Improving access to mental health supports for pregnant women and new mothers

By Sean O’Malley, Senior Writer

CAMH Senior Scientist Dr. Daisy Singla has devoted her entire career to one goal: improving access to mental health carefor pregnant women and new mothers.

In 2018, Dr. Singla became the youngest recipient of a $13-million-USD award to conduct a five-year clinical trial known as SUMMIT (Scaling Up Maternal Mental Healthcare by Increasing Access to Treatment) funded by the Patient-Centered Outcomes Research Institute in the United States. The study is implemented at three sites across Toronto (led by Drs. Singla, Simone Vigod, and Cindy-Lee Dennis), as well as Chapel Hill (led by Dr. Samantha Meltzer-Brody) and Chicago (led by Dr. Richard Silver) in the U.S.

Talk therapies are amongst the most effective interventions in medicine but remain inaccessible to many. Around the world, as few as one in five women can access effective treatment for anxiety and depression during pregnancy and postpartum due to a dearth of available specialists, and high costs, transportation and childcare. When women don’t receive treatment for these conditions, the ripple effects can be devastating for them, their children, their partners and their communities.

The broad ambition of the SUMMIT trial is to see if talk therapy delivered by treatment providers with no previous training in mental health—for example nurses, midwives and doulas—is as effective as talk therapy delivered by mental health specialists, and if telemedicine is as effective as in-person treatment. In SUMMIT, everyone receives eight sessions of Behavioural Activation (BA) therapy, an approach that focuses on helping individuals increase their engagement in positive and fulfilling activities to improve their mood and overall wellbeing. “We chose BA because it is effective and easy to teach to non-mental health providers,” adds Singla.

This historic trial has already recruited more than 1,100 perinatal women and is run by a diverse, interdisciplinary team of 120 investigators, advisors, research staff and stakeholders across North America. The study results are expected to be released early in 2024.

“We are not currently optimizing the human resources in our healthcare system,” says Dr. Singla. “If we can show that non-specialists are as effective as specialists to deliver effective treatments, the implications go beyond perinatal mental health to revolutionize how mental healthcare is delivered across Canada. It means that we could offer a stepped care model with reduced wait times and patient-centered care. It would allow us to broaden access to effective treatments by relying beyond a small cadre of specialized treatment providers.”

A sub-study within SUMMIT trial looked at the impact of BA through what the researchers describe as a “culturally-sensitive lens”. This study was recently published in the Journal of Consulting and Clinical Psychology.

“Historically, all perinatal women are underserved when it comes to mental health,” says Dr. Singla. “However, BIPOC women face even greater barriers to mental health care due to systemic factors. SUMMIT is unique because almost 50 per cent of recruited patients self-identify as BIPOC. Equally important, we have found that most participants report being highly satisfied with their treatment, irrespective of their race or ethnicity.”

For Tracy Robert, participation in the SUMMIT trial as a non-specialist provider has enabled her to connect with patients more deeply than through her work as a nurse alone, and has led her to want to devote the rest of her career to mental health.

“I’ve loved nursing but I think [SUMMIT] has been my greatest work,” says Robert. “I was able to spend more time with patients than I typically do in a nursing role.” 

For Dr. Singla, her drive to improve access to mental health treatments was instilled early on by her parents’ experiences of immigration to Canada and further fostered by her work abroad. “In some ways, my parents are the greatest psychologists I’ve known,” she says. “Their resolve and resiliency in overcoming adversity reminds me that solutions are always available. In collaboration with organizations globally, I’m reminded of their attributes and the privilege to do this important work.”