by Anne M. Stoline, M.D.
[Winter 1997; Vol. 24 No. 4]
Mercy Medical Center, located in the heart of downtown Baltimore, is a cultural crossroads that serves VIPs, the inner-city poor, the downtown work force, and suburbanites. Having since 1992 placed special emphasis on the medical care of women, Mercy now wants to become more comprehensive by forming a women’s mental health program. Development of this program, which began in early 1997, is an exciting venture.
Program planning began with trying to determine the scope of what may become a new sub-speciality in psychiatry, women’s mental health. The requirements for defining its boundaries as a sub-speciality include stating the potential impact of female biology, physiology, and pharmacokinetics on psychopathology, dysfunction, and subsequent treatment planning. A program based solely on biological differences would not begin to address the myriad needs of women.
The sub-specialty’s name, women’s mental health, broadens the spectrum of interest to include commonly occurring and expectable states of mind that may arise when women face transitional life struggles. A complete definition of a mental health program would include both a subjective and objective understanding of women, and the distress that they may develop within their social, familial, and occupational roles. It would draw from a variety of psychological theories and strategies and would provide comprehensive services in a multitude of settings.
The program offers a new opportunity to innovatively address women’s problems. Education and support groups for new mothers, “empty nesters,” and others who face major life transitions will help ease the burdens of these struggles. The program hopes to prevent dysfunction for some, ameliorate the reactions of others, and provide for early detection and clinical intervention for those in need of more intensive care.
Post-partum depression provides an example of a clinical condition requiring a multifaceted approach. The tearful new mother seeking help may need hospitalization for a life-threatening depressive psychosis; however, she may only need reassurance from her peers in a new mother’s support group.
In addition to implementing clinical and preventive programs and providing education and support, the program must also consider how social factors influence women’s mental health. Distress brought on by poverty, unemployment, and lack of fulfillment, or anxiety created in trying to meet the dual demands of career and family are examples of social factors influencing women’s mental health.
The potential scope of women’s mental health encompasses not only clinical psychiatry, but also attempts to help women with issues that apply only to their gender. It deals with the impact of social and familial roles and the expectations of women, and the benefits of family-friendly work policies. In order to provide for a family-oriented work setting, Mercy leadership has begun exploring the creation of a child care program for its staff. Affordable, safe, high-quality care for children of working women cannot eliminate the pull of a working mother’s competing demands, but it might lessen it.
While those of us involved in this venture learn, plan, and grow a step at a time, news of a comprehensive women’s mental health program at Mercy Medical Center is premature. A few building blocks are in place along with a vision for the program’s growth—with a large patchwork quilt of comprehensive services emerging over time. In response to the changing needs of our society, community, and patients, we will make modifications. Developing this program will take time—perhaps a lifetime before we realize its full potential.
Dr. Stoline is the director of Women’s Mental Health, Mercy Medical Center, Baltimore, Maryland.