S4727

An Act concerning postpartum psychosis and amending P.L.2000, c.167.

Be It Enacted by the Senate and General Assembly of the State of New Jersey:

1. Section 1 of P.L.2000, c.167 (C.26:2-175) is amended to read as follows:

1. The Legislature finds and declares that:

a. Postpartum depression is the name given to a wide range of emotional, psychological and physiological reactions to childbirth, including loneliness, sadness, fatigue, low self-esteem, loss of identity, increased vulnerability, irritability, confusion, disorientation, memory impairment, agitation and anxiety, which challenge the stamina of the new mother and impair her ability to function and nurture her newborn child;

b. Postpartum depression is the result of a chemical imbalance triggered by a sudden dramatic drop in hormonal production after the birth of a baby, and women at highest risk for postpartum depression are those with a previous psychiatric difficulty, such as depression, anxiety or panic disorder and those with a family member suffering from such a psychiatric difficulty, but postpartum depression frequently strikes without warning in women without any past emotional problems or psychiatric difficulties and without any complications in pregnancy. Symptoms may appear at any time after delivery;

c. Women are more likely to suffer from mood and anxiety disorders during pregnancy and following childbirth than at any other time in their lives; 70 to 80% of all new mothers suffer some degree of postpartum mood disorder lasting anywhere from a week to as much as a year or more, and approximately 10 to 20% of new mothers experience a paralyzing, diagnosable clinical depression;

d. Many new mothers suffering from postpartum depression require counseling and treatment, yet many do not realize that they need help. Those whose illness is severe may require medication to correct the underlying brain chemistry that is disturbed;

e. Postpartum depression dramatically distorts the image of perfect new motherhood and is often dismissed by the woman suffering from this illness and those around her. Sometimes it is thought to be a weakness on the part of the sufferer that is self-induced and self-controllable;

f. Currently, the United States lacks any organized treatment protocol for postpartum depression and lags behind most other developed countries in providing information, support and treatment for postpartum depression;

g. If early recognition and treatment are to occur, postpartum depression must be discussed in childbirth classes and obstetrical office visits and public education about this illness must be enhanced to lift the social stigma associated with the illness. Such discussion and education will increase the chance that a woman will inform others of her symptoms as she would for physical complications;

h. It is imperative that health care providers who provide prenatal and postnatal care to women have a thorough understanding of postpartum depression so that they can detect and diagnose this illness in its earliest stages and thus prevent the most severe cases;

i. In addition to the mother, the effects of postpartum depression can also impact the child and the father significantly. Maternal depression can affect the mother's ability to respond sensitively to her infant's needs, and can strain the parent's relationship as the father feels anxious and helpless because he does not understand what is going wrong or what is the source of the depression; [and]

j. Postpartum depression is one of the most treatable and curable of all forms of mental illness, and education about this illness can be very beneficial to new parents coping with these emotional and hormonal changes by helping them decide if and when they need outside help[.] ;

k. Postpartum psychosis is a rare condition that involves the abrupt onset of psychotic symptoms shortly following childbirth, which affects a person’s sense of reality, causing hallucinations, delusions, paranoia, or other behavior changes. In severe cases, people with postpartum psychosis may attempt to harm themselves or their newborn;

l. Experts don’t know why postpartum psychosis happens but suspect that it involves a combination of factors, including, but not limited to: a person’s or a family history of mental health conditions; the number of pregnancies; sleep deprivation; hormonal changes during pregnancy; and other medical conditions, such as autoimmune and inflammatory diseases, electrolyte imbalances, vitamin deficiencies;

m. Postpartum psychosis can affect anyone who recently gave birth. While this condition usually happens within several days of giving birth, it can happen up to six weeks after a person gives birth. Postpartum psychosis affects one to two per 1,000 women, and in the United States, occurs in between 320 and 9,400 births each year;

n. Postpartum psychosis constitutes a true psychiatric emergency and almost always requires immediate inpatient hospitalization and treatment. However, other interventions including pharmacological treatment, psychosocial supports, and long-term preventative strategies can help reduce the recurrence of the condition during subsequent pregnancies; and

o. Like postpartum depression, postpartum psychosis is treatable. Unfortunately, the rarity of this condition and the lack of knowledge about what it is, how to recognize it, and how to treat it – combined with stigma about perinatal psychiatric disorders in general and the lack of appropriate treatment venues – mean that it is often missed, by obstetricians and psychiatrists, with sometimes tragic consequences. Therefore, public awareness, education, and early diagnosis are critical to ensure that new parents recognize the symptoms of this condition and that obstetricians and psychiatrists provide proper treatment to reduce the risk of recurrence and ensure maternal and infant safety.

(cf: P.L.2000, c.167,s.1)

2. Section 2 of P.L.2000, c.167 (C.26:2-176) is amended to read as follows:

2. The Commissioner of Health, in conjunction with the State Board of Medical Examiners and the New Jersey Board of Nursing, shall [work with] require health care facilities and licensed health care professionals in the State to develop and implement policies and procedures to achieve the following requirements concerning postpartum depression and postpartum psychosis:

a. Physicians, nurse midwives, and other licensed health care professionals providing prenatal care to women shall provide education to women and their families about postpartum depression and postpartum psychosis in order to lower the likelihood that new mothers will continue to suffer from [this illness] these illnesses in silence;

b. All birthing facilities in the State shall provide departing new mothers and fathers and other family members, as appropriate, with complete information about postpartum depression and postpartum psychosis, including [its] their symptoms, methods of coping with [the illness] these illnesses, and treatment resources;

c. Physicians, nurse midwives, and other licensed health care professionals providing postnatal care to women shall screen new mothers for postpartum depression or postpartum psychosis symptoms prior to discharge from the birthing facility and at the first few postnatal check-up visits; and

d. Physicians, nurse midwives, and other licensed health care professionals providing prenatal and postnatal care to women shall include fathers and other family members, as appropriate, in both the education and treatment processes to help them better understand the nature and causes of postpartum depression and postpartum psychosis so that they too can overcome the spillover effects of [the illness] these illnesses and improve their ability to be supportive of the new mother.

(cf: P.L.2012, c.17, s.130)

3. Section 3 of P.L.2000, c.167 (C.26:2-177) is amended to read as follows:

3. The Commissioner of Health shall establish a public awareness campaign to inform the general public about the nature and causes of postpartum depression and postpartum psychosis and [its] theirhealth implications, including [its] their symptoms, methods of coping with [the illness] these illnesses, and the most effective means of treatment.

(cf: P.L.2012, c.17, s.130)

4. This act shall take effect immediately.

STATEMENT

This bill amends P.L.2000, c.167 (C.26:2-175 et seq.) to mandate that the Department of Health (the department), in conjunction with the State Board of Medical Examiners and the New Jersey Board of Nursing, require health care facilities and licensed health care professionals in the State to develop and implement policies and procedures to achieve certain requirements concerning postpartum depression and postpartum psychosis.

Currently, the law requires health care facilities and licensed health care professionals in the State to develop such policies and procedures to achieve certain requirements concerning postpartum depression, but does not require such facilities and professionals to implement the policies and procedures or mandate they include requirements concerning postpartum psychosis. This bill would require that the policies and procedures developed by health care facilities and health care professionals be implemented and include requirements concerning postpartum psychosis.

The bill also amends section 3 of P.L.2000, c.167 (C.26:2-177) to require that the Commissioner of Health expand the public awareness campaign established by the law to inform the general public about the nature and causes of postpartum psychosis and its health implications.

Currently, the public awareness campaign provides information to the public about the nature and causes of postpartum depression but does not require information be provided about postpartum psychosis. This bill would expand the requirements of the public awareness campaign to include information about the nature and causes of postpartum psychosis and its health implications.