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Introduction
In the United States, one in five pregnant and postpartum people experience mental health and substance use conditions.1 As a result, many counties face elevated risks for poor maternal mental health outcomes.2 Maternal mental health conditions have significant social implications, reducing the quality of life for both parent and child. These conditions carry economic costs as well; the estimated financial toll of untreated conditions is $14 billion annually due to a loss of productivity.3 Counties play a critical role in addressing these challenges through local public health infrastructure, community partnerships and service delivery.4
County Role in Maternal Mental Health
- Deliver public health and behavioral health services for pregnant and postpartum people
- Integrate mental health and substance use treatment within broader health systems
- Lead outreach, education and early identification efforts
- Coordinate crisis response and support services across agencies
- Address social and structural determinants that affect maternal health outcomes
County Examples
Placer County, Calif. operates a perinatal substance use services program that provides safety-net care offering numerous services, including substance use treatment, counseling, education, childcare and transportation. The model emphasizes individualized care and helps connect participants to appropriate treatment pathways. The program has doubled its client capacity in recent years, improving continuity of care for high-risk populations.5
Kent County, Mich. developed the Perinatal Mood & Anxiety Disorders Coalition, comprising over a dozen healthcare professionals, therapists, individuals impacted by mental health conditions and other local representatives. The coalition, active since 2007, brings together representatives from all three local hospitals along with community organizations and individuals with lived experience. It meets monthly to coordinate re
Washington County, Vt. created the Doula Project to provide evidence-based, non-judgmental support to pregnant and parenting individuals facing mental health concerns, substance use disorders and other complications. The program delivers prenatal, labor and postpartum support to people at high risk for maternal mental health and substance use complications through tailored services such as home visits, transportation to appointments and emotional support throughout the pregnancy process.7 In an eight-month period, the project connected with over 100 families in a county that averages roughly 250 births annually and has since served as a model for Vermont’s statewide effort to expand Medicaid coverage for doula services.
Key Strategies for Counties
- Implement coordinated screening processes to identify needs early through healthcare and community touchpoints
- Develop individualized treatment that reflects clinical needs and social circumstances
- Convene cross-sector coalitions to align providers, stakeholders and community resources
- Expand access to home-based and holistic service models that meet families where they are
This content is intended for educational purposes only. The National Association of Counties (NACo) supports policies and programs that equip county governments with the reot endorse any particular strategy or approach shared in this reheAmerican County Platform
References
1. Fawcett EJ, Fairbrother N, Cox ML, White IR, Fawcett JM | The prevalence of anxiety disorders during pregnancy and the postpartum period: a multivariate Bayesian meta-analysis. J Clin Psychiatry. 2019;80(4):18r12527. https://pubmed.ncbi.nlm.nih.gov/31347796/ |
2. Policy Center for Maternal Mental Health | 2025 U.S. Maternal Mental Health Risks and Re/2025-us-maternal-mental-health-risk-and-re |
3. Luca, D. L., Margiotta, C., Staatz, C., Garlow, E., Christensen, A., & Zivin, K | Financial Toll of Untreated Perinatal Mood and Anxiety Disorders Among 2017 Births in the United States. American Journal of Public Health, 110(6), 888-896. https://doi.org/10.2105/AJPH.2020.305619 |
4. O’Neil SS, Platt I, Vohra D, Pendl-Robinson E, Dehus E, Zephyrin L, et al | The High Costs of Maternal Morbidity Show Why We Need Greater Investment in Maternal Health. The Commonwealth Fund; Published November 12, 2021. https://www.commonwealthfund.org/publications/issue-briefs/2021/nov/high-costs-maternal-morbidity-need-investment-maternal-health |
5. Placer County Health and Human Services | Perinatal Substance Use Services. https://www.placer.ca.gov/2195/Perinatal-Substance-Use-Services |
6. Kent County Health Connect | Perinatal Mood & Anxiety Disorders Coalition. https://kentcountyhealthconnect.org/healthy-kent/perinatal-mood-anxiety-disorders-coalition/ |
7. Vermont Care Partners | Washington County Mental Health Services. Updated November 21, 2025. https://vermontcarepartners.org/agencies/washington-county-mental-health-services/ |
Tagged In:
- Human Services,
- Behavioral Health
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