Senate Bill 1375

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S 1375 IS

To ensure that new mothers and their families are educated about postpartum depression, screened for symptoms, and provided with essential services, and to increase research at the National Institutes of Health on postpartum depression.

Mr. MENENDEZ (for himself, Mr. DURBIN, Ms. SNOWE, Mr. BROWN, Mr. DODD, and Mr. LAUTENBERG) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions

To ensure that new mothers and their families are educated about postpartum depression, screened for symptoms, and provided with essential services, and to increase research at the National Institutes of Health on postpartum depression.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the `Mom's Opportunity to Access Health, Education, Research, and Support for Postpartum Depression Act' or the `MOTHERS Act'.

SEC. 2. FINDINGS.

The Congress finds as follows:
(1) Postpartum depression is a devastating mood disorder which strikes many women during and after pregnancy.
(2) Postpartum mood changes are common and can be broken into three subgroups: `baby blues,' which is an extremely common and the less severe form of postpartum depression; postpartum mood and anxiety disorders, which are more severe than baby blues and can occur during pregnancy and anytime within the first year of the infant's birth; and postpartum psychosis, which is the most extreme form of postpartum depression and can occur during pregnancy and up to twelve months after delivery.
(3) `Baby blues' is characterized by mood swings, feelings of being overwhelmed, tearfulness, irritability, poor sleep, mood changes, and a sense of vulnerability that usually starts in the first week and resolves without treatment by the end of the second week postpartum.
(4) The symptoms of postpartum mood and anxiety disorders are as defined in the latest edition of Diagnostic and Statistical Manual of Mental Disorders (DSM), as published by American Psychological Association.
(5) The symptoms of postpartum psychosis include losing touch with reality, distorted thinking, delusions, auditory hallucinations, paranoia, hyperactivity, and rapid speech or mania.
(6) Baby blues afflicts up to 80 percent of new mothers, postpartum depression occurs in 10 to 20 percent of new mothers, and postpartum psychosis strikes 1 in 1,000 new mothers.
(7) The causes of postpartum depression are complex and unknown at this time; however, contributing factors include: a steep and rapid drop in hormone levels after childbirth; difficulty during labor or pregnancy; a premature birth; a miscarriage; feeling overwhelmed, uncertain, frustrated or anxious about one's new role as a mother; a lack of support from one's spouse, friends or family; marital strife; stressful events in life such as death of a loved one, financial problems, or physical or mental abuse; a family history of depression or mood disorders; a previous history of major depression or anxiety; or a prior postpartum depression.
(8) Postpartum depression is a treatable disorder if promptly diagnosed by a trained provider and attended to with a personalized regimen of care including social support, therapy, medication, and when necessary hospitalization.
(9) All too often postpartum depression goes undiagnosed or untreated due to the social stigma surrounding depression and mental illness, the romanticization of motherhood, the new mother's inability to self-diagnose her condition, the new mother's shame or embarrassment over discussing her depression so near to the birth of her child, the lack of understanding in society and the medical community of the complexity of postpartum depression, and economic pressures placed on hospitals and providers.
(10) Untreated, postpartum depression can lead to further depression, substance abuse, loss of employment, divorce and further social alienation, self-destructive behavior, or even suicide.
(11) Untreated, postpartum depression impacts society through its effect on the infant's physical and psychological and cognitive development, child abuse, neglect or death of the infant or other siblings, and the disruption of the family.
(12) This Act shares the goals of the Melanie Blocker-Stokes Postpartum Depression Research and Care Act and will help new mothers who are battling with postpartum conditions.

SEC. 101. DELIVERY OF SERVICES REGARDING POSTPARTUM DEPRESSION AND PSYCHOSIS.

Subpart 3 of part B of title V of the Public Health Service Act (42 U.S.C. 290bb-31 et seq.) is amended--
(1) by inserting after the subpart heading the following:

`CHAPTER I--GENERAL PROVISIONS';

and
(2) by adding at the end thereof the following:

`CHAPTER II--DELIVERY OF SERVICES REGARDING POSTPARTUM DEPRESSION AND PSYCHOSIS

`SEC. 520K. ESTABLISHMENT OF PROGRAM OF GRANTS.

`(a) In General- The Secretary shall in accordance with this chapter make grants to provide for projects for the establishment, operation, and coordination of effective and cost-efficient systems to--
`(1) provide education to women who have recently given birth, and their families, concerning postpartum depression, postpartum mood and anxiety disorders, and postpartum psychosis (referred to in this chapter as `postpartum conditions') before such women leave their birthing centers and to screen new mothers for postpartum conditions during their first year of postnatal checkup visits, including the standard 6-week postnatal checkup visit; and
`(2) provide for the delivery of essential services to individuals with postpartum conditions and their families.
`(b) Recipients of Grants- A grant under subsection (a) may be made to an entity only if the entity--
`(1) is--
`(A) in the case of a grant to carry out the activities described in subsection (c)(1), a State; and
`(B) in the case of a grant to carry out the activities described in subsection (c)(2), a public or nonprofit private entity, which may include a State or local government; a public or nonprofit private hospital, community-based organization, hospice, ambulatory care facility, community health center, migrant health center, tribal government or territory, or homeless health center; or other appropriate public or nonprofit private entity; and
`(2) submits to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.
`(c) Certain Activities-
`(1) EDUCATION-
`(A) IN GENERAL- To the extent practicable and appropriate, the Secretary shall ensure that projects under subsection (a)(1) develop policies and procedures to ensure that education concerning postpartum conditions is provided to women in accordance with subparagraph (B), that training programs regarding such education are carried out at health facilities within the State, and that screening and referral is provided in accordance with subparagraph (C).
`(B) REQUIREMENTS- A State that receives a grant or contract under subsection (a)(1) shall ensure that postpartum condition education complies with the following:
`(i) Physicians, certified nurse midwives, certified midwives, nurses, and other licensed health care professionals within the State who provide prenatal and postnatal care to women shall also provide education to women and their families concerning postpartum conditions to promote earlier diagnosis and treatment.
`(ii) All birthing facilities in the State shall provide new mothers and fathers, and other family members as appropriate, with complete information concerning postpartum conditions, including its symptoms, methods of coping with the illness, and treatment resources prior to such mothers leaving the birthing facility after a birth.
`(iii) Physicians, certified nurse midwives, certified midwives, nurses, and other licensed health care professionals within the State who provide 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 conditions.
`(C) SCREENING AND REFERRAL- A State that receives a grant or contract under subsection (a)(1) shall ensure that new mothers, during visits to a physician, certified nurse midwife, certified midwife, nurse, or licensed healthcare professional who is licensed or certified by the State, within the first year after the birth of their child, are offered screenings for postpartum conditions by using the Edinburgh Postnatal Depression Scale (EPDS), or other appropriate tests. If the results of such screening provide warning signs for postpartum conditions, the new mother shall be referred to an appropriate mental healthcare provider.
`(D) SUBGRANTS- A State that receives a grant or contract under subsection (a)(1) to carry out activities under this paragraph may award subgrants to entities described in subsection (b)(1)(B) to enable such entities to provide education of this type described in subparagraph (B).
`(2) SERVICES- To the extent practicable and appropriate, the Secretary shall ensure that projects under subsection (a)(2) provide services for the diagnosis and management of postpartum conditions. Activities that the Secretary may authorize for such projects may also include the following:
`(A) Delivering or enhancing outpatient and home-based health and support services, including case management, screening and comprehensive treatment services for individuals with or at risk for postpartum conditions, and delivering or enhancing support services for their families.
`(B) Delivering or enhancing inpatient care management services that ensure the well being of the mother and family and the future development of the infant.
`(C) Improving the quality, availability, and organization of health care and support services (including transportation services, attendant care, homemaker services, day or respite care, and providing counseling on financial assistance and insurance) for individuals with postpartum conditions and support services for their families.
`(d) Integration With Other Programs- To the extent practicable and appropriate, the Secretary shall integrate the program under this title with other grant programs carried out by the Secretary, including the program under section 330.

`SEC. 520L. TECHNICAL ASSISTANCE.

`The Secretary may provide technical assistance to assist entities in complying with the requirements of this chapter in order to make such entities eligible to receive grants under section 520K.

`SEC. 520M. AUTHORIZATION OF APPROPRIATIONS.

`For the purpose of carrying out this chapter, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2008 through 2010.'.

SEC. 201. CONSENSUS RESEARCH CONFERENCE AND PLAN CONCERNING POSTPARTUM DEPRESSION AND PSYCHOSIS.

Part B of title IV of the Public Health Service Act (42 U.S.C. 284 et seq.) is amended by adding at the end the following:

`SEC. 409J. CONSENSUS RESEARCH CONFERENCE AND PLAN CONCERNING POSTPARTUM DEPRESSION AND PSYCHOSIS.

`(a) Consensus Research Conference and Plan-
`(1) CONFERENCE- The Secretary, acting through the Director of NIH, the Administrator of the Substance Abuse and Mental Health Services Administration, and the heads of other Federal agencies that administer Federal health programs including the Centers for Disease Control and Prevention, shall organize a series of national meetings that are designed to develop a research plan for postpartum depression and psychosis (referred to in this section as `postpartum condition').
`(2) PLAN- The Secretary, taking into account the findings of the research conference under paragraph (1), shall develop a research plan relating to postpartum conditions. Such plan shall include--
`(A) basic research concerning the etiology and causes of postpartum conditions;
`(B) epidemiological studies to address the frequency and natural history of postpartum conditions and the differences among racial and ethnic groups with respect to such conditions;
`(C) the development of improved diagnostic techniques relating to postpartum conditions; and
`(D) clinical research for the development and evaluation of new treatments for postpartum conditions, including new biological agents.
`(3) REPORT- Not later than 2 years after the date of enactment of this section, the Secretary shall prepare and submit to the appropriate committees of Congress a report concerning the research plan under paragraph (2).
`(b) Activity Relating to Research Plan-
`(1) IN GENERAL- After the development of the research plan under subsection (a)(1), the Secretary, acting through the Director of NIH shall expand and intensify research and related activities of the Institutes relating to postpartum conditions in a manner appropriate to carry out such plan, and in particular shall direct research efforts to carry out such plan.
`(2) REPORT- Not later than 1 year after the development of the research plan under subsection (a)(1), and annually thereafter, the Secretary shall prepare and submit to the appropriate committees of Congress a report on the progress made with respect to such plan and the status of ongoing activities regarding postpartum conditions at the National Institutes of Health.'.