BILL ANALYSIS
AB 2317
Page 1
Date of Hearing: April 4, 2006
ASSEMBLY COMMITTEE ON HEALTH
Wilma Chan, Chair
AB 2317 (Koretz) - As Amended: March 28, 2006
SUBJECT : Postpartum mood and anxiety disorders.
SUMMARY : Requires the Department of Health Services (DHS) to
conduct the Perinatal
Mood and Anxiety Disorders (PMAD) Community Awareness Campaign,
as specified. Specifically, this bill :
1)Makes a number of findings and declarations regarding PMAD,
the number of women affected by it, symptoms, and the lack of
information, screening, and treatment for the disorder.
2)Requires DHS to conduct the PMAD Community Awareness Campaign
to:
a) Provide awareness, assistance, and information regarding
PMAD using television, print media, radio, Internet Web
sites, outdoor advertising, and other media where
appropriate, to disseminate information to pregnant women
and new mothers regarding the availability of services and
treatment for PMAD, which may include medication,
professional therapy and counseling, support groups, and
telephone crisis hotlines;
b) Establish an Internet Web site devoted to providing
information about the symptoms and treatment of PMAD that
is accessible to the general public; and,
c) Undertake public education activities related to PMAD,
as appropriate.
3)Requires the campaign, to the extent feasible and appropriate,
to be incorporated into existing mental health awareness
programs implemented by DHS.
4)Requires DHS to convene a work group to develop
recommendations on the most efficient and effective ways to
raise public awareness of the symptoms, warning signs, and
treatment of PMAD.
AB 2317
Page 2
5)Requires the workgroup to be responsible for securing private
contributions to fund the campaign and permits it to include
members from the California Medical Association (CMA), the
American College of Obstetrics and Gynecology (ACOG), the
California Psychiatric Association, Postpartum Support
International (PSI), the California Hospital Association
(CHA), and the California Psychological Association.
6)Permits DHS to use nonpublic sources of funding to support the
activities of the workgroup and to fund the campaign.
7)Requires the work group, by January 1, 2008, to prepare and
submit to DHS its recommendations relating to the PMAD
campaign.
8)Requires voluntary contributions received for the purposes of
this bill to be deposited into the Community Postpartum
Anxiety and Mood Disorders Awareness Campaign Fund, which is
created under this bill in the State Treasury. Continuously
appropriates monies from the fund to DHS to implement this
bill.
9)Requires this bill to be implemented only after the Department
of Finance (DOF) determines that nonstate funds in an amount
sufficient to fully support Campaign activities have been
deposited. Requires the Campaign to continue to be
implemented thereafter only to the extent that DOF determines
that sufficient nonstate funds to fully support its activities
have been deposited for those purposes.
10)Requires DOF, if it determines that insufficient voluntary
contributions have been deposited by January 1, 2008, to
notify either the Chief Clerk of the Assembly or the Secretary
of the Senate of this fact, in which case, the Campaign
remains in effect only until January 1, 2008, and unless there
is a later enacted statute that deletes or extends that date,
the statute is repealed.
EXISTING LAW :
1)Requires DHS to maintain a program of maternal and child
health, including pregnancy testing, perinatal health care,
and nutrition.
2)Requires DHS to develop and provide information regarding a
AB 2317
Page 3
variety of diseases and health care issues, including
gynecological cancers, breast cancer, hepatitis C, Lyme
disease, reproductive health, children's health, drug
overdose, HIV/AIDS, nutrition, and oral health.
FISCAL EFFECT : Unknown
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, no laws in
California currently exist in regards to postpartum depression
information, treatment or resources. Additionally, despite
the high statistics of occurrence, the state has not created a
uniform standard of care. There is a significant need for
women and families to be educated and made aware of the
statistics and symptoms related to PMAD as well as the
treatment and support options available. In raising the level
of awareness, we can reduce the stigma associated with PMAD,
which prevents most women from seeking adequate care.
2)BACKGROUND . PMAD affects childbearing women and takes many
forms, including depression, anxiety, panic disorder,
obsessive-compulsive disorder, and psychosis. Postpartum
depression, which differs from the "baby blues," affects
approximately 10% of new mothers and usually occurs within
days of the delivery but could take weeks to appear. Symptoms
include sluggishness, fatigue or exhaustion, feelings of
hopelessness, appetite and/or sleep disturbances, confusion,
and lack of interest in the baby. Postpartum depression can
sometimes develop into psychosis following a traumatic event
and often characterized by hallucinations and/or delusions.
Estimates of the prevalence of psychotic episodes are one to
two in every 1,000 deliveries. The medical community does not
fully understand all factors contributing to PMAD, but it is
commonly thought that it is caused by physiological factors,
such as hormone levels, and can be exacerbated by external
risk factors such as marital problems, sleep deprivation, and
pre-existing mental illness. Women who have a prior
postpartum mood episode and those who have a history of mood
disorders outside of pregnancy are at higher risk of having a
PMAD with psychotic features.
3)PMAD SCREENING AND TREATMENT . Many physicians contend that
screening, diagnosis, and treatment of PMAD is challenging due
to a lack of awareness of the seriousness of the problem,
AB 2317
Page 4
cracks in the health care system, and the nature of the
postpartum period. Breaks in continuity of care add to the
difficulties in screening and diagnosis. A woman is
frequently discharged from the hospital shortly after delivery
and usually does not see her obstetrician for six to eight
weeks later. Following that visit, she generally returns to
the care of her general practitioner, but contact with that
physician is not routine. The American Academy of Family
Physicians recommends universal screening, stating that
doctors should use a standard protocol when screening
patients. The American College of Obstetricians and
Gynecologists (ACOG) encourages its membership to screen
patients for depression and have an educational program
related to recognizing and treating depression in patients.
Once diagnosed, the common mode of treatment includes
psychiatric evaluation, psychotherapy, medication, and support
groups.
4)LAWS IN OTHER STATES . A 2000 New Jersey law requires the
Commissioner of Health and Senior Services, the State Board of
Medical Examiners, and the New Jersey Board of Nursing to
develop policies and procedures for PMAD education and
screening, including the provision of PMAD information for all
new mothers by birthing facilities and screening for PMAD by
physicians and nurse midwives as part of prenatal and
postnatal care. A 1997 New York state law requires that
information regarding postpartum depression be added to a
leaflet given to maternity patients at hospitals.
5)PREVIOUS LEGISLATION . In 2003, AB 367 (Koretz) would have
established the Postpartum Mood and Anxiety Disorder
Information Program in DHS' Maternal and Child Health Branch
and required the program to include continuing medical
education activities, the posting of relevant information on
the DHS website, and communication through radio, television,
and billboards. This bill was held under submission in the
Assembly Committee on Appropriations. Earlier this year, AB
291 (Koretz) would have required DHS to prepare an information
sheet on postpartum mood and anxiety disorders and would have
required health care providers to provide a copy of the
information sheet to pregnant women. This bill was set to be
heard in the Assembly Committee on Health, but the hearing was
cancelled at the request of the author.
6)SUGGESTED AMENDMENTS . This bill requires DHS to incorporate
AB 2317
Page 5
the new PMAD program into existing mental health awareness
programs that it administers. Since the Department of Mental
Health administers the state's mental health programs, the
author may wish to amend this bill to require DHS to work with
DMH on incorporating the PMAD information into existing DMH
programs.
7)SUPPORT . The American College of Obstetricians and
Gynecologists, District IX, writes that part of PMAD makes it
difficult for the patient to be able to recognize her
situation, or reach out for help. Stigma still exists where a
woman may not feel she's a good mother if she suffers from
this condition and education will help to erase that stigma.
The California Psychiatric Association asserts that this bill
will ensure that no woman needlessly suffers prolonged
undetected bouts of perinatal mood or anxiety disorders. The
American Federation of State, County, and Municipal Employees
states that PMAD education is crucial not only for the mother
but for friends and relatives as well so that they may learn
to recognize symptoms and take appropriate precautions. The
California Association for Nurse Practitioners writes that
they share the author's commitment to women's health issues,
including the identification and treatment of postpartum mood
and anxiety disorders. The California Medical Association
believes the early diagnosis and treatment of mental illness
is cost-effective and can greatly benefit patients and a
statewide program to raise awareness about risk factors,
symptoms and screening tools as well as available therapy and
medication will enable both mothers and fathers to better
identify and respond to PMAD in their families. The
California Psychological Association states that this bill
will help create a healthy physical and mental environment for
California's mothers, children, and families. The California
National Organization for Women recognizes the devastating
impact that PMAD disorders can have on new mothers and their
children and supports programs that aim to increase awareness
and provide education around this important issue.
8)OPPOSE . The Citizens Commission on Human Rights writes that
there is no objective or scientific test for any psychiatric
illness, including postpartum depression and that there are
many known physical causes for the symptoms labeled by the
psychiatric industry as postpartum depression and the other
so-called disorders named in this bill. The Citizens
Commission on Human Rights contends that the biggest
AB 2317
Page 6
beneficiary of this bill would be the psychiatric and
pharmaceutical industries, not mothers and children. The
Elders' Freedom Coalition writes that in the majority of
cases, documented causes of so-called "depression" have their
bases in hormonal or other physical problems, including
malnutrition and that these tax dollars would be better spent
on effective programs for the benefit of all of us, not wasted
on destructive programs as these.
REGISTERED SUPPORT / OPPOSITION :
Support
American College of Obstetricians and Gynecologists, District IX
(Sponsor)
California Psychiatric Association (Sponsor)
American Federation of State, County, and Municipal Employees
California Association of Marriage and Family Therapists
California Association for Nurse Practitioners
California Hospital Association
California Medical Association
California National Organization for Women
One individual
Opposition
Citizens Commission on Human Rights
Elders' Freedom Coalition
One individual
Analysis Prepared by : Melanie Moreno / HEALTH / (916)
319-2097