Although clinical need for a mother-baby day hospital is
likely to exist in many locales, it is only feasible to establish
a separate service in locations where the population
density provides sufficient and ongoing demand. Hospitals
located in rural or small town settings may not have
adequate clinical demand to warrant development of a
specialized mother-baby unit. In order to demonstrate
feasibility in our area, we assessed patient flow at the obstetric
hospital where we intended to base our service, and
found that there were a sufficiently large number of
patients to keep the DH well utilized. Specifically, by
extrapolating from conservative prevalence estimates regarding
the rates of depression, the most common perinatal
mental illness, we estimated that roughly 10% of the
9000 women who delivered their infants at the hospital
each year would be likely to meet criteria for admission.
In addition, because the hospital had an existing psychiatric
consultation-liaison (CL) service, a mechanism was
already in place to identify patients in need of care. Moreover,
discussions with CL staff revealed that although
obstetric patients were often referred to a local psychiatric
day hospital following discharge, patients frequently did
not follow through and cited separation from their infants
as a reason for non-compliance.
Collaborating with stakeholders
Perhaps most importantly, during the development of
program, we consulted with members of local stakeholder
groups to discuss the proposed program and clarify
its role in relation to existing hospital and communitybased
services. Without involvement and support of these
groups – hospital administrators, representatives from relevant
hospital departments, state and private insurers –
the program would have been unlikely to become a
reality. Over a period of three years, numerous meetings
took place to explain the rationale for the DH and share
our vision for its implementation; during this time we also
gathered suggestions from others to help shape the DH.
Because cost is an important consideration for hospital
administrators and insurers, we noted during these discussions
that psychiatric day hospitalization is recognized as
a generally effective approach that is less costly than
inpatient treatment (Mazza et al, 2004). Based on data
collected from a local psychiatric facility regarding the
actual cost of treating postpartum women during a oneyear
time period, we presented our own calculations estimating
that the program would amount to a cost savings
of approximately 50% in comparison to traditional inpatient
treatment. Ultimately, a culminating meeting was
held that included our state’s Director of Human Services
and the Medical and Executive Directors of all private
insurers for the state. At the conclusion of this meeting,
state and private insurers expressed philosophical support
for the DH, as well as willingness to contract for the
delivery of psychiatric services to pregnant and postpartum
women. In our negotiations with insurers, we clearly
outlined that only the mothers (not their infants) would be
considered the insured ‘‘patients’’ and the cost of infant
care would be included in the overall fee for the program
for postpartum patients. The contractual and philosophical
commitment expressed by statewide insurers, as well
as the states Director of Human Services, was critical in
our developing a thriving, sustainable program.