BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Deborah V. Ortiz, Chair
BILL NO: AB 2317
A
AUTHOR: Koretz
B
AMENDED: May 26, 2006
HEARING DATE: June 21, 2006
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FISCAL: Appropriations
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CONSULTANT:
7
Vazquez / ak
SUBJECT
Postpartum mood and anxiety disorders
SUMMARY
This bill requires the Department of Health Services (DHS)
to conduct the Perinatal Mood and Anxiety Disorders (PMAD)
Community Awareness Campaign (Campaign), as specified.
ABSTRACT
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 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.
This bill:
1.Makes a number of findings and declarations regarding
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PMAD, the number of women affected by it, and the lack of
information, screening, and treatment for the disorder.
2.Requires DHS to conduct the PMAD Campaign to:
a. Provide awareness, assistance, and information
regarding PMAD using television, print media, radio,
Internet websites, 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 website 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 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.
4.Requires the workgroup to be responsible for securing
private contributions to fund the campaign and permits it
to include a survivor of PMAD and members from the
California Medical Association, the American College of
Obstetrics and Gynecology, the California Psychiatric
Association, Postpartum Support International, the
California Hospital Association, the California
Psychological Association, the California Nurses
Association, the California Association for Nurse
Practitioners, and the California Nurse Midwives
Association.
5.Permits DHS to use nonpublic sources of funding to
support the activities of the workgroup and to fund the
PMAD Campaign.
6.Requires the work group, by January 1, 2008, to prepare
and submit to DHS its recommendations relating to the
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PMAD Campaign.
7.Requires voluntary contributions received for the
purposes of this bill to be deposited into the PMAD
Campaign Fund, which is created by this bill in the State
Treasury. Continuously appropriates from the fund to DHS
to implement this bill.
8.Requires this bill to be implemented only after the
Department of Finance (DOF) determines that nonstate
funds in an amount sufficient to fully support PMAD
Campaign activities have been deposited. Requires the
PMAD 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.
9.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 PMAD 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.
FISCAL IMPACT
According to the Assembly Appropriations Committee, there
would be annual on-going cost pressure, likely in the
hundreds of thousands to millions of dollars annually,
depending upon the scope of the PMAD Campaign. This bill
is operative only to the extent nonstate funding is made
available to fully support the activities of the bill, so
the amount of funding would depend upon funds received.
BACKGROUND AND DISCUSSION
Purpose of this bill
According to the author, no laws in California currently
exist regarding 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
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statistics and symptoms related to PMAD, as well as the
treatment and support options available. In raising the
level of awareness, the stigma associated with PMAD can be
reduced, which prevents most women from seeking adequate
care.
Background
PMAD affects childbearing women and takes many forms,
including depression, anxiety, panic disorder,
obsessive-compulsive disorder, and psychosis. PMAD, which
differs from the "baby blues," or a normal postpartum
adjustment, affects approximately 10 to 20 percent 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. PMAD can sometimes develop into psychosis
following a traumatic event and often characterized by
hallucinations and 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 to be 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.
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, weaknesses 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 until 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
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American College of Obstetricians and Gynecologists (ACOG)
encourages its membership to screen patients for depression
and to 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.
Arguments in support
ACOG, District IX, writes that the nature of PMAD makes it
difficult for the patient to recognize her situation and
subsequently 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 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.
Arguments in opposition
The Los Angeles/Hollywood Chapter of 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. The
Commission contends that the biggest beneficiary of this
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bill would be the psychiatric and pharmaceutical
industries, not mothers and children.
Prior legislation
AB 367 (Koretz, 2003) attempted to establish the PMAD
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 measure was held
in the Assembly Appropriations Committee.
AB 291 (Koretz, 2005) would have required DHS to prepare
an information sheet on PMAD and would have required
health care providers to provide a copy of the
information sheet to pregnant women. This measure was
held in the Assembly Committee on Health.
Questions
There are two organizations listed to serve all members
of the workgroup charged in the bill to develop
recommendations that have not weighed in with formal
positions, Postpartum Support International the
California Nurses Association. What are the positions of
these organizations?
What are the likely sources of nonpublic funding to
support the activities in the bill?
Will DHS have the resources to convene the workgroup and
report recommendations by January 1, 2008? Does the
timeline for the workgroup need to be conditioned
depending on resources?
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PRIOR ACTIONS
Assembly Floor: 55 - 25 Pass
Assembly Appropriations:14 - 4 Do Pass as Amended
Assembly Health: 11 - 0 Do Pass as Amended
POSITIONS
Support: American College of Obstetricians and
Gynecologists,
District IX (co-sponsor)
California Psychiatric Association (co-sponsor)
California Psychological Association
California Association of Marriage and Family
Therapists
California Association for Nurse Practitioners
California Hospital Association
California Medical Association
California National Organization for Women
California Nurse Midwives Association
Mental Health Association in California
National Association of Social Workers,
California Chapter
Two individuals
Oppose:Citizens Commission on Human Rights, Los
Angeles/Hollywood Chapter
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