La inmigrante originaria de India le creyó a su esposo cuando le dijo por teléfono que la mataría, si todavía estaba en su casa de Georgia para cuando él llegase en 10 minutos.

Contó que su esposo y su familia —también inmigrantes— la maltrataron durante todo el matrimonio: la golpeaban con un cinturón, le echaban agua caliente sobre el cuerpo, le hacían cortes en la piel y le estrellaban la cabeza contra la pared.

“Varias veces intenté escapar, pero me encontraban y me llevaban de vuelta a casa”, contó la mujer, quien está en el país sin autorización legal y habló bajo condición de anonimato por temor a que su identificación perjudicara sus posibilidades de regularizar su situación migratoria.

Sin tiempo para huir después de escuchar la amenaza de su esposo, en julio de 2020, llamó al 911, aunque sabía que eso podía llevar a su deportación. La policía llegó y, según recuerda, encontró al esposo amenazándola con un cuchillo frente a sus hijos pequeños. Él hombre fue arrestado, pero no procesado, dijo ella.

La mujer y sus hijos buscaron apoyo en el Centro de Justicia Tahirih (Tahirih Justice Center), una organización sin fines de lucro que ofrece servicios a nivel nacional a inmigrantes sobrevivientes de violencia de género. Cinco años después, aún sigue lidiando con el proceso migratorio.

Además de ser más vulnerables a la violencia sexual, los inmigrantes enfrentan múltiples desafíos de salud física y mental, según los investigadores. Tienen tasas elevadas de trastorno de estrés postraumático, depresión, suicidio y ansiedad, de acuerdo con un estudio de 2024.

“A nivel personal, sé que la ansiedad relacionada con el clima político actual está llevando a visitas costosas a salas de emergencia y afecta la capacidad de las personas para llegar al trabajo y ganarse la vida”, dijo Nicole E. Warren, enfermera obstetra y profesora de la Escuela de Enfermería de la Universidad Johns Hopkins en Baltimore.

Los inmigrantes sin papeles también enfrentan tasas más altas de enfermedades crónicas y mayor mortalidad por enfermedades prevenibles, debido a su acceso limitado a servicios médicos y al miedo a solicitarlos, según activistas.

“Una de nuestras clientas tenía tanto miedo de salir de su casa que evitó buscar atención médica durante su embarazo, por temor a tener contacto con el ICE”, contó Miriam Camero, directora de defensa del cliente y servicios sociales en Tahirih.

Los bancos de alimentos han informado que muchas personas inmigrantes que antes buscaban ayuda han dejado de ir por temor a la deportación.

Siempre ha sido difícil para las personas indocumentadas obtener ayuda cuando la necesitan. Pero la represión migratoria del gobierno de Donald Trump ha aumentado las dificultades. Y la situación también ha complicado el trabajo de quienes defienden sus derechos.

“Estamos trabajando horas extra para poder cubrir todo”, dijo Vanessa Wilkins, directora ejecutiva de la oficina de Tahirih en Atlanta. “El planeamiento de seguridad y la protección adicional que podrían necesitar las clientas —incluyendo documentos que aseguren que estén a salvo— pueden hacer que una se sienta completamente abrumada”.

El difícil camino a la visa U

Para sobrevivientes de abuso doméstico sin estatus legal, como la mujer de India, ir a las autoridades se vuelve aún más riesgoso en medio de la crisis migratoria, dijo Maricarmen Garza, abogada principal de la Comisión sobre Violencia Doméstica y Sexual de la Asociación de Abogados de Estados Unidos (American Bar Association Commission on Domestic & Sexual Violence).

“No hay garantías”, explicó Garza, “especialmente por cómo la aplicación de las leyes migratorias está entrelazada con las fuerzas del orden”.

En más de la mitad de los estados, los agentes del Servicio de Inmigración y Control de Aduanas de Estados Unidos (ICE) pueden colaborar mediante acuerdos formales con agencias policiales estatales y locales para identificar y deportar a personas que se encuentran en el país sin autorización. Según defensores de víctimas, esto puede obstaculizar los intentos de obtener el certificado necesario para solicitar una “visa U”, que permitiría a la persona vivir y trabajar legalmente en Estados Unidos, con la posibilidad de obtener la residencia permanente.

La mujer de India recuerda que la policía le dijo que, si presentaba cargos, podría obtener el certificado para solicitar una visa U. Ella aceptó, pero recuerda la ansiedad que le provocó presentar alrededor de cinco informes de abuso en dos años para lograrlo. “Me daban ataques de pánico solo al escribirlos, porque significaba revivir todo otra vez”, contó.

Al ser consultada sobre las dificultades que enfrentan las víctimas inmigrantes de violencia doméstica, la vocera de la Casa Blanca, Abigail Jackson, elogió los esfuerzos del presidente Donald Trump para frenar la inmigración ilegal. “El esfuerzo exitoso del presidente para deportar a inmigrantes ilegales con antecedentes penales está haciendo que todas las víctimas estén más seguras y garantiza que no volverán a ser dañadas por criminales peligrosos sin estatus legal”, dijo Jackson en un comunicado.

Agregó que las “acusaciones sin pruebas” de que a inmigrantes se les ha pedido que retiren cargos “no deben tomarse en serio”.

Las mujeres inmigrantes sin estatus legal pueden ser especialmente vulnerables al abuso y a la explotación debido a barreras de idioma, aislamiento cultural y social, según investigadores.

Un informe de 2023 señaló que, en algunos grupos de inmigrantes, hasta el 93% de las mujeres ha sufrido violencia de pareja en algún momento de su vida, en comparación con alrededor del 41% de las mujeres nacidas en Estados Unidos.

A medida que la administración Trump reconfigura el sistema migratorio del país, quienes han sufrido violencia y llegaron sin autorización enfrentan mayores obstáculos para demostrar su abuso y trauma ante las autoridades migratorias, dijeron defensores.

Un programa de salud para refugiados y asilo de la Universidad Johns Hopkins ofrece evaluaciones forenses gratuitas a víctimas inmigrantes para respaldar sus solicitudes de ayuda humanitaria, incluyendo la solicitud de visas U.

Warren, subdirectora del programa para la salud de la mujer, dijo que antes bastaba con una declaración escrita de los hallazgos clínicos para respaldar las declaraciones legales de las solicitantes.

“Ahora, nos están pidiendo que demos testimonio en persona”, afirmó.

Retrasos en las solicitudes

La mujer de India solicitó una visa después de obtener el certificado de la policía en 2023. Su caso forma parte de los casi 11,6 millones de solicitudes migratorias pendientes hasta junio, la cifra más alta registrada por los Servicios de Ciudadanía e Inmigración de Estados Unidos (USCIS, en inglés). Según la agencia, hay 415.000 solicitudes de visas U en espera.

Solo se otorgan alrededor de 10.000 de estas visas por año, y el trámite puede tardar más de siete años, según Garza.

A eso se suma que la administración Trump ha reducido la disponibilidad de los vales de vivienda de la Sección 8, que ayudan a personas con bajos ingresos a pagar la renta. Desde septiembre, quienes no tienen autorización legal para estar en el país ya no pueden recibir esa ayuda, aunque vivan con ciudadanos estadounidenses.

“Si Tahirih no estuviera apoyándome, podría estar en la calle”, dijo la mujer, quien afirmó que solo puede pagar la mitad de su renta.

Las defensoras de víctimas aseguran que están trabajando más que nunca para apoyar a sus clientas, pero que los recursos se están agotando ante los recortes federales y la creciente demanda.

El centro Tahirih reportó un aumento del 200% en el volumen de llamadas durante los cuatro meses posteriores a la llegada de Trump a la presidencia, en comparación con el mismo período del año anterior.

“Al final del día hay muchos correos electrónicos y muchas personas a las que ya no podemos responder tan rápido como antes”, dijo Casey Carter Swegman, directora de políticas públicas del centro.

Para llegar a sobrevivientes inmigrantes que tienen miedo de pedir ayuda, las defensoras están “volviendo a lo básico”, dijo Joanna Otero-Cruz, presidenta y directora ejecutiva del grupo Mujeres contra el Abuso (Women Against Abuse), con sede en Philadelphia.

“Estamos haciendo trabajo comunitario con peluqueras y otros pequeños negocios”, explicó. “Ellos son nuestros ojos y oídos”.

En Riverhead, Nueva York, una mujer de 38 años originaria de El Salvador contó que ha sido víctima de violencia doméstica en dos ocasiones, pero tuvo demasiado miedo como para denunciarlo a la policía.

Dijo que la segunda agresión la cometió un hombre para quien cocinaba y limpiaba. La mujer, quien también pidió el anonimato por vergüenza y temor a la deportación, dijo que la violó, le tomó fotos desnuda y la amenazó con publicarlas en redes sociales si iba a las autoridades. Luego, comenzó a acosarla, contó.

Noemi Sánchez, coordinadora regional en Long Island del Ministerio Rural y Migrante, una organización sin fines de lucro que apoya a trabajadores agrícolas, trabaja estrechamente con la mujer para fortalecer su autoestima y ayudarla a entender que “ninguna mujer merece que un hombre la maltrate”.

Mientras tanto, la sobreviviente de India recibió un permiso temporal de trabajo en 2024 y ahora trabaja como asistente de enfermería certificada. “Eso me ayuda a sobrevivir”, dijo.

“He recorrido un largo camino”, agregó. “No fue fácil. Tuve mucho apoyo. No me dejaron sola”.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

The immigrant from India believed her husband when he said that if she wasn’t gone by the time he got to their Georgia home in 10 minutes, he would kill her.

She said her husband and his family, who are also immigrants, abused her throughout their marriage, beating her with a belt, pouring hot water on her, cutting her, and pushing her head through a wall.

“Several times I tried to escape, but they found me and brought me back home,” said the woman, who is in the country illegally and spoke on the condition of anonymity because she is afraid being identified would harm her chances of gaining legal status.

With no time to run after her husband’s call in July 2020, she dialed 911, even though she knew she could be deported. The police arrived to find the husband threatening her with a knife in front of their young children, she recalled. He was arrested but not prosecuted, she said.

The woman and her children sought services from the Tahirih Justice Center, a national nonprofit organization that serves immigrant survivors of gender-based violence. She is still winding through the immigration process five years later.

Besides immigrants’ increased vulnerability to sexual violence, they face a host of mental health and physical challenges, researchers say. They have high rates of post-traumatic stress disorder, depression, suicide, and anxiety, according to a 2024 study.

“Personally, I know anxiety related to the current political climate is precipitating expensive emergency room visits and negatively impacting people’s ability to get to work and make a living,” said Nicole E. Warren, a nurse midwife and an associate professor at the Johns Hopkins School of Nursing in Baltimore.

Immigrants without legal status also face increased rates of chronic conditions and higher death rates from preventable diseases due to their limited access to health care and their fear of seeking it, advocates say.

“One of our clients was so afraid to leave her home that she avoided seeking medical care during her pregnancy, out of fear of interacting with ICE,” said Miriam Camero, director of client advocacy, social services, at Tahirih.

Food banks have reported that many immigrants in need of food assistance have stopped coming, for fear of deportation.

It has always been difficult for people without legal immigration status to get help when they need it. The Trump administration’s crackdown on people in the country illegally has intensified the pressure. The situation has also hampered the advocates and attorneys who defend their rights.

“We’re working extra hours to do all the work,” said Vanessa Wilkins, executive director of Tahirih’s office in Atlanta. “The safety planning and added protection that clients might need, including documents just to make sure they are safe, can definitely make you feel overwhelmed.”

U Visas

For domestic abuse survivors without legal status, like the woman from India, going to the authorities seems more fraught amid the immigration crackdown, said Maricarmen Garza, chief counsel of the American Bar Association Commission on Domestic & Sexual Violence.

“There are just no guarantees,” Garza said, “especially with how law enforcement is intertwined in enforcing immigration law.”

In more than half of states, U.S. Immigration and Customs Enforcement agents can collaborate by formal written agreements with state and local law enforcement agencies to identify and remove people in the country illegally. Advocates say this can interfere with victims’ efforts to get a certificate to file for a “U visa,” which would allow them to live and work in the U.S. with the possibility of lawful permanent residency.

The battered woman from India recalls police telling her that if she did not press charges, she could get a certificate for a U visa. She agreed to their suggestion but recalls the anxiety of filing about five abuse reports over two years to get the certificate. “I got panic attacks just writing them down, because it meant I was reliving the situations again,” she said.

When asked for comment about the difficulties immigrant domestic violence victims face, White House spokesperson Abigail Jackson touted President Donald Trump’s efforts to crack down on illegal immigration. “The president’s successful effort to deport criminal illegal aliens is making all victims safer and ensuring they will never again be harmed by dangerous criminal illegal aliens,” Jackson said in a statement. She said “allegations without evidence” that immigrants have been told to drop charges “should not be taken seriously.”

Immigrant women without legal status can be particularly vulnerable to abuse and exploitation because of language barriers, as well as cultural and social isolation, researchers have found.

According to a 2023 report, lifetime rates of abuse by intimate partners range up to 93% in some immigrant groups, compared with about 41% of U.S.-born women experiencing such abuse in their lifetime.

As the Trump administration reshapes the country’s immigration system, survivors of violence who entered the country illegally have a tough time proving their abuse and trauma to get relief, advocates say.

A refugee health and asylum program at Johns Hopkins in Baltimore provides immigrant victims of abuse with free forensic evaluations to support their claims for humanitarian relief, including applications for U visas.

Warren, the program’s associate director for women’s health, said that in the past, a written affidavit of the clinic’s findings was enough to corroborate an applicant’s legal accounts of past trauma.

“Now, we are getting requests for our in-person testimony,” Warren said.

Application Backlogs

The woman from India applied for a visa after she received a certificate from law enforcement allowing her to do so in 2023. Hers is one of nearly 11.6 million pending visa applications, according to data through June — the highest volume of cases ever recorded by U.S. Citizenship and Immigration Services. The number of pending U visa applications is 415,000, according to the agency.

Only about 10,000 U visas are issued per year, and it can take more than seven years to process applications, Garza said.

Adding to the pressure, the Trump administration has reduced the availability of Section 8 housing, which helps low-income individuals and others pay their rent. As of September, people without legal authorization to be in the United States are not eligible to receive rental help over U.S. citizens.

“If Tahirih wasn’t behind me, I could be homeless,” said the woman, who said she can afford only half her rent.

Victims’ advocates say they are working harder than ever to support their clients but are stretched thin as they face federal funding cuts and increased demand.

The Tahirih center reported a 200% increase in call volume in the four months after Trump took office, compared with the same period last year.

“At the end of the day there are a lot of emails and a lot of people we aren’t able to reach as quickly as in the past,” said Casey Carter Swegman, the center’s director of public policy.

To reach immigrant survivors of abuse who are afraid to come forward, advocates are “getting back to basics,” said Joanna Otero-Cruz, executive director and president of the Philadelphia group Women Against Abuse.

“We’re doing grassroots outreach to hairdressers and other small-business owners,” she said. “They’re the eyes and ears for us.”

In Riverhead, New York, a 38-year-old woman who emigrated from El Salvador said she has twice been the victim of domestic abuse but was too scared to report it to police.

She said the second assault was by a man for whom she cooked and cleaned in his home. The woman, who spoke on the condition of anonymity because of her sense of shame and her fears of deportation, said he raped her, took pictures of her naked, and threatened to put them on social media if she tried to go to the police. He then stalked her, she said.

Noemi Sanchez, Long Island regional coordinator for the Rural & Migrant Ministry, a nonprofit that supports farm workers, is working closely with the woman to elevate her self-esteem and help her understand that “no woman deserves to have a man mistreat them.”

Meanwhile, the survivor from India received a temporary work permit in 2024 and is employed as a certified nursing assistant, which “helps me survive,” she said.

“I have really come a long way,” she added. “It wasn’t easy. I had great support behind me. They didn’t let me down.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

Elliott Hinkle experienced depression and suicidal thoughts even before entering the foster care system in Casper, Wyoming, at age 15.

At the time, Hinkle, who is transgender, struggled with their sexual identity and gender issues, and their difficulties continued in foster care. They felt like they had no one to confide in — not their foster parents, not church leaders, not their caseworker.

“To my knowledge, I don’t remember ever taking a suicide screening,” Hinkle said. “No one ever said: ‘Are you having thoughts of taking your life? Do you feel hopeless?’”

With their psychological and behavioral health needs left unaddressed, Hinkle’s depression and suicidal thoughts worsened.

“Do I stay in the closet and feel terrible and want to end my life?” Hinkle said. “Or do I come out and lose all my supports, which also feels dangerous?”

Children in foster care are significantly more likely to have mental health issues, researchers say. They attempt or complete suicide at rates three to four times that of youths in the general population, according to several studies.

LGBTQ+ people in foster care, like Hinkle, are at an even higher risk of having suicidal thoughts.

Yet despite the concentration of young people at risk of serious mental illness and suicide, proactive efforts to screen foster children and get them the treatment they need have been widely absent from the system. And now, efforts underway to provide widespread screening, diagnosis, and treatment are threatened by sweeping funding cuts the Trump administration is using to reshape health care programs nationwide.

In June, federal officials announced they would shut down a suicide hotline serving LGBTQ+ youths as part of those cuts.

Children in foster care use a disproportionate amount of Medicaid-funded mental health services. Meanwhile, President Donald Trump’s massive budget package, passed this month by Congress, contains substantial shifts in Medicaid funding and policies that are projected to drastically reduce services in many states.

“I think anybody who cares about kids’ well-being and mental health is concerned about the possibility of reduced Medicaid funding,” said Cynthia Ewell Foster, a child psychologist and clinical associate professor in the University of Michigan psychiatry department. “The most vulnerable children, including those in foster care, are already having trouble getting the services they need.”

A lack of federal standards and other system-level issues create barriers to psychological and behavioral care in the child welfare system, said Colleen Katz, a professor at Hunter College’s Silberman School of Social Work in New York.

“When you’re talking about anyone getting screened for suicide ideation upon entrance into the system, it’s inconsistent at best,” she said.

Katz said all children entering foster care should have a brief, standardized suicide screening embedded into their initial medical assessment. And more screenings need to be conducted throughout a foster care stay, she said, because youths getting ready to transition out of the system are also vulnerable. 

Hinkle, now 31, said the summer before they aged out of the system was “one of the darkest periods, because I was coming to terms with the church not wanting me to be gay and I was about to lose stable housing and whatever foster care support there was.”

Katz studied transition-age youths in foster care in California, which has the highest numbers of placements in foster care nationwide. According to her analysis, 42% of study participants had thoughts of taking their life and 24% had attempted suicide, and she expects findings would be similar in other states.

Katz also examined suicide screening tools and found many that already exist could work and be easily administered by trained child welfare workers or alternative frontline service providers, or embedded in existing mental health services.

Still, the quality of services varies by state and locality and can hinder attempts to curb suicides.

Julie Collins, vice president of practice excellence at the Child Welfare League of America, which advocates for improvements to the child welfare system, said the gap in suicide prevention in foster care mirrors the overall nationwide void of behavioral health services for children and adolescents. “The preparation of people coming into the field isn’t what it needs to be,” Collins said of the lack of training for caseworkers.

Ewell Foster is trying to change that.

She worked with the state of Michigan to redefine and update the competencies required to earn an undergraduate certificate in child welfare in the state. Eighteen colleges and universities that offer certificate programs in child welfare in Michigan now teach about suicide prevention.

“It’s something the workforce has asked for,” Ewell Foster said. “They need real clear guidance on what to do when they are worried about someone.”

So far, Ewell Foster’s effort to change the wider system has not run into any roadblocks. Her work with Michigan’s child welfare agency is still being funded under a grant administered by the Substance Abuse and Mental Health Services Administration.

Agency spokesperson Danielle Bennett said such grants will continue for up to three years.

However, the future of the federal agency has been in question for months. The Trump administration has laid off hundreds of its employees and has proposed folding its functions into another agency.

Some states have made changes to address the foster care gaps on their own, but often it has taken legal action to spark changes in suicide prevention efforts.

In Kansas, officials made several changes after the state settled the McIntyre v. Howard class action lawsuit in 2021 on behalf of foster children who the suit alleged were subjected to inadequate access to mental health resources and moved from home to home frequently.

The state increased salaries for social workers in the child welfare system and reduced their caseloads, among other things.

Other states, including Texas, have implemented similar changes after facing lawsuits.

Still, experts caution that the changes taking place in foster care systems are not enough to steer outcomes.

Lily Brown, an assistant professor of psychology and director of the Center for the Treatment and Study of Anxiety at the University of Pennsylvania Perelman School of Medicine, said moving the needle in suicide prevention will require implementing a universal risk assessment for children in state care.

Brown recently sought a grant to fund and implement free, universal suicide risk screening in foster care throughout Pennsylvania. She had several counties agree to the project, but not enough to support her application — the study wouldn’t have had enough participants to work statistically, she said.

Without such studies, foster care systems nationwide can’t meet the needs of children, she said.

April Miller, 27, entered the system in Minnesota at age 3. As a Native American, she is part of a group that is overrepresented in foster care.

“The child welfare system as a whole neglected me,” said Miller, who said she endured several traumatic events in her early life, including witnessing a murder.

“I did a lot of self-harm and had thoughts of suicide but didn’t have access to means, which is why I am still alive,” she said.

Today, Miller is a social worker and suicide prevention coordinator in Bemidji, Minnesota.

Similarly, Hinkle’s experience in the system made them driven to change the trajectory of other young people.

Hinkle provides training, consultation, and policy development services at Unicorn Solutions in Oregon in support of youths and young adults affected by systems such as child welfare, with a particular focus on the LGBTQ+ community.

They said they are committed to making sure that sexual identity and gender topics are not avoided in the system.

“I think every young person should feel loved and cared for,” Hinkle said.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

“It put a smile on my face to see him so happy,” Schachter said.

Alex would have turned 21 that day, six years after he and 16 other children and staff at Marjory Stoneman Douglas High School in Parkland, Florida, were shot and killed by a former student in 2018. In the years before the shooting, that former student had displayed concerning behavior that elicited dozens of calls to 911 and at least two tips to the FBI.

“Alex should still be here today. It’s not fair,” Schachter said.

After two weeks of grieving Alex’s death, Schachter, propelled by anger and pain, began advocating for school safety. In part, he wanted to ensure his three other children would never be harmed in the same way. He joined the newly formed Marjory Stoneman Douglas High School Public Safety Commission to improve the safety and security of Florida’s students. And he launched a nonprofit bearing Alex’s name, which advocates for school safety.

Doing that work, he learned about threat assessment teams, groups of law enforcement and school officials who try to identify potentially dangerous or distressed kids, intervene, and prevent the next school shooting. Florida is one of about 18 states that require schools to have threat assessment and intervention teams; a national survey estimates 85% of public schools have a team assigned to the task.

The teams, whose mission and operational strategies often are based on research from the FBI and the Secret Service’s National Threat Assessment Center, or NTAC, have become more common as the number of school shootings has increased. Despite their prevalence for almost 25 years, some of the teams have developed systemic problems that put them at risk of unfairly labeling and vilifying children.

States vary widely in their requirements of threat assessment teams and there isn’t a nationwide archetype. Few school districts and states collect data about the teams, little is known about their operations, and research on their effectiveness at thwarting mass shootings and other threats is limited. But a 2021 analysis by the NTAC of 67 plots against K-12 schools found that people “contemplating violence often exhibit observable behaviors, and when community members report these behaviors, the next tragedy can be averted.”

“School shooters have a long thought process. They don’t just snap. They have concerning behavior over time. If we can identify them early, we can intervene,” said Karie Gibson, chief of the FBI’s Behavioral Analysis Unit.

Yet, Dewey Cornell, a forensic clinical psychologist who in 2001 developed one of the first sets of guidelines for school threat assessment teams, said there have been problems. In many cases, he said, threats have been deemed not serious “but parents and teachers are so alarmed that it is difficult to assuage their fears. The school community gets in an uproar and the school administrators feel pressured to expel the student.”

And in other cases, a school doesn’t do a threat assessment and assumes a student is dangerous when somebody else reports them as a threat, and they may take a zero tolerance approach and remove them from the school, said Cornell, the Virgil S. Ward professor of education at the University of Virginia.

A task force convened by the American Psychological Association found little evidence that zero tolerance policies have improved school climate or school safety and said they may create negative mental health outcomes for students. The task force cited examples of students who were expelled for incidents or school rule violations as minor as having a knife in their lunch box for cutting an apple.

Marisa Randazzo, a research psychologist and the director of threat assessment for Georgetown University, said she has also seen “hyperreactions,” especially among school communities that have experienced a mass killing.

“It’s understandable. People who have been close to an event like this are on higher alert than other people,” said Randazzo, who previously worked for the Secret Service and co-founded Sigma Threat Management Associates.

Threat assessments are supposed to be a graduated process calibrated to the seriousness of a problem, since the majority of student threats are not credible and can be resolved through supportive interventions, according to research from the Secret Service.

Stephanie Crawford-Goetz, a school psychologist and the director of mental health for student support services in the Douglas County School District in Colorado, where a shooting occurred at a charter school in 2019, said her district’s threat assessment process emphasizes a proactive, rehabilitative approach to managing potential threats, as the NTAC suggests.

Crawford-Goetz said her district interviews students before convening the team to assess whether a threat is a misguided expression of anger or frustration and if the student has a plan and means to carry out violence.

Students whose threats are deemed transient receive support, such as help with coping skills, and they may meet with a mental health provider.

If the threat is credible, a student may be temporarily removed from the classroom or school.

Randazzo said the vast majority of kids who make threats are suicidal or despondent: “The process is designed primarily to figure out if someone is in crisis and how we can help. It is not designed to be punitive.”

Crawford-Goetz tells parents about her district’s threat assessment team at the beginning of the school year. Some districts report keeping their teams a secret from parents, which is not how they were designed to operate, said Lina Alathari, chief of the NTAC. Her team encourages schools to educate the whole community about the threat assessment process.

Some advocacy groups contend that threat assessment teams have perpetuated inequities. There has also been widespread concern that children with disabilities can easily get swept into a threat assessment.

In a 2022 report, the National Disability Rights Network, a nonprofit based in Washington, D.C., said some threat assessment teams have become “judge, jury, and executioner,” going beyond assessing risk of serious, imminent harm to determining guilt and punishment.

Expanding their scope allows threat assessment teams to get around civil rights protections, the report says.

Cornell disputed the disability rights group’s conclusion. “This has not been corroborated by scientific studies and is speculative,” he said.

Some states, such as Florida, mandate that threat assessment teams determine whether a student’s disability played a role in their behavior and recommend they include special education teachers and other professionals in their evaluation.

In Texas, which has mandated threat assessment teams, a third of students subjected to threat assessments in the Dallas Independent School District receive special education services.

Yet, the district doesn’t have a special education staff representative on its threat assessment team, according to a March 2023 report by Texas Appleseed, a nonprofit public interest justice center.

Many school districts are developing their own models in the absence of national standards for threat assessments.

Florida revamped its threat assessment system in January 2024 to improve response times, provide consistent data collection, and build in more checks and balances and oversight, said Pinellas County Sheriff Bob Gualtieri, who is also chair of the Marjory Stoneman Douglas High School Public Safety Commission.

The new model requires the teams to work quickly and file uniform, electronic summary reports of threat assessment findings. Those results follow students throughout their school years.

The adjustments are intended to eliminate the risk of not knowing about a student’s past troubling behavior if they change schools, as occurred with the Parkland shooter and a student who shot and killed classmates at a high school near Winder, Georgia, in September, said Gualtieri.

“As parents, you never stop worrying about your kids,” Schachter said.

Virginia mandates that all public schools and higher education institutions, including colleges, have threat assessment teams. In Florida, where one of Schachter’s daughters attends college, threat assessment teams are mandated in all public schools, including charter schools.

“There’s more work to be done,” Schachter said.

Cheryl Platzman Weinstock’s reporting is supported by a grant from the National Institute for Health Care Management Foundation.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

Cuando el hermano menor de Pooja Mehta, Raj, murió por suicidio a los 19 años en marzo de 2020, ella se sintió “inesperadamente sorprendida”.

El último mensaje de texto de Raj fue para su compañero de laboratorio en la universidad sobre cómo organizar las preguntas de una tarea.

“No dices que vas a tomar las preguntas del 1 al 15 si planeas estar muerto una hora después”, dijo Mehta, de 29 años, defensora de salud mental y prevención del suicidio en Arlington, Virginia. Había recibido capacitación en Primeros Auxilios de Salud Mental, un programa nacional que enseña cómo identificar, comprender y responder a las señales de enfermedad mental. Sin embargo, dijo que su hermano no mostró signos de problemas.

Mehta dijo que algunas personas la culparon por la muerte de Raj porque los dos vivían juntos durante la pandemia de covid-19, mientras Raj tomaba clases por internet. Otros dijeron que su capacitación debería haberla ayudado a reconocer que su hermano estaba en crisis.

Pero Mehta dijo que “actuamos como si supiéramos todo lo que hay que saber sobre la prevención del suicidio. Hemos hecho un buen trabajo desarrollando soluciones para parte del problema, pero realmente no sabemos lo suficiente”.

La muerte de Raj ocurrió en medio de décadas de intentos fallidos para reducir las tasas de suicidio a nivel nacional.

Durante los últimos 20 años, funcionarios federales han lanzado tres estrategias nacionales de prevención del suicidio, incluida una anunciada en abril.

La primera estrategia, de 2001, se centró en abordar los factores de riesgo del suicidio y se basó en algunas intervenciones comunes.

La siguiente, pidió desarrollar e implementar protocolos estandarizados para identificar y tratar a personas en riesgo de suicidio, con seguimiento y el apoyo necesario para continuar el tratamiento.

La iniciativa más reciente se basa en las anteriores e incluye un plan de acción federal que llama a implementar 200 medidas durante los próximos tres años, incluidas priorizar a las poblaciones desproporcionadamente afectadas por el suicidio, como los jóvenes negros, los nativos americanos y de Alaska.

A pesar de estas estrategias en evolución, desde 2001 hasta 2021, las tasas de suicidio aumentaron la mayoría de los años, según los Centros para el Control y Prevención de Enfermedades (CDC). Los datos provisionales de 2022, los más recientes disponibles, muestran que las muertes por suicidio aumentaron un 3% adicional con respecto al año anterior.

Funcionarios de los CDC proyectan que el número final de suicidios en 2022 será aún mayor.

En las últimas dos décadas, las tasas de suicidio en estados rurales como Alaska, Montana, Dakota del Norte y Wyoming han sido aproximadamente el doble que en áreas urbanas, según los CDC.

A pesar de esas cifras persistentemente desalentadoras, expertos en salud mental sostienen que las estrategias nacionales no son el problema. En cambio, argumentan que las políticas, por muchas razones, simplemente no se están financiando, adoptando y poniendo en marcha.

Esa lenta adopción se vio agravada por la pandemia de covid-19, que tuvo un amplio y negativo impacto en la salud mental.

Un grupo de expertos nacionales y funcionarios gubernamentales coincide en que las estrategias simplemente no han sido adoptadas de manera generalizada, y dijeron que incluso el seguimiento básico de las muertes por suicidio no es universal.

Los datos de vigilancia se utilizan comúnmente para impulsar la mejora de la calidad de la atención médica y han sido útiles para abordar el cáncer y las enfermedades cardíacas. Sin embargo, no se han utilizado en el estudio de problemas de salud conductual como el suicidio, dijo Michael Schoenbaum, asesor principal de servicios de salud mental, epidemiología y economía en el Instituto Nacional de Salud Mental (NIMH).

“Pensamos en tratar los problemas de salud conductual de manera diferente a como pensamos en los problemas de salud física”, dijo Schoenbaum.

Sin estadísticas precisas, los investigadores no pueden averiguar quién muere con mayor frecuencia por suicidio, qué estrategias de prevención están funcionando y dónde se necesita más dinero para la prevención.

Muchos estados y territorios no permiten que los registros médicos se vinculen a los certificados de defunción, dijo Schoenbaum, pero el NIMH está colaborando con otras organizaciones para documentar estos datos por primera vez en un informe público y una base de datos que se publicarán antes de fin de año.

Además, las estrategias enfrentan obstáculos en el hecho de que la financiación federal y local sube y baja, y algunos esfuerzos de prevención del suicidio no funcionan en ciertos estados y localidades debido a la geografía desafiante, dijo Jane Pearson, asesora especial de investigación sobre suicidio para el director del NIMH.

Wyoming, donde unos cientos de miles de residentes viven dispersos en un paisaje extenso y desigual, consistentemente se ubica entre los estados con las tasas más altas de suicidio.

Los funcionarios estatales han trabajado durante muchos años para abordar el problema del suicidio en el estado, dijo Kim Deti, portavoz del Departamento de Salud de Wyoming.Pero desplegar servicios, como unidades móviles de crisis, un elemento central de la estrategia nacional más reciente, es difícil en un estado grande y escasamente poblado.

“El trabajo no se detiene, pero algunas estrategias que tienen sentido en algunas áreas geográficas del país pueden no tenerlo en un estado con nuestras características”, dijo.

La falta de implementación no es solo un problema de los gobiernos estatales y locales. A pesar de la evidencia de que examinar a los pacientes en busca de pensamientos suicidas durante las visitas médicas ayuda a evitar catástrofes, no se obliga a los profesionales de la salud a hacerlo.

Muchos médicos dicen que hacer las preguntas sobre el suicidio es desalentador porque tienen poco tiempo, una formación insuficiente y no se sienten cómodos hablando de suicidio, dijo Janet Lee, especialista en medicina adolescente y profesora asociada de pediatría en la Escuela de Medicina Lewis Katz de la Universidad Temple.

“Creo que es realmente aterrador y sorprendente pensar que si algo es una cuestión de vida o muerte, alguien no pueda preguntar sobre ello”, dijo.

El uso de otras medidas también ha sido inconsistente. Los servicios de intervención de crisis son fundamentales para las estrategias nacionales, pero muchos estados no han construido sistemas estandarizados.

Además de ser fragmentados, los sistemas de crisis, como las unidades móviles de crisis, pueden variar de un estado a otro y de un condado a otro. Algunas unidades móviles de crisis utilizan telemedicina, algunas operan las 24 horas del día y otras de 9 a 5, y algunas recurren a la policía local en lugar de buscar a trabajadores de salud mental.

Y la incipiente línea 988 de prevención del suicidio y crisis también enfrenta problemas graves.

Solo el 23% de los estadounidenses están familiarizados con el 988 y hay una brecha significativa de conocimiento sobre las situaciones en las que las personas deberían llamar al 988, según una encuesta reciente realizada por Ipsos y la Alianza Nacional sobre Afecciones Mentales.

La mayoría de los estados, territorios y naciones indígenas aún no han financiado de manera permanente al 988, que se lanzó a nivel nacional en julio de 2022 y ha recibido alrededor de $1,500 millones en fondos federales, según la Administración de Servicios de Salud Mental y Abuso de Sustancias (SAMHSA).

Anita Everett, directora del Centro de Servicios de Salud Mental de SAMHSA, dijo que su agencia está realizando una campaña de concientización para promover el sistema.

Algunos estados, como Colorado, están tomando otras medidas.

Allí, funcionarios estatales lanzaron incentivos financieros para implementar esfuerzos de prevención del suicidio, entre otras medidas de seguridad para los pacientes, a través del Programa Estatal de Pago por Incentivos de Calidad Hospitalaria.

El programa otorga alrededor de $150 millones al año a los hospitales por su buen desempeño. En el último año, 66 hospitales mejoraron su atención a los pacientes que tuvieron conductas suicidas, según Lena Heilmann, directora de la Oficina de Prevención del Suicidio del Departamento de Salud Pública y Medio Ambiente de Colorado.

Los expertos esperan que otros estados sigan el ejemplo de Colorado.

Y a pesar del lento avance, Mehta ve puntos positivos en la última estrategia y plan de acción.Aunque es demasiado tarde para salvar a Raj, “abordar los factores sociales que impulsan la salud mental y el suicidio e invertir en espacios para que las personas busquen ayuda mucho antes de una crisis me da esperanza”, dijo Mehta.

El reportaje de Cheryl Platzman Weinstock cuenta con el apoyo de una beca del National Institute for Health Care Management Foundation.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

When Pooja Mehta’s younger brother, Raj, died by suicide at 19 in March 2020, she felt “blindsided.”

Raj’s last text message was to his college lab partner about how to divide homework questions.

“You don’t say you’re going to take questions 1 through 15 if you’re planning to be dead one hour later,” said Mehta, 29, a mental health and suicide prevention advocate in Arlington, Virginia. She had been trained in Mental Health First Aid — a nationwide program that teaches how to identify, understand, and respond to signs of mental illness — yet she said her brother showed no signs of trouble.

Mehta said some people blamed her for Raj’s death because the two were living together during the covid-19 pandemic while Raj was attending classes online. Others said her training should have helped her recognize he was struggling.

But, Mehta said, “we act like we know everything there is to know about suicide prevention. We’ve done a really good job at developing solutions for a part of the problem, but we really don’t know enough.”

Raj’s death came in the midst of decades of unsuccessful attempts to tamp down suicide rates nationwide.

During the past two decades federal officials have launched three national suicide prevention strategies, including one announced in April.

The first strategy, announced in 2001, focused on addressing risk factors for suicide and leaned on a few common interventions.

The next strategy called for developing and implementing standardized protocols to identify and treat people at risk for suicide with follow-up care and the support needed to continue treatment.

The latest strategy builds on previous ones and includes a federal action plan calling for implementation of 200 measures over the next three years, including prioritizing populations disproportionately affected by suicide, such as Black youth and Native Americans and Alaska Natives.

Despite those evolving strategies, from 2001 through 2021 suicide rates increased most years, according to the Centers for Disease Control and Prevention. Provisional data for 2022, the most recent numbers available, shows deaths by suicide grew an additional 3% over the previous year. CDC officials project the final number of suicides in 2022 will be higher.

In the past two decades, suicide rates in rural states such as Alaska, Montana, North Dakota, and Wyoming have been about double those in urban areas, according to the CDC.

Despite those persistently disappointing numbers, mental health experts contend the national strategies aren’t the problem. Instead, they argue, the policies — for many reasons —simply aren’t being funded, adopted, and used. That slow uptake was compounded by the covid-19 pandemic, which had a broad, negative impact on mental health.

A chorus of national experts and government officials agree the strategies simply haven’t been embraced widely, but said even basic tracking of deaths by suicide isn’t universal.

Surveillance data is commonly used to drive health care quality improvement and has been helpful in addressing cancer and heart disease. Yet, it hasn’t been used in the study of behavioral health issues such as suicide, said Michael Schoenbaum, a senior adviser for mental health services, epidemiology, and economics at the National Institute of Mental Health.

“We think about treating behavioral health problems just differently than we think about physical health problems,” Schoenbaum said.

Without accurate statistics, researchers can’t figure out who dies most often by suicide, what prevention strategies are working, and where prevention money is needed most.

Many states and territories don’t allow medical records to be linked to death certificates, Schoenbaum said, but NIMH is collaborating with a handful of other organizations to document this data for the first time in a public report and database due out by the end of the year.

Further hobbling the strategies is the fact that federal and local funding ebbs and flows and some suicide prevention efforts don’t work in some states and localities because of the challenging geography, said Jane Pearson, special adviser on suicide research to the NIMH director.

Wyoming, where a few hundred thousand residents are spread across sprawling, rugged landscape, consistently ranks among the states with the highest suicide rates.

State officials have worked for many years to address the state’s suicide problem, said Kim Deti, a spokesperson for the Wyoming Department of Health.

But deploying services, like mobile crisis units, a core element of the latest national strategy, is difficult in a big, sparsely populated state.

“The work is not stopping but some strategies that make sense in some geographic areas of the country may not make sense for a state with our characteristics,” she said.

Lack of implementation isn’t only a state and local government problem. Despite evidence that screening patients for suicidal thoughts during medical visits helps head off catastrophe, health professionals are not mandated to do so.

Many doctors find suicide screening daunting because they have limited time and insufficient training and because they aren’t comfortable discussing suicide, said Janet Lee, an adolescent medicine specialist and associate professor of pediatrics at the Lewis Katz School of Medicine at Temple University.

“I think it is really scary and kind of astounding to think if something is a matter of life and death how somebody can’t ask about it,” she said.

The use of other measures has also been inconsistent. Crisis intervention services are core to the national strategies, yet many states haven’t built standardized systems.

Besides being fragmented, crisis systems, such as mobile crisis units, can vary from state to state and county to county. Some mobile crisis units use telehealth, some operate 24 hours a day and others 9 to 5, and some use local law enforcement for responses instead of mental health workers.

Similarly, the fledgling 988 Suicide & Crisis Lifeline faces similar, serious problems.

Only 23% of Americans are familiar with 988 and there’s a significant knowledge gap about the situations people should call 988 for, according to a recent poll conducted by the National Alliance on Mental Illness and Ipsos.

Most states, territories, and tribes have also not yet permanently funded 988, which was launched nationwide in July 2022 and has received about $1.5 billion in federal funding, according to the Substance Abuse and Mental Health Services Administration.

Anita Everett, director of the Center for Mental Health Services within SAMHSA, said her agency is running an awareness campaign to promote the system.

Some states, including Colorado, are taking other steps. There, state officials installed financial incentives for implementing suicide prevention efforts, among other patient safety measures, through the state’s Hospital Quality Incentive Payment Program. The program hands out about $150 million a year to hospitals for good performance. In the last year, 66 hospitals improved their care for patients experiencing suicidality, according to Lena Heilmann, director of the Office of Suicide Prevention at the Colorado Department of Public Health and Environment.

Experts hope other states will follow Colorado’s lead.

And despite the slow movement, Mehta sees bright spots in the latest strategy and action plan.

Although it is too late to save Raj, “addressing the social drivers of mental health and suicide and investing in spaces for people to go to get help well before a crisis gives me hope,” Mehta said.

Cheryl Platzman Weinstock’s reporting is supported by a grant from the National Institute for Health Care Management Foundation.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

BRIDGEPORT, Conn. — Milagros Aquino was trying to find a new place to live and had been struggling to get used to new foods after she moved to Bridgeport from Peru with her husband and young son in 2023.

When Aquino, now 31, got pregnant in May 2023, “instantly everything got so much worse than before,” she said. “I was so sad and lying in bed all day. I was really lost and just surviving.”

Aquino has lots of company.

Perinatal depression affects as many as 20% of women in the United States during pregnancy, the postpartum period, or both, according to studies. In some states, anxiety or depression afflicts nearly a quarter of new mothers or pregnant women.

Many women in the U.S. go untreated because there is no widely deployed system to screen for mental illness in mothers, despite widespread recommendations to do so. Experts say the lack of screening has driven higher rates of mental illness, suicide, and drug overdoses that are now the leading causes of death in the first year after a woman gives birth.

“This is a systemic issue, a medical issue, and a human rights issue,” said Lindsay R. Standeven, a perinatal psychiatrist and the clinical and education director of the Johns Hopkins Reproductive Mental Health Center.

Standeven said the root causes of the problem include racial and socioeconomic disparities in maternal care and a lack of support systems for new mothers. She also pointed a finger at a shortage of mental health professionals, insufficient maternal mental health training for providers, and insufficient reimbursement for mental health services. Finally, Standeven said, the problem is exacerbated by the absence of national maternity leave policies, and the access to weapons.

Those factors helped drive a 105% increase in postpartum depression from 2010 to 2021, according to the American Journal of Obstetrics & Gynecology.

For Aquino, it wasn’t until the last weeks of her pregnancy, when she signed up for acupuncture to relieve her stress, that a social worker helped her get care through the Emme Coalition, which connects girls and women with financial help, mental health counseling services, and other resources.

Mothers diagnosed with perinatal depression or anxiety during or after pregnancy are at about three times the risk of suicidal behavior and six times the risk of suicide compared with mothers without a mood disorder, according to recent U.S. and international studies in JAMA Network Open and The BMJ.

The toll of the maternal mental health crisis is particularly acute in rural communities that have become maternity care deserts, as small hospitals close their labor and delivery units because of plummeting birth rates, or because of financial or staffing issues.

This week, the Maternal Mental Health Task Force — co-led by the Office on Women’s Health and the Substance Abuse and Mental Health Services Administration and formed in September to respond to the problem — recommended creating maternity care centers that could serve as hubs of integrated care and birthing facilities by building upon the services and personnel already in communities.

The task force will soon determine what portions of the plan will require congressional action and funding to implement and what will be “low-hanging fruit,” said Joy Burkhard, a member of the task force and the executive director of the nonprofit Policy Center for Maternal Mental Health.

Burkhard said equitable access to care is essential. The task force recommended that federal officials identify areas where maternity centers should be placed based on data identifying the underserved. “Rural America,” she said, “is first and foremost.”

There are shortages of care in “unlikely areas,” including Los Angeles County, where some maternity wards have recently closed, said Burkhard. Urban areas that are underserved would also be eligible to get the new centers.

“All that mothers are asking for is maternity care that makes sense. Right now, none of that exists,” she said.

Several pilot programs are designed to help struggling mothers by training and equipping midwives and doulas, people who provide guidance and support to the mothers of newborns.

In Montana, rates of maternal depression before, during, and after pregnancy are higher than the national average. From 2017 to 2020, approximately 15% of mothers experienced postpartum depression and 27% experienced perinatal depression, according to the Montana Pregnancy Risk Assessment Monitoring System. The state had the sixth-highest maternal mortality rate in the country in 2019, when it received a federal grant to begin training doulas.

To date, the program has trained 108 doulas, many of whom are Native American. Native Americans make up 6.6% of Montana’s population. Indigenous people, particularly those in rural areas, have twice the national rate of severe maternal morbidity and mortality compared with white women, according to a study in Obstetrics and Gynecology.

Stephanie Fitch, grant manager at Montana Obstetrics & Maternal Support at Billings Clinic, said training doulas “has the potential to counter systemic barriers that disproportionately impact our tribal communities and improve overall community health.”

Twelve states and Washington, D.C., have Medicaid coverage for doula care, according to the National Health Law Program. They are California, Florida, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, Oklahoma, Oregon, Rhode Island, and Virginia. Medicaid pays for about 41% of births in the U.S., according to the Centers for Disease Control and Prevention.

Jacqueline Carrizo, a doula assigned to Aquino through the Emme Coalition, played an important role in Aquino’s recovery. Aquino said she couldn’t have imagined going through such a “dark time alone.” With Carrizo’s support, “I could make it,” she said.

Genetic and environmental factors, or a past mental health disorder, can increase the risk of depression or anxiety during pregnancy. But mood disorders can happen to anyone.

Teresa Martinez, 30, of Price, Utah, had struggled with anxiety and infertility for years before she conceived her first child. The joy and relief of giving birth to her son in 2012 were short-lived.

Without warning, “a dark cloud came over me,” she said.

Martinez was afraid to tell her husband. “As a woman, you feel so much pressure and you don’t want that stigma of not being a good mom,” she said.

In recent years, programs around the country have started to help doctors recognize mothers’ mood disorders and learn how to help them before any harm is done.

One of the most successful is the Massachusetts Child Psychiatry Access Program for Moms, which began a decade ago and has since spread to 29 states. The program, supported by federal and state funding, provides tools and training for physicians and other providers to screen and identify disorders, triage patients, and offer treatment options.

But the expansion of maternal mental health programs is taking place amid sparse resources in much of rural America. Many programs across the country have run out of money.

The federal task force proposed that Congress fund and create consultation programs similar to the one in Massachusetts, but not to replace the ones already in place, said Burkhard.

In April, Missouri became the latest state to adopt the Massachusetts model. Women on Medicaid in Missouri are 10 times as likely to die within one year of pregnancy as those with private insurance. From 2018 through 2020, an average of 70 Missouri women died each year while pregnant or within one year of giving birth, according to state government statistics.

Wendy Ell, executive director of the Maternal Health Access Project in Missouri, called her service a “lifesaving resource” that is free and easy to access for any health care provider in the state who sees patients in the perinatal period.

About 50 health care providers have signed up for Ell’s program since it began. Within 30 minutes of a request, the providers can consult over the phone with one of three perinatal psychiatrists. But while the doctors can get help from the psychiatrists, mental health resources for patients are not as readily available.

The task force called for federal funding to train more mental health providers and place them in high-need areas like Missouri. The task force also recommended training and certifying a more diverse workforce of community mental health workers, patient navigators, doulas, and peer support specialists in areas where they are most needed.

A new voluntary curriculum in reproductive psychiatry is designed to help psychiatry residents, fellows, and mental health practitioners who may have little or no training or education about the management of psychiatric illness in the perinatal period. A small study found that the curriculum significantly improved psychiatrists’ ability to treat perinatal women with mental illness, said Standeven, who contributed to the training program and is one of the study’s authors.

Nancy Byatt, a perinatal psychiatrist at the University of Massachusetts Chan School of Medicine who led the launch of the Massachusetts Child Psychiatry Access Program for Moms in 2014, said there is still a lot of work to do.

“I think that the most important thing is that we have made a lot of progress and, in that sense, I am kind of hopeful,” Byatt said.

Cheryl Platzman Weinstock’s reporting is supported by a grant from the National Institute for Health Care Management Foundation.