Psyched Out

An often overlooked issue of social justice is the disparity in treatment for psychosis during pregnancy between poor or underinsured women and middle class privately insured women. An impoverished, pregnant and actively psychotic woman is among society's most vulnerable citizens. Yet doctors often will not prescribe the same medications for potentially deadly psychosis that they give for inconvenient nausea in pregnancy. This leaves pregnant women committed in locked facilities for weeks or months untreated, fully psychotic and incapable of directing their own medical tereatment. Incarceration is not treatment.

Psychosis is the most severe form of mental illness, often robbing its sufferers of recognition that they are ill. 4-10% of psychotic patients commit suicide. Unmedicated pregnant psychotic women run four times the risk of psychiatric hospitalization as those who take antipsychotics. Hospitalized women have twice or more the rate of stillbirth, infant death, premature birth and low birth weight. Antipsychotics are proven safe throughout pregnancy; several are routinely used to treat nausea. Mood stabilizers are safe after the first trimester, and one is proven safe throughout. The fact that middle class women with private insurance are not routinely committed and left untreated indicates that the lack of treatment of impoverished women is a case of social injustice, not prudent medicine.

This travesty could end. Widespread advocacy and education on the safety of antipsychotics and risks of witholding them would protect doctors and benefit patients. Networking could link women with doctors who will prescribe medications during pregnancy. Volunteer medical guardians enforcing the treatment preferences of psychotic women incapable of consent could be provided. Universal health care could reduce discrimination based on insurance and give poor women access to doctors with ethical treatment standards. This would prevent a woman from being held in a locked unit rather than medically treated until she gives birth, simply because she is poor.