Mental health service utilization in a novel insurance-based Ob/Gyn integrated model for women across the lifespan

PURPOSE: Women’s Mental Health @Obstetrics and Gynecology (WMH @Ob/Gyn) is a novel, insurance-based clinical model integrated in Ob/Gyn practices that offers approachable, acceptable, available, and affordable mental healthcare to women across the lifespan. Women seen by Ob/Gyn physicians for physical healthcare needs are referred to the WMH @Ob/Gyn service based on patient request, provider observation, and/or results on universal depression screening. WMH@Ob/Gyn’ services include mental health screening, psychotherapy, psychopharmacology and support groups, all embedded into Ob/Gyn. Here, we sought to evaluate utilization rates of mental health services as an outcome of increased access resulting from real-world implementation of WMH @Ob/Gyn. METHODS: This prospective observational cohort study followed all patients referred to WMH @Ob/Gyn from 02/2020 to 12/2022. Data were obtained from a clinical registry and patient electronic health records. Utilization was estimated on initiation (proportion of women who attended at least one mental health visit), and sustainment (proportion of women who attended three or more visits). RESULTS: 2,661 women were referred to WMH @Ob/Gyn; 65% initiated, out of which 36% sustained treatment. Hispanic/Latina/Spanish women were less likely to initiate treatment. Of those who initiated, women whose insurance was non-participating in mental healthcare, women that were not pregnant, and younger women, had lower odds of sustaining treatment. CONCLUSION: WMH @Ob/Gyn facilitates the initiation and sustainment of mental health treatment at rates considerably higher than those observed in comparable perinatal-integrated programs or the general population. However, persistent systemic barriers, including disparities in physical and mental health insurance coverage, continue to constrain equitable, sustained access to mental healthcare.