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Roundtable Discussion

Military Mothers’ Mental Health

Unique Challenges and Opportunities

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Military

Maternal

Mental

Health

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Military

Maternal

Mental

Health

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Military

Maternal

Mental

Health

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How we will get there…

Introductions

Level set

Maternal mental health
Military lifestyle and culture
Medical and mental health care in the military
Federal government activities

Share information about activities, programs, policies supporting the mental health of our nation’s military mothers

Next Steps

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Introductions

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MMH conditions include

depression
anxiety disorders
obsessive-compulsive disorder
post-traumatic stress disorder
bipolar illness
psychosis
substance use disorders

MMH conditions can occur during pregnancy and up to one year following pregnancy

There are a range of MMH conditions

It’s not just postpartum.

It’s not just depression.

Maternal Mental Health Conditions

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1 in 5 Mothers Are Impacted by Mental Health Conditions�

Maternal mental health (MMH) conditions are the

MOST COMMON

complications of pregnancy and birth, affecting 800,000 families each year in the United States.^1,2

Mental Health Conditions Are A Leading Cause of Maternal Deaths�

Suicide and overdose are a

LEADING CAUSE

of death for women in the first year

following pregnancy.³

MMH Facts & Figures

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$14 Billion: The Cost of Untreated MMH Conditions�

The cost of not treating MMH conditions is $32,000 per mother-infant pair, or

$14 BILLION

each year in the United States.⁵

Most Individuals Are Untreated, Increasing Risk of Negative Impacts�

75% of individuals impacted by MMH conditions REMAIN UNTREATED,

increasing the risk of long-term negative impacts on mothers, babies, and families.⁴

MMH Facts & Figures

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SOURCES: Zhou et al., 2019; Jahan et al., 2021; Fitelson et al., 2011

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SOURCES: Jahan et al., 2021; Langham et al., 2023; Zhang et al., 2023; Mughal et al., 2019; Felitti et al., 1998

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SOURCES: Da Costa et al., 2019; Foli et al., 2016; Field, 2010; Sills et al., 2007

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The Steps to Wellness

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Level Set

Maternal Mental Health

in the Military

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Military Mothers are at Increased Risk

for MMH Conditions

TRICARE Beneficiary Category	Prevalence
Retired servicemembers	63%
Active duty servicemembers	38%
Dependents	36%
Inactive guard / reserve members	30%
Other	40%
All beneficiaries	36%

GAO Report May 2022

Prevalence of and Efforts to Screen and Treat Mental Health Conditions in Prenatal and Postpartum TRICARE Beneficiaries

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Active Duty and Dependents

	Active Duty Servicemembers	Dependents Spouses
Total	1.4 million	1 million
Women	130,000	920,000
% Women	17%	92%
# giving birth annually	16,000	85,000

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30,000

Military families are impacted by MMH conditions each year

Mother, baby, spouse, family

Military unit

Force readiness

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Race & Ethnicity

Race / Ethnicity of Women	General Population	Active Duty
American Indian or Alaska Native	1%	1.3%
Asian	7%	6%
Black	13%	26%
Hispanic or Latina	19%	21%
Native Hawaiian or Pacific Islander	<1%	1.5%
White	56%	57%

Source: MMHLA Fact Sheet on MIlitary Mothers, 2024

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Disparities in maternal mortality and morbidity persist in the military despite universal healthcare and similar socioeconomic status.
Black and Asian/Pacific Islander women service members experience higher rates of severe maternal morbidity.
Black women service members are especially impacted, with significantly higher rates of complications and death compared to their White counterparts.
Equal access and socioeconomic status do not eliminate racial differences in maternal outcomes for women of color in the military.

Increased Risk

Black and Asian/Pacific Islander women servicemembers

Source: MMHLA Fact Sheet on MIlitary Mothers, 2024

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Increased Risk for MMH Conditions

36%

of military mothers�experience MMH conditions

50%

of mothers with deployed spouses experience postpartum depression

2X

Women servicemembers who have been deployed experience MMH conditions at TWICE the rate of non-deployed women

40%

of women service members

report experiencing sexual assault

Source: MMHLA Fact Sheet on MIlitary Mothers, 2024

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Screening & Treating MMH

Sources: GAO Report 22-105136; Giesseman et al, Military Science, 2021.

GAO Report

DOD encourages mental health screening for perinatal beneficiaries in TRICARE
DOD provides treatment to most beneficiaries with mental health diagnoses

2021 Study | OB screenings

96%

first appointment

60%

28-week appointment

85%

postpartum appointment

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Level Set

Impact of Military Lifestyle & Culture on MMH Conditions

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Military Lifestyle

Distance from family of origin
Frequent moves and separations
Disruption to family structure and routines
Lack of social support
Concern about service member in harm’s way
Dual-military relationships

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Military Culture

Understanding the

unique military culture

is necessary to appreciate the impact

it may have on the mental health

of military mothers

Hierarchical and male-dominated culture

Impacts all aspects of life

Service member and family

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Military

Culture

and

Mental

Health

Service members are expected to be

disciplined in their actions and words,

and always to be in control of their emotions.

In the military environment,

individuals who are perceived to be

NOT mentally or physically tough

may be looked down upon or ostracized.

Experiencing mental health challenges

can be seen as a sign of weakness

or lack of professionalism,

which are the antithesis of military culture.

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Not only do they perceive

stigma related to mental illness,

but also stigma associated with gender.

Showing emotion, being vulnerable,

feeling fear, and seeking help are

associated with femininity

rather than the masculinity

that underlies the military mindset.

Impact on Female

Service Members

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Barriers To Providing

MMH Care

Knowledge
Time
Resources

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Barriers To

Accessing MMH Care

Access: Availability of specialized mental health care, cost

Logistics: Childcare, transportation, time off from work

Stigma: Concern about being a ‘bad mom’ and about impact on career or security clearance

Culture: Military culture which emphasizes self-reliance, strength, hierarchy

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Level Set

Medical & Mental Health

in the Military

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Military Health System (MHS) - Dual Mission

Readiness

A Medically Ready Force,

A Ready Medical Force

Benefit Provision

For military families, retirees and their families, and survivors

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Military Health System: Sources of Care

Direct Care/ Military Treatment Facilities (MTFs)

Purchased Care/ Civilian Network

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MHS Maternal Health Care Challenges

MTFs

Appointment shortages
Administrative hurdles
Inconsistency across geographies

TRICARE

Network reductions
Inaccurate provider directories
Contract/region transitions

Referrals

Enrollment

Transitioning Care During PCS Moves

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Resources

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Share the Number!
Request Free Promotional Materials
Amplify on Social Media

24/7, Free, Confidential Mental Health Support for Pregnant and Postpartum Individuals and their Families
Qualified counselors provide emotional support, resources and referrals in English, Spanish
60+ on-demand Additional Languages via Voice & Text

National Maternal Mental Health Hotline

LINK

1-833-TLC-MAMA

LINK

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Current Activities to Support MMH in the Military

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Prevalence of and Efforts to Screen and Treat Mental Health Conditions in Prenatal and Postpartum TRICARE Beneficiaries

GAO Report 22-105136

LINK

Key Takeaways

Military mothers experience MMH conditions at 2x the rate of civilian counterparts
DoD encourages mental health screening and provides treatment

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DOD Should Improve Accuracy of Behavioral Health Provider Information in TRICARE Directories

GAO Report 24-106588

LINK

Key Takeaways

Approximately 80% of behavioral health provider listings in TRICARE network directories are inaccurate
DoD could do more to identify and address inaccuracies in the directories and periodically monitor them

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TRICARE beneficiaries can only switch plans during annual Open Season or if they have a Qualifying Life Event (QLE)
QLE: change in circumstances that may make someone eligible to enroll in health insurance outside Open Season
Making pregnancy a QLE would ensure that beneficiaries can access care that meets their needs.
Legislation included in FY 2025 NDAA that passed House

Pending Legislation

Pregnancy Qualifying Life Event

LINK

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Free, DoD-funded program
Military members and their families
24/7 connection to information and support services
Consultation, coaching, counseling

Military OneSource

LINK

Military OneSource is a Department of Defense program that is a 24/7 call center (800-342-9647), website (MilitaryOneSource.mil), and mobile app (My Military OneSource) providing comprehensive information, resources and assistance on every aspect of military life at no cost to Service members and their families. Veterans, including Coast Guard, and their immediate family can access Military OneSource up to 365 days post-separation or retirement.

Military OneSource fills a gap in DoD military and family support programs with 24/7 worldwide access to comprehensive services supported by legislative requirements.

Military OneSource offers a wide range of individualized consultations, coaching and counseling to help Service members and families reach their goals, overcome challenges, and thrive.

Master’s level consultants provide information and referral on a wide range of topics including deployment, reintegration, financial, relationship issues, grief, spouse employment and education, parenting and life skills.

Non-medical counseling gives Service members and families a place to speak confidently with a licensed mental health provider for up to 12 sessions, per issue, to address daily life issues before they compromise military and family readiness.

Specialty consultants help address questions and concerns about the care and education of family members with special needs — both children and adults. They can provide information about the Exceptional Family Member Program, special education cycle, specialized doctors, and more.

Service members and their families can get help achieving their health and wellness goals with coaches who offer support for different areas of wellness—from weight management, fitness and nutrition, to stress management and life transitions.

MilitaryOneSource.mil and the My Military OneSource mobile app seamlessly integrate with the call center to make it easy for Service members and families to connect directly to Military OneSource consultants via live chat.

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HealthySteps is an evidence-based pediatric primary care model and a program of ZERO TO THREE
There are 8 Core Components, which include child and family screening (including maternal depression screening); referrals and care coordination; and provision of positive parenting guidance and early learning resources

HealthySteps

https://www.healthysteps.org/

https://www.zerotothree.org/

ZERO TO THREE is a non-partisan, national non-profit whose mission is to ensure that all babies and toddlers have a strong start in life.

HealthySteps embeds an early childhood expert – a HealthySteps Specialist – into the primary care setting. This person is part of the care team and supports families with non-medical questions and concerns. As a risk-stratified model, the families with the highest level of need or several, complex needs, will have the most access to the HSS.

And why primary care? Almost all families (90%) take their babies to see a pediatric primary care provider. New parents and caregivers attend up to 8 well-child visits in a child’s first year, so the multiple touchpoints provide a great opportunity to check in with caregivers early and often.

Laura Ptucha and Jennifer Novak

There are currently 11 HealthySteps sites on Department of Defense installations across 6 states (AL, CA, HI, NC, TX, and WA) and Germany. At these sites, all HS Specialists are specially trained Military & Family Life Counselors. These HealthySteps Specialists work closely with families to connect them to needed services, including New Parent Support Home Visitors on the installation, and Exceptional Family Member Support as needed.

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Active Duty, Spouses, and Veterans

	Service Members Active duty	Spouses Dependents	Veterans Formerly active duty
Total	1.4 million	1 million	16 million
Women	130,000	920,000	2 million
% Women	17%	92%	10%
# giving birth annually	16,000	85,000	10,000

Source: MMHLA Fact Sheet on MIlitary Mothers, 2024

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Recognizes that there are not enough mental health providers, and that more clinicians need to treat mental health
Addresses wide range of reproductive mental health concerns
Email consultation system with replies in writing to ensure accuracy, retention, and sharing with others
Multidisciplinary team of experts that provide replies, increasing quality control

Reproductive Mental Health Consultation Program

LINK

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Aaliyah in Action provides women, birthing people and families with tangible bereavement support, in the form of self-care packages and support books, after experiencing a perinatal, neonatal or infant loss

Partners with hospitals (60+) who have inventory of our thoughtfully curated packages & books & ships packages nation/worldwide to families who self-request

AiA is looking to connect with military bases to provide our resources in the US and abroad (as we know there can be little to no support after this form of loss and families may not have much support from loved ones given their locations)

Aaliyah in Action

LINK

Aaliyah in Action

Follow us on IG!

@aaliyahinaction

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Perinatal mood and anxiety disorders are some of the most common pregnancy complications
Often under-diagnosed, untreated, or under-treated
Clinician education, screening tools
Education for patients and families
Guide for integrating mental healthcare into obstetric practice

ACOG Perinatal Mental Health Toolkit

LINK

www.acog.org/programs/perinatal-mental-health

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Our mission is to provide an empowering and supportive network to military and veteran families navigating the challenges in the family building process through support groups, education, and resources.
How do we accomplish this?

Support Groups
Education Center
Resource Library
Advocacy

Building Military Families Network

buildingmilitaryfamiliesnetwork.org

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Our mission to provide proactive, holistic, & easily accessible tools to prevent postpartum anxiety & depression for moms and their support system.

HIVE app launch for iOS & Android –> October 2024

Founded by Dr. Danielle Wright-Terrell (OBGYN)

Please email inquiries to danielle@honeypostpartum.com

Designed to help parents establish healthy habits during their transition into early parenthood.
Automated assessments & trackers that help moms & dads thrive in their physical, mental, social, and parenting wellness

Honey Postpartum

honeypostpartum.com

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MISSION: strengthen the world one mama, one baby & one organization at a time.
Founded by a birth doula, global childbirth educator and serial entrepreneur, the Maternal Care Institute is a purpose-driven company that collaborates exclusively with organizations supporting moms from conception through childbirth and into postpartum.
We help clients create compelling and commercially successful products for the global maternal care market. Known for delivering intelligent, cost-effective, & attentive client service that achieves remarkable results.

Maternal Care Institute

www.maternalcareinstitute.com

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An all-in-one digital platform offering:

Screening, Referrals, Care and Support�

A solution for both Providers (portal) and Patients (mobile app)

Unique mobile app experience for the Patient and their Partner�

Includes tailored content, curated specifically for military families �
Provides a suite of services for all mental health needs

Mammha

LINK

Mammha is a complete and comprehensive perinatal maternal health solution

mammha.com

No mother or father slipping through mental health gaps. EVER.

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It is an effective preventive intervention for postpartum depression that focuses on the parent-infant dyad.
It is brief: 3 sessions and 2 phone check-ins.
It uses targeted psychotherapy and infant behavior interventions to reduce infant fuss/cry, improve parent and baby sleep and reduce parent’s mood symptoms postpartum.
It is an accessible model offered in conjunction with routine perinatal medical visits or via telehealth.

Practical Resources for Effective

Postpartum Parenting (PREPP)

www.perinatalpathways.org

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OPERATIONAL OVERVIEW

Deliver convenient, affordable, and secure mental health care for military members and their families nationally.
Partnered with both TRICARE and the VA, ensuring quality care access.

AVAILABLE ENGAGEMENT PROGRAMS

PTSD & Military Specific Therapy, Intensive Support for Passive Suicidality, Couples/Marital Counseling, Anxiety/Stress Management, and Deployment Readiness.
Child and adolescent support programs are available for children ages 5 and above, offered in-school and remote.

TELEMYND

LINK

www.telemynd.com

Mental Health Support For The Military Community

Contact Meredith Sieller

MCM Capital Region

(757) 355-2977

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What to Expect is a highly engaged and supportive community of 20 million new and expecting moms, including an active community of 11,000 military moms. WTE embeds vital maternal mental health and maternal health resources and information throughout the app and helps moms recognize symptoms of PMADs and seek support and treatment.
The What To Expect Project is the non-profit arm of WTE, dedicated to educating, supporting, and empowering at risk moms, in the United States and around the world, so they can expect healthier pregnancies, safer deliveries, healthier babies, and healthier futures.
Through our baby shower initiative, we’ve hosted 350 baby showers for 35,000 military moms and dads since 2013. WTEP works directly with the Marine Corps, Navy, and Army, sponsoring showers to celebrate military families and provide wraparound services and resources, including Military OneSource, Family Advocacy, EFMP, WIC, NHTSA, CDC’s #HearHer and HRSA’s TLCMama hotline, gifts and giveaways, plus hugs, books and a Q&A with Heidi.

What to Expect (WTE)

Military Baby Shower Initiative

LINK

www.whattoexpectproject.org

ADVOCACY PRIORITIES

TRICARE Coverage for Doula Support Act
Provider choice for pregnant active duty service members
GAO report on MMH in the military
Resource sharing

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Wrap Up & Next Steps

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Military

Maternal

Mental

Health

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Military

Maternal

Mental

Health

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References Maternal Mental Health Key Facts

Fawcett, E. J., Fairbrother, N., Cox, M. L., White, I. R., & Fawcett, J. M. (2019). The Prevalence of Anxiety Disorders During Pregnancy and the Postpartum Period: A Multivariate Bayesian Meta-Analysis. The Journal of clinical psychiatry, 80(4), 18r12527. https://doi.org/10.4088/JCP.18r12527.
Gavin, N. I., Gaynes, B. N., Lohr, K. N., Meltzer-Brody, S., Gartlehner, G., & Swinson, T. (2005). Perinatal depression: a systematic review of prevalence and incidence. Obstetrics and Gynecology, 106(5 Pt 1), 1071–1083. https://doi.org/10.1097/01.AOG.0000183597.31630.db.
Trost, et al., (2022). Pregnancy-Related Deaths: Data from Maternal Mortality Review Committees in 36 US States, 2017–2019. Centers for Disease Control and Prevention. https://www.cdc.gov/reproductivehealth/maternal-mortality/erase-mm/data-mmrc.html.
Byatt, N., Levin, L. L., Ziedonis, D., Moore Simas, T. A., & Allison, J. (2015). Enhancing Participation in Depression Care in Outpatient Perinatal Care Settings: A Systematic Review. Obstetrics and gynecology, 126(5), 1048–1058. https://doi.org/10.1097/AOG.0000000000001067.
Luca, D. L., Margiotta, C., Staatz, C., Garlow, E., Christensen, A., & Zivin, K. (2020). Financial Toll of Untreated Perinatal Mood and Anxiety Disorders Among 2017 Births in the United States. American journal of public health, 110(6), 888–896. https://doi.org/10.2105/AJPH.2020.305619.
United States Government Accountability Office, (2022). Defense Health Care: Prevalence of and Efforts to Screen and Treat Mental Health Conditions in Prenatal and Postpartum TRICARE Beneficiaries. https://www.gao.gov/assets/gao-22-105136.pdf.
Taylor, J., Novoa, C., Hamm, K. & Phadke, S., “Eliminating Racial Disparities in Maternal and Infant Mortality: A Comprehensive Policy Blueprint,” Center for American Progress, May 2019. https://www.americanprogress.org/article/eliminating-racial-disparities-maternal-infant-mortality.
Postpartum Support International, (2023). https://www.postpartum.net/learn-more/.

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References Military Families

9.Freedle, A., & Kashubeck-West, S. (2021). Core belief challenge, rumination, and posttraumatic growth in women following pregnancy loss. Psychological Trauma: Theory, Research, Practice, and Policy, 13(2), 157–164. https://doi.org/10.1037/tra0000952

10. Hutti, M. H., Myers, J. A., Hall, L. A., Polivka, B. J., White, S., Hill, J., Grisanti, M., Hayden, J., & Kloenne, E. (2018). Predicting Need for Follow-Up Due to Severe Anxiety and Depression Symptoms After Perinatal Loss. Journal of Obstetric, Gynecologic & Neonatal Nursing, 47(2), 125–136. https://doi.org/10.1016/j.jogn.2018.01.003

11. Inati, V., Matic, M., Phillips, C., Maconachie, N., Vanderhook, F., & Kent, A. L. (2018). A survey of the experiences of families with bereavement support services following a perinatal loss. Australian and New Zealand Journal of Obstetrics and Gynaecology, 58(1), 54–63. https://doi.org/10.1111/ajo.12661

12. Dyer, E., Bell, R., Graham, R., & Rankin, J. (2019). Pregnancy decisions after fetal or perinatal death: systematic review of qualitative research. BMJ Open, 9(12), e029930. https://doi.org/10.1136/bmjopen-2019-029930

13. Roberts, L. R., Sarpy, N. L., Peters, J., Nick, J. M., & Tamares, S. (2022). Bereavement care immediately after perinatal loss in health care facilities: a scoping review protocol. JBI Evidence Synthesis, 20(3), 860–866. https://doi.org/10.11124/JBIES-21-00053

14. Hawthorne, D. M., Joyner, R., Gaucher, E., & Liehr, P. (2021). Death of an infant: Accessing the voices of bereaved mothers to create healing. A qualitative study. Journal of Clinical Nursing, 30(1–2), 229–238. https://doi.org/10.1111/jocn.15542

15. Farrales, L. L., Cacciatore, J., Jonas-Simpson, C., Dharamsi, S., Ascher, J., & Klein, M. C. (2020). What bereaved parents want health care providers to know when their babies are stillborn: a community-based participatory study. BMC Psychology, 8(1), 18. https://doi.org/10.1186/s40359-020-0385-x

16. Return to Zero: H.O.P.E. website, https://rtzhope.org/

17. Pruitt S.M., Hoyert D.L., Anderson K.N., et al. Racial and Ethnic Disparities in Fetal Deaths — United States, 2015–2017. MMWR Morb Mortal Wkly Rep 2020;69:1277–1282. https://www.cdc.gov/mmwr/volumes/69/wr/mm6937a1.htm