4 Effective Strategies for Supporting Military-Connected Mothers in Perinatal Mental Healthcare (Part II)
By Shakima Tozay LICSW, PMH-C, CCM, CDP®
This article is the second in a two-part series that explores the lived experiences of military-connected mothers and how perinatal mental health professionals can effectively support them. Read part I .
Having self-awareness is crucial when providing support for military members and their families. However, it’s not enough. We must also be aware of the specific challenges they face, such as the emotional cycle of deployment, exposure to combat, and trauma. The strong bonds between service members are a valuable resource that greatly influences their ability to adapt.
Understanding the differences among branches of the military can also aid in comprehending the unique experiences of military life. As a perinatal mental health clinician, gaining this knowledge will allow you to approach your practice from a positive perspective and build trusting relationships with your military clients. Here are four strategies you can use to support military-connect mothers.
1. Enhance your understanding of military culture by building cultural competence and practicing cultural humility.
There is a unique culture within the military community, but many providers may not realize this or have the resources to provide culturally appropriate care for military-connected, perinatal clients.
When it comes to providing effective healthcare, cultural competence and cultural humility must be at the forefront of our minds. Cultural competency is an ethical obligation whether you are a practicing clinical social worker, marriage and family therapist, professional, or clinical psychologist. According to the National Association of Social Workers (NASW), “Cultural competence requires self-awareness, cultural humility, and the commitment to understanding and embracing culture as central to effective practice” (NASW, 2001).
Being culturally competent means respecting and understanding the diverse beliefs and practices of different groups and being able to communicate with diverse groups effectively. The Substance Abuse and Mental Health Services Administration (SAMSHA) describes the path to becoming culturally competent as developmental — starting with self-awareness, a strong commitment to learning, and “being rooted in respect, validation, and openness toward someone whose social and cultural background is different from one’s own” (SAMSHA, 2014).
On the other hand, cultural humility involves a deep awareness of one’s limitations in fully grasping a client’s cultural background and experiences. It also requires an empathetic and other-oriented approach toward learning about and acknowledging the client’s cultural identity. As the authors of “Cultural Humility: Engaging Diverse Identities in Therapy” explain in their book:
“This process is characterized by acknowledging and owning limitations and striving to express openness and interest in the client’s salient cultural identities; there is no end state of competence there is only humility and continued growth and development over time” (Hook et al., 2017).
The Center for Deployment Psychology (CDP) is one of the premier military competency training sites for healthcare providers. The CDP offers courses, videos, and summer and winter educational institutes on military competency and the Star Behavioral Health Provider tier-based continuing education program. You can also take the Military Culture Self-Awareness Exercise to better gauge your bias and knowledge of military culture and its diverse communities. Attending training or reading a book about another group just doesn’t meet the mark of becoming a culturally humble provider. Listening to the stories of those with lived experience and remaining curious are just some steps toward strengthening this muscle and moving in the right direction.
What’s your plan for building your competence and cultural knowledge of military culture to better serve your perinatal clients?
2. Know the facts about maternal mental health in military communities.
Did you know that research shows being deployed and having a deployed spouse can increase the risk of postpartum depression in military-connected women (Klaman & Turner, 2016)?
A study published in Military Medicine noted that out of 3,882 surveys from pregnant and new military mothers (between 2007-2009), only 4.6% showed signs of high risk for depression. However, visits with an obstetrician showed “significantly higher” scores for women whose husbands were deployed or planning to deploy (Spooner et al., 2012).
Still, not enough information is available about how high-risk women obtain the necessary treatment for maternal mental health or what resources to access to get support.
A Government Accountability Office (GAO) 2022 report discovered potential ways to improve access to perinatal mental health treatment at certain military treatment facilities (MTF). One beneficial measure is integrating mental health services into the women’s health clinic. Providers at these MTFs have observed that this helps to reduce any stigma surrounding seeking mental health support for pregnant or postpartum individuals (U. S. Government Accountability Office, 2022).
GAO’s report also revealed that three of the most common categories of mental health diagnoses were anxiety disorders, depressive disorders, and trauma- and stressor-related disorders. When it came to receiving mental health treatment, about 75% of beneficiaries received some form of care, such as taking medication or attending therapy sessions, indicating that more awareness and advocacy are needed to ensure all individuals have access to the care they need.
3. Always screen for maternal mental health conditions.
To ensure the best outcomes for both mother and baby, mental health providers must screen for maternal mental health conditions and provide appropriate support and referrals. Proper and frequent screening improves timely access to care. A CNN report published this year noted that mental health disorders such as suicide and opioid overdose are responsible for nearly 1 in 4 maternal deaths in the U.S. (Cheng, 2024).
There’s also evidence that screening pregnant and postpartum women for depression can actually help reduce symptoms in those who already have it, and even lower rates of depression overall in a specific group (O’Connor et al., 2016).
Even though the Department of Defense (DOD) encourages screenings and offers treatment, a lot of people still don’t seek the help they need because of stigma, according to the GAO.
More work is needed to reduce stigma, normalize screening efforts to detect mental health symptoms and employ prevention approaches. The key is in the messaging military-connected mothers receive and don’t receive about maternal mental health, which contributes to proactive engagement or a lack of education.
4. Know the resources and advocate for your clients.
Part of developing your military cultural competence involves familiarizing yourself with the available resources for military-connected mothers and families. As the saying goes, knowledge is power. A mental health provider who is knowledgeable about community resources available to support their clients becomes an invaluable asset to their clients.
Some important resources to be aware of include Military and Family Readiness Centers, which offer a wide range of assistance and services to active-duty members and their dependents across multiple branches, including the Navy, Air Force and Army. For instance, we previously mentioned the Pregnancy Loss Awareness Network (PLAN) initiative, part of the Navy Fleet and Family Support Center, in the first installment of this series.
Moreover, each branch of the military provides New Parent Support Programs, which include home visitation support services for parents with children from birth to 36 months old. This program is a prime illustration of the various forms of assistance accessible to military families during the perinatal period. Military OneSource, Military & Family Life Counseling, and the Cohen Veterans Network are additional resources that provide links to behavioral health services specifically tailored for military communities.
By first cultivating cultural humility, awareness of the resources, and engaging in continuous learning, our efforts, combined with our expertise, can strengthen support and services for these courageous women and their loved ones.
Military service is noble and honorable for both active-duty members and dependent spouses. Yet, military-connected mothers often face unique challenges and stressors during pregnancy and postpartum, which can make for an isolating experience. As perinatal mental health clinicians, it is our responsibility to listen, provide support and resources, and advocate for equitable access to mental health care during this vulnerable time.
It is crucial that we make a conscious effort to empathize with and acknowledge the struggles and perspectives of these mothers, all while empowering them. Every mother deserves care and support as they fulfill pivotal roles in their families, workplaces and communities. Through our efforts, military-connected mothers experiencing perinatal mood and anxiety disorders will know they are not alone, and they are not to blame. And, with help, they will get better.
*This article is for informational purposes only and should not be taken as legal, financial, or medical advice. The views expressed are based on the authors and publicly available information and do not represent any official position or policy of an organization or institution.
About the Author
Shakima “Kima” Tozay, LICSW, PMH-C, CCM, CDP®
Shakima “Kima” Tozay, LICSW, PMH-C, CCM, CDP® is a mother to her son Jaxson, who was born stillborn due to complications related to Preeclampsia. She is a writer, speaker, military Veteran, and military spouse. She has over 17 years of experience serving the military and veteran community in various roles. Kima is a Clinical Social Worker with certifications in Perinatal Mental Health, Case Management, Diversity, Equity, and Inclusion. She is driven by the belief that everyone deserves access to health care that is respectful and equitable. In addition to volunteering with Postpartum Support International, she shares her story to raise awareness of the importance of integrating the patient voice in health research and quality improvement as a member of the Preeclampsia Foundation Patient Advisory Council and MoMMa’s Voices. When not volunteering, Kima enjoys hiking, writing, and taking road trips with her husband and furry side kicks where she finds peace walking along rocky beaches.
