to other areas of medicine, then the comparison isn't between the risk of the treatment and no exposure to the fetus and to her her health, but it's a comparison between the risk of that treatment, the exposure to that treatment in pregnancy and postpartum, to the risk of what her illness looks like off of that medication or outside of that treatment.

So you're saying that uh that weighs more heavily than their fear of what the effect would be to the fetus?

No, not at all.

It's that we want to we want both.

We want to talk about the risks of the treatment and weigh that to the potential risks of her illness, which are really important.

The way that people often frame it or see it is it's the potential risks of exposure to treatment in pregnancy compared to no exposure.

But what I'm gonna go over on the subsequent slides is that the risk of under-treated psychiatric illness in pregnancy and postpartum is really significant, and so it's not a question of just or comparison of you know what the risk of the treatment is in pregnancy or postpartum of nothing, but what you have to weigh is the risk of that treatment to what her illness looks like off of that treatment.

And so for milder depression, we have excellent evidence-based psychotherapies, exercise sleep due so much for more severe illness, though, medication is often an important component to be able to adequately treat that illness and to prevent many of the adverse outcomes that can occur similarly to if someone has just different outcomes but you know, untreated or under-trained gestational diabetes of you know, diet control and exercise are inadequate for that, then you know, insulin would be an important component both for the mother's health in pregnancy and for the offspring, and similarly for psychiatric illness.

And so we have to have the right comparison, not just looking as in those examples that those people work we're looking at the risk of the treatment compared to if they're off of the treatment, there's no risk.

But if someone's in treatment or on a medication, they're on it for an indication.

So we have to look at what it looks like for them to not be on that treatment and not in the risks associated with that.

Does that make sense?

Yeah, thank you for I always playing devil's advocate, so thank you for down on that.

Let me just uh um welcome a Samantha Vanity executive director push for an empowerment pregnancy.