1. Maternal and Child Health and Mental Health: Time for Action Ken Thompson MD Associate Director for Medical Affairs CMHS/SAMHSA CityMatCH Teleconference June 28, 2007

2. The Mental Health Imperative: Inventing the neck

3. Human Capability Motivation Concentration Organization Patience/Tolerance Problem solving Sociability

4. mental health in impoverished women of childbearing age Population(s) at risk Ecology of Disability, welfare and poverty- Drift and causation- incidence and prevalence

5. What we think we know Homeless and low income housed single mothers- 2/3rds have lifetime Axis I diagnosis (Bassuk et al. 1996) Approximately 20% of working, single mothers, women on welfare and non working single mothers had DSM III diagnosis in past year (Jayakody and Stauffer 2000) In the 52% of women experiencing barriers to employment, 34% had depression, ptsd or anxiety (Danziger et al. 2000)

6. more.... In Pittsburgh in 158 women on Tanf (Gorske et al. 2006) 67% met criteria for Axis I diagnosis In order of prevalence- Panic Disorder, Major Depression, Alcoholism, Drug Abuse, Dysthymia, PTSD, Agoraphobia 36% had more then 1 diagnosis

7. more.... Almost 50% reported significant histories of either physical and emotional abuse/neglect or sexual abuse. A history of abuse was significantly correlated with psychiatric and functional impairment More then psychiatric impairment (per se), impaired cognitive ability predicted impairment of employment High rates of tobacco use

8. Types of Psychiatric Impairment Panic Disorder with/without agoraphobia Major Depression (Bipolar Disorder) PTSD Generalized Anxiety Alcohol and Substance Abuse Personality Disorders Psychosis- Schizophrenia and others

9. Physical Disease Addiction Psychiatric Disorder

10. Response Presumption of high likelihood of a variety of impairments and the need to address them Screening Easy access to integrated care and treatment Engage in recovery- peer specialists? Deal with disability Address family and their burdens

11. Illness Health The way I used to think

12. Ill Not Ill Healthy Not Healthy How I have learned to think

13. Ken Thompson MD Ken.Thompson@samhsa.hhs.gov 240.427.7911