You're Not Alone: Supporting New Moms With the National Maternal Mental Health Hotline

00:00:00:27 - 00:00:37:25
Tom Haederle
On Mother's Day in May of 2022, the U.S. Department of Health and Human Services, Health Resources and Services Administration launched the National Maternal Mental Health Hotline. Now, one and a half years later, the hotline is a resource for many who need to know they are not alone, and there is help for them to feel better. Welcome to Advancing Health, a podcast from the American Hospital Association.

00:00:37:27 - 00:01:12:20
Tom Haederle
I'm Tom Haederle, with AHA Communications. Overwhelmed, stressed, anxious, exhausted are among the many emotions that pregnant and postpartum moms experience if left unidentified and untreated. These emotions can have a huge impact on one's well-being. The Health Resources and Services Administration, also known as HRSA, offers maternal mental health support and resources to pregnant or new moms via call or text. HRSA's national maternal mental health hotline can be accessed at 1-833-TLC-Mama.

00:01:12:22 - 00:01:24:09
Tom Haederle
To learn more about this hotline, Julia Resnick, AHA director of Strategic Initiatives, spoke with Dr. Michael Warren, associate administrator of the Maternal and Child Health Bureau at HRSA.

00:01:24:11 - 00:01:36:18
Julia Resnick
Dr. Warren, thank you so much for being here today to talk to us about HRSA’s National Maternal Mental Health Hotline. So let's jump right in to talking about that hotline and what was the impetus for launching it?

00:01:36:20 - 00:02:06:12
Dr. Michael Warren
Well, maternal health has been a longstanding priority for our bureau, and we know that as a nation, we find ourselves in the middle of a maternal health crisis, where maternal health outcomes in this country are not good, whether we're talking about maternal mortality or maternal morbidity, we tend to do worse than most other resource rich countries. We also know that above those top line numbers, there are marked disparities across populations.

00:02:06:12 - 00:02:32:25
Dr. Michael Warren
And as we dive into the data, working with partners across the governments and working with partners across states and communities, we know that maternal mental health conditions are a leading cause of pregnancy related deaths. And so as we think collectively about how we tackle this problem, getting this maternal mental health hotline up and off the ground is an important way to make sure that we're addressing one of those leading causes of these deaths.

00:02:32:28 - 00:02:39:00
Julia Resnick
Absolutely. And why is it so important to have a maternal mental health hotline at the national level?

00:02:39:02 - 00:03:04:18
Dr. Michael Warren
Well, as we just talked about, those mental health conditions are a leading driver. And what we know is that many women are not screened for common mental health conditions like depression or anxiety, either in prenatal care or in the postpartum period after a delivery. And so there is an opportunity to make sure that there are resources outside of traditional clinical settings that women can access.

00:03:04:21 - 00:03:30:02
Dr. Michael Warren
The other thing that we know is that even when screening does occur or a woman seeks help, depending on where you live, help may not be readily available in your community. And so having this national maternal mental health hotline really breaks down barriers around access and makes sure that wherever you are in the country, you've got 24/7 access to mental health services, either in pregnancy or in the postpartum period.

00:03:30:04 - 00:03:47:09
Julia Resnick
Yeah, that is so important, especially with those areas that are not as resource rich as others. So I know this hotline is more than a year old now and it has been recently revamped complete with a new phone number. So can you talk about what that new phone number is and what other changes have been made to the hotline recently?

00:03:47:12 - 00:04:10:29
Dr. Michael Warren
Yes. So we were really excited to celebrate the one year anniversary of the hotline. We initially launched on Mother's Day 2022. So back in May of this year, 2023, we hit the one year milestone and we learned a lot in that first year of operation. This was our first attempt at standing up a national 24/7 hotline available to address maternal mental health conditions.

00:04:11:02 - 00:04:31:16
Dr. Michael Warren
One of the things that we heard among the many pieces of feedback that we got from stakeholders across the country was that the original toll free number was hard for folks to remember. So we engaged stakeholders and we said, here are some options. What would be easier? And so our our current number, the new number is 1-833-TLC-MAMA.

00:04:31:17 - 00:04:53:16
Dr. Michael Warren
We tested that with a number of folks got a lot of great feedback. Folks think that resonates just from the name of the line, but it's also easy to remember. So 1-833-TLC-MAMA is the number. And that seems to be working really well. Now that we have also changed that number, we've really ramped up our marketing and promotion efforts.

00:04:53:16 - 00:05:14:04
Dr. Michael Warren
We wanted to make sure during that first year that we were able to have sufficient capacity to meet the demands across the country. Again, this was a brand new endeavor for us. We feel very confident in that. And so we have really started to work to engage, to make sure that stakeholders just like your listeners know about this hotline and what a wonderful resource it is for folks across the country.

00:05:14:06 - 00:05:22:09
Julia Resnick
So for our listeners, can we go a little bit deeper into how the hotline works? And can you just walk me through how someone would go about using the hotline?

00:05:22:12 - 00:05:49:07
Dr. Michael Warren
Yes. And I think sometimes when we think about hotline, we think about literally picking up a phone and calling. You can do that. You can call, but you can also text. So call or text 1-833-TLC-MAMA. The service is available 24/7. It is free of charge. And regardless of how someone reaches out, whether they call or whether they text, they're connected very quickly with someone specially trained in perinatal mental health

00:05:49:07 - 00:06:17:11
Dr. Michael Warren
on the other end. Those hotline counselors who answer the phone can provide referrals and connections with local resources in the callers community, and they're going to talk to the person very basically to find out what's going on and and how can the hotline be of help. We know from this first year that the most common reasons that people call the hotline are for feeling depressed, feeling anxious or feeling overwhelmed.

00:06:17:13 - 00:06:26:26
Dr. Michael Warren
And when we think about how common those scenarios are among pregnant and postpartum women, we're really glad the hotline is there to be able to be a resource in those circumstances.

00:06:26:29 - 00:06:37:18
Julia Resnick
I'm so glad that such a resource exists. So someone calls, they text. How are how are you recording that information and how are you keeping it confidential?

00:06:37:21 - 00:07:09:02
Dr. Michael Warren
It's a really important question. So we want folks to know the calls are not recorded and and the content of those calls is not shared. The calls are confidential. The hotline counselors are trained in that to make sure that is the case. And I think that's really important for folks to know if they're going to access the hotline. We actually, as we were thinking about how the hotline was going to work, really wanted to make sure we focused on service delivery and not data collection.

00:07:09:04 - 00:07:29:09
Dr. Michael Warren
And so while it's an option for folks to share information like demographic data, for example, it's not required. They don't have to answer those questions. And our first and foremost priority is to make sure that we're answering the questions they have, the reasons they're calling and making sure if needed, they get connected to resources.

00:07:29:12 - 00:07:46:04
Julia Resnick
Speaking of demographic diversity, obviously new parents come from a whole spectrum of different cultural and linguistic backgrounds. So how are you thinking about hotlines and services that are culturally and linguistically appropriate for these diverse populations?

00:07:46:06 - 00:08:19:21
Dr. Michael Warren
This is such an important topic, and as we were laying out the specifications for the hotline, one of the key principles was making sure that services were culturally and linguistically competent and matched the diversity of folks who are seeking help. So you see that in the diversity of staff who are working on the hotline, representing a variety of races, ethnicities, lived experience, but also representing a diverse variety of disciplines.

00:08:19:21 - 00:08:33:02
Dr. Michael Warren
So physicians, nurses, mental health clinicians, doulas, peer support specialists on the other end of the line. And all of these folks in particular have received special training to be able to support pregnant and postpartum women.

00:08:33:04 - 00:08:45:17
Julia Resnick
That's fantastic. So we have the National Maternal Mental Health Hotline and SAMHSA's National Suicide and Crisis Lifeline. What's the difference and how does someone know who they should be contacting?

00:08:45:19 - 00:09:12:27
Dr. Michael Warren
This is another important topic. So our partners at SAMHSA launched their national nine state suicide and crisis lifeline. That gives 24/7 support, prevention and crisis resources. The 988 line is a crisis line, and that's the biggest difference between the two lines. The 988 line is for crisis services. Our hotline 1-833-TLC-MAMA is really focused on pregnant women, new moms,

09:12:27 - 00:09:38:17
Dr. Michael Warren
and it's not a crisis line. Now, if someone calls our line and they are in crisis, we will actually provide a warm handoff to the SAMHSA line, to the 988 line. But our line is not designed for crisis. And as your listeners know well, from the conversations they have with patients and folks every day, if someone is in immediate danger and worried about harm to themselves or someone else, they should always call 911.

00:09:38:20 - 00:09:55:18
Julia Resnick
Mm hmm. And fantastic that there are these complimentary resources based at what level of support people need. So I'm interested. I know that everything is confidential, but are there any stories about the calls or texts that have been received through the line that can really bring to life how important this is?

00:09:55:20 - 00:10:18:24
Dr. Michael Warren
There are and again, we are very careful not to identify any individual callers or situations. And so counselors, as they've reflected back over the course of a year, can share general examples of the kinds of reasons why people call. But when we look at those, they're incredibly compelling and I think really underscore the need for why a line like this is so important.

00:10:18:27 - 00:10:39:21
Dr. Michael Warren
So the counselors tell us, for example, that they've helped pregnant women who've decided they're going to leave an abusive partner. We know that intimate partner violence is unfortunately far too common in this country. And so being able to have a resource like the hotline when folks want to talk and in this case talk about wanting to leave is so incredibly important.

00:10:39:24 - 00:11:08:27
Dr. Michael Warren
The counselors have talked to women who have a history of trauma and who have anxiety associated with that and with the various challenges associated with pregnancy. That anxiety has risen. And so having a resource to be able to call or text and talk to someone about those feelings and how to navigate those is so incredibly important. One of the examples that I really love, I think just underscores the incredible time demands that pregnant women and new moms face.

00:11:08:27 - 00:11:34:01
Dr. Michael Warren
And so counselors will tell you about moms who call while they're pumping because it's the only time they have a moment to themselves. And so they are doing this work literally on behalf of their child, but also taking time to engage in this self-care at the same time. And I'm so glad that the hotline is a resource when they do find that time to be able to take care of themselves, to be able to reach out and have somebody on the other end who's willing to help.

00:11:34:04 - 00:11:44:06
Julia Resnick
Absolutely. And beyond these really powerful anecdotes, how do you know that you're making an impact? What kind of data are you collecting and how is that guiding your future work?

00:11:44:08 - 00:12:05:13
Dr. Michael Warren
So one of the key things that we look at is call volume. The number of calls coming in to the line, calls or text. That has steadily increased over time. Right now we're receiving about 1600 calls a month. What we know from the data that we look at, most people are calling for themselves. And so even though anyone can call, it doesn't have to be a pregnant woman or a new mom.

00:12:05:14 - 00:12:23:24
Dr. Michael Warren
Sometimes we get dads or partners that call. Sometimes we get providers who call who who want to help a patient. Sometimes we get other family members. We'll take those incoming conversations from anyone. But the vast majority of folks who are reaching out are doing so on behalf of themselves. About two thirds of folks are engaging on the phone.

00:12:23:24 - 00:12:45:00
Dr. Michael Warren
About a third of those are coming in through text. And we know that call volume is highest from the middle of the day through the early evening. And so as we think about how we're using those data, one, we're monitoring the call volume data to make sure that we're adequately staffed. We want there to be resources on the other end when people reach out so they get a timely response.

00:12:45:02 - 00:13:08:23
Dr. Michael Warren
But we're also using the data around timing of calls and reasons for calls to help us think about targeted promotion and marketing. So there are key times where we need to be focusing advertising, for example. Are there key themes in our messaging that we need to emphasize, particularly around those common reasons people call anxiety depression feeling overwhelmed? Are there ways that we need to engage there?

00:13:08:25 - 00:13:23:01
Dr. Michael Warren
And as we're doing that, are there partners that come to mind because of those reasons people are calling that we need to be sure to reach out to. How do we broaden net net to get the word out? And the data are helping to inform those decisions.

00:13:23:03 - 00:13:34:18
Julia Resnick
So continuing with that thread, how how can health hospitals and health care systems help get the word out there to their patients and to community stakeholders who can share with their constituents?

00:13:34:21 - 00:13:59:12
Dr. Michael Warren
There is such tremendous opportunity here, and I think if folks listening to this come away with one message or one request: it's please help us spread the word. And hospitals and health systems see women both in the prenatal setting during labor and delivery and also postpartum periods. So there is a real opportunity to be able to meet women in their families where they are and share these messages.

00:13:59:17 - 00:14:22:14
Dr. Michael Warren
So one easy thing is to make sure that there's information about the hotline in your hospitals and in your facilities, your clinical spaces. There are a variety of free materials that are available on our website, things like posters and wallet cards, magnets. We can actually ship those to you for free. You can also go online and print some of those on your own if you would like.

00:14:22:16 - 00:14:44:11
Dr. Michael Warren
But we're really excited, particularly as we move into this phase where we're doing more promotion to be able to get those materials out to partners, including hospitals and health systems. I think a lot of times we think about focusing our information, sharing with our patients, but we also know that staff who work in hospitals are pregnant and have new children at home.

00:14:44:11 - 00:15:12:15
Dr. Michael Warren
And so, so important to be able to reach out to staff and for each of us to share information about the hotline with friends and family, whether that's through individual conversations or on social media. I think also that there's a tremendous opportunity to share information about the hotline with community partners. Hospitals and health systems are so trusted in communities, and they partner with a variety of folks to make sure that the needs of pregnant women and families with new children are met.

00:15:12:21 - 00:15:41:11
Dr. Michael Warren
And so thinking about who those partners might be ... OB-GYN clinic, WIC clinics and sites, pediatric offices, diaper banks, faith based community centers. All of those are examples of folks that hospitals partner with regularly for a variety of activities, and those can be key partners for getting the word out around the hotline. Of course, right now everybody has social media and and hospitals and health care facilities are no different.

00:15:41:12 - 00:16:04:09
Dr. Michael Warren
So thinking about including hotline materials and promotional materials in your social is a great way to do that. We've got some resources on our Web site with ready-made images and copy that can be inserted in to make that much easier for you. Many of these materials are also available in Spanish, and so just a variety of ways that hospitals can can be connected.

00:16:04:11 - 00:16:07:02
Julia Resnick
And where can folks find this partner toolkit?

00:16:07:05 - 00:16:25:13
Dr. Michael Warren
So on our Web site, HRSA.gov, and you can just search for the national maternal mental health hotline there. You'll find it, some basic information about the hotline, but also those downloadable resources and also a place for you to order resources. And again, we will ship those to you free of charge.

00:16:25:15 - 00:16:36:26
Julia Resnick
Wonderful. And I think that everyone listening to this will know by the end that the phone number for the hotline is 833-TLC-MAMA. I know I've got it. And I think you need a jingle.

00:16:36:28 - 00:16:51:24
Dr. Michael Warren
We do need a jingle. Maybe you can help us with that. But I do hope folks have heard I have said it multiple times, 1-833-TLC-MAMA, 24/7 availabity. Call or text. Our folks are ready on the other end to hear from the folks who are in need.

00:16:51:27 - 00:16:56:25
Julia Resnick
And as we wrap up, is there anything else that you want our listeners to know about the hotline?

00:16:56:28 - 00:17:19:09
Dr. Michael Warren
I want to thank you all, first of all, for spending the time to listen to this. I hope that you recognize the hotline is an important resource. Again, it's a great tool for breaking down barriers regardless of where folks live in the country. This is a tool that they can access 24/7 via phone or text. And there is someone on the other end who is waiting right now to help them.

00:17:19:12 - 00:17:39:04
Julia Resnick
That is wonderful. So thank you so much, Dr. Warren, for sharing the work of the National Maternal Mental Health Hotline and all the work you're doing to recognize the mental health needs of pregnant and postpartum women because of this hotline at 1-833-TLC-MAMA, it's comforting to know that help can just be a phone call or text away.

00:17:39:07 - 00:17:59:04
Julia Resnick
To our listeners, please help us share the word about the hotline with your partners and communities. As we mentioned, you can access the Hotline Partner Toolkit on HRSA's website as well as the AHA's website. So thank you again, Dr. Warren, for your time and thank you to all of our listeners for being here and for helping spread the word about the hotline.

00:17:59:06 - 00:17:59:21
Dr. Michael Warren
Thank you.