How a famous hospital turned around its low rate of screening moms for depression [CenterForHealthJournalism.org]

I commend Cedars Sinai for the incredible work they are doing and we can all learn from successful models that screen, refer, diagnose and link to services. We need to learn from them and look closely at all the pieces they put in place to make it work because it can work! BUT....

One of my biggest concerns about proposed legislation which requires an unfunded mandate for screening is this...There has been and continues to be a HUGE shortage in system capacity to refer, diagnosis, treat and follow up women who screen positive for a MMH disorder.

A screening mandate when system capacity is low is unethical because A DECISION TO SCREEN IS A DECISION TO TREAT.  

 And if we are talking about ACEs and becoming healing informed and trauma informed, isn't it even MORE important that we consider all ramifications of asking questions? 

In the healthcare world, we would never screen for diabetes without offering mom a diagnosis, education or treatment. It's unethical to screen mom and not assure access and treatment.

I know the legislation proposes case management but THERE IS NOT ENOUGH TREATMENT OR RESOURCES for maternal mental health right now for this to be successful across California. So case management without adequate and timely access to treatment and resources is just a pipeline to a dead end, to quote a colleague who is a nurse case manager in a large health insurance system.

In some areas a screening and case management mandate it will work because those systems have integrated behavioral health or leadership that is building capacity. But for most of us, we are just not there.  And when there isn't enough capacity that provides adequate levels of treatment,  a mother in crisis may end up routed to police, emergency rooms and child welfare systems who also may not be trained. Harm can be done here. So let's think about the order in which we do things.

I'm not saying we shouldn't screen, but screening to me is a tool to initiate a conversation. And screening isn't our first step, but later down the road. And here's another thing to consider...a zero score on a screener could be just as concerning as a positive screen for increased risk. 

If I was traumatized by the healthcare system in the past, would I really tell the truth about my current mental health status through a screening tool, given by a provider's office that I didn't know? I think that mandates can do harm and we must seriously consider the ORDER in which we do things. 

Legislation should focus on evidence informed and evidence based interventions known to make our moms WELL.  Screening and case management are not interventions.

Our actions and our legistation should focus on changing behavior using SCREENING as the OUTCOME measure and not the intervention itself.