Bridging Maternal Mental Health Gaps

Tina Keshani:
First symptoms of anxiety, depression actually start during pregnancy. And the realities of how our healthcare system is set up today is we're not screening those patients until postpartum. So yes, we do often think about postpartum being the time when we're identifying those needs and challenges, but it actually does most often start much, much sooner.

Jennifer Sargent:
Welcome to Maternity Reimagined​, a podcast exploring the future of maternal healthcare through the lens of innovation and human connection. I'm Jennifer Sargent. In each episode, I'll be speaking with healthcare leaders, providers, and changemakers who are working to transform how we support expecting parents and families. From hybrid care models and emerging technologies to policy shifts and real world solutions, we'll uncover insights that are shaping a more connected, accessible future for maternal care.
Whether you're a healthcare leader, provider, or just passionate about advancing maternal health, this podcast is for you. Join me as we reimagine what maternal healthcare can and should be. Hi, I'm your host, Jennifer Sargent, and I'm here with Tina Keshani, co-founder and CEO of Seven Starling, a leading virtual provider of women's behavioral health services supporting every stage of motherhood.
Seven Starling's holistic clinical model combines specialized therapy, peer support, and medication management to effectively treat common perinatal mood disorders like postpartum depression and anxiety, with over 90% of patients seeing a clinically significant improvement in their symptoms after completing the program, which is incredible. And best of all, they're covered by insurance. Tina, thank you for joining me today.

Tina Keshani:
Thank you for having me. I'm so excited for this conversation, Jennifer.

Jennifer Sargent:
Yes, as am I. Before we get started with some specific questions, can you just share with our listeners a little more about Seven Starling's origin story and your personal mission behind why you started the organization?

Tina Keshani:
Yes, of course. So I'm really excited to be chatting with you today. I'm sure we'll talk about it in a second, but May is Maternal Mental Health Month. So we are in full gear celebrating the mission and all the impact that we're having on our patients and providers. Really, for me, the mission has started from the very, very beginnings of starting the company. My co-founders, Julia, Sophia, and I met while we were studying at business school together.
And really what brought us together was our passion for innovating in the women's health space. And up until that point, each of us have had a challenging, confusing journey through navigating through the healthcare system, as I'm sure many other women can relate to. And we were looking forward to our own motherhood journeys and knew that things are probably not going to get much easier.
We all had our own very close family and friends go through the motherhood experience, and we're just always so shocked that to hear just how different their experiences have been and how there's really such a lack of support out there for expecting new moms and especially as we think about the postpartum period. So that was really the early, early beginnings. And fast-forward, we've been running the company for five years.
I've been through my own motherhood journey, lots of ups and downs. I have a one-year-old daughter, her name is Daria. And before having her, I've gone through miscarriage, loss, all the things to get on other side. And I've been so fortunate to have Seven Starling as a resource. And truly what drives me today and my why for the company is making sure every woman, just like myself, has access to that resource when she needs it.

Jennifer Sargent:
That's great. Thank you for sharing. I often say that becoming a mom was one of the hardest, most wonderful, but hardest things I've done. And I particularly think that postpartum period is such a important time for there to be great support for new parents. So that's great.

Tina Keshani:
Yes, I totally agree. Yeah, and it is the most fulfilling, meaningful part of my life, balances out and fills gaps that I never thought existed, but certainly a huge transition. And I think one that, especially as working mom, a mom who doesn't have family nearby, my parents live in Ohio, I live in DC area, I think having that additional support has been really valuable.

Jennifer Sargent:
You mentioned that May is Maternal Mental Health Month, so this is timely that we're chatting now. Can you share a little bit about what you think the biggest challenges in maternal mental health are right now?

Tina Keshani:
Yes, absolutely. So just starting from the very high level numbers, today about one in five women struggle with perinatal mood and anxiety disorder. About 75% of women who are diagnosed with these conditions never get treated. So we have so many women who are never getting connected to that support, and that's really the problem that we're trying to solve at Seven Starling. And when we really dug into what were the driving issues there, we found a few different things.
So number one, most of the patients that we work with have to wait over three to six months to see a therapist. I mean, that alone is just fully unsustainable. And in our patient population where especially patients who are struggling with postpartum depression or experience a traumatic birth experience, they cannot wait. Their symptoms can become really severe really quickly.
And so getting that timely care is just absolutely critical. The other piece of the puzzle is that most therapists don't accept insurance. So even if you're willing to wait that long, you might not be able to afford care. And again, that is just so fundamental to be able to really move the needle and the mission is ensuring that patients and our moms have access to timely and affordable care.
And then finally, there are so many women straight up just falling through the cracks. So today, only 20% of women are getting screened by their OB-GYN for mental health conditions. And it's not because there isn't a process around this, it's already mandated by ACOG, it is a HEDIS measure, but OB-GYNs just don't have a reliable resource to refer their patients to.
And so what are they going to do when a patient screens high? And so that is really where we come into play is making sure that we connect directly with OB-GYNs across the country and other women's health providers and making sure that we're there at the time of diagnosis and can provide that timely, affordable, seamless care.

Jennifer Sargent:
You talk a little bit about providers and the need for this resource. I know you as a part of your model working with providers is really important. Can you share feedback you're getting from the providers and how that's working?

Tina Keshani:
Yeah, absolutely. So just to share some background, we from the very beginning have built Seven Starling in mind that we are going to be partnering directly with OB-GYNs and women's health providers, clinics, hospitals to make sure that we are a great referral source and a seamless referral source at the time when a patient starts to experience symptoms. So from the very beginning, we've built technology and workflows and built our team around this idea.
And we now have over 1,500 actively referring OB-GYNs across the country, across over 500 clinics, across over 40 hospitals. And we're so proud of this because unlike in most companies where the patient has to really seek out that resource, we are really priding ourselves on meeting the patient where she's at. And that really starts with their OB-GYN oftentimes during that sixth week visit when hopefully your OB-GYN is providing you with that screen, but also an opportunity to start that conversation of how are you doing?
Do you have the support you need? How are you feeling? And just really begin that conversation and get connected. And one of the fundamental pieces that has been so successful for us is that we've actually developed and built an experience that is so seamless, we're referring providers to use. So we integrate into their EMR. We do all the follow-up after that referral is made with patient directly. We text. We call. We do all the heavy lifting to make sure patient gets into care.
And then once they're established in care with us, we provide ongoing reporting to the OB about how their patient is doing, how they're progressing, how their outcomes are improving. And that is just a really nice way to build that trust with the provider, but also to make sure that that patient is having a really collaborative experience where their provider knows how they're progressing with their mental health care as well.

Jennifer Sargent:
Yeah, I think that's so great. I know just in our business, as we think about our doulas and lactation consultants, one of our biggest challenges has always been when we identify a member with a need, we just haven't had anywhere to send them to get really timely and good care. So it sounds like your providers and us as your partners, this is just such a tremendous value that you're providing.

Tina Keshani:
Oh yeah, absolutely. And similarly, we're really excited. I mean, I know I'm sure we'll talk about it in a second, but to be partnering a Pacify, one of the pieces that we always get asked about, especially in the mental health care journey, is do you have recommendations for lactation consultants?
Or as I'm preparing to give birth, and we have patients who are going through a pretty anxious journey in their pregnancy, how do I get connected with a doula? And these are just such complimentary experiences where, yes, we're treating the mental health component of course, but that doesn't mean the resources have to stop there.

Jennifer Sargent:
Exactly. I'm going to switch gears just a little bit. We talked about this early on. When people think about maternal mental health, they automatically think of the postpartum period, and we do obviously see a lot of needs during that period. But can you share more about what you see maternal health needs are across the entire perinatal journey?

Tina Keshani:
Absolutely. So first and foremost, yes, we support patients during the postpartum period. Actually, we think about postpartum as the first year after your baby's born, not just three months. I mean, most of our patients actually join us after the first three months because oftentimes even those first weeks, you're just in a haze. You have no idea. Is this postpartum depression?
Is this baby blues? What am I even feeling, experiencing? Like when I became a Seven Starling patient, that really happened after the first few months after my baby was born. So really for us, it's just even redefining postpartum in and of itself, but we actually treat patients as Seven Starling through the whole motherhood spectrum. That's what we like to refer it to.
And that really is the whole journey from fertility to pregnancy, miscarriage and loss, postpartum, again, first year, and then early parenthood, which is up to two years after your baby is born. So really, it's that entire journey. And as you can imagine, each of those phases and stages are so unique in terms of what you are experiencing and what your mental health needs are. The other really important thing to highlight is that a really large portion of our patients are pregnant.
And oftentimes those first symptoms of anxiety, depression actually start during pregnancy. And the realities of how our healthcare system is set up today is we're not screening those patients until postpartum. So yes, we do often think about postpartum being the time when we're identifying those needs and challenges, but it actually does most often start much, much sooner.
And so what I'm really excited about is how Seven Starling can actually support and identifying those symptoms earlier on, helping some of our referring guiders actually work with patients and having is conversations sooner, and navigating them to care before their symptoms get much worse. And so that is just one of the major realities of the journey that we support.
And the other piece is that most women who are experiencing these conditions, about 50% actually have had other mental health challenges in the past. So if you are someone who has experienced anxiety, depression, other mental health conditions and challenges, it's worth thinking about getting a resource in place sooner than later just to make sure that you're set up for success.
And so really for us, it's kind of that entire journey. And of course, your journey through parenthood informs a lot about how you're going to feel through the evolution of your pregnancy and into postpartum. If you've experienced a loss or a miscarriage, or you've had a difficult time getting pregnant, all of those things are going to inform your experience. And again, more support is going to go a long way.

Jennifer Sargent:
I can imagine if you're able to work with an expectant parent before they give birth, it helps to prepare them for that postpartum journey and understand, especially if it's their first time going through it, what they might expect, symptoms to watch for. Do you get some of that opportunity and see some of those results?

Tina Keshani:
Absolutely, and we encourage that so much. And actually, a big part of it is that once you are a new mom, you are balancing so many things at once. You are barely sleeping. You are figuring out breastfeeding. You probably have very little time for yourself, let alone to find a resource. And so we actually encourage moms to get signed up sooner than later.
Because by the time baby's there, it's just hard to carve out that time or even make the time and space to just sign up for care. Oftentimes the biggest step... We always celebrate our patients on when they actually reach out to seek help, because that's actually the hardest part is taking that step. And so just having the support system in place is incredibly helpful when you're in those really, really early postpartum days.

Jennifer Sargent:
So Tina, as you think about your use of technology and virtual care, I think one of the things we've certainly been watching and looking at is the role that technology can use to expand access, particularly in rural areas where there's maternal care deserts. Can you share a little bit about how you're thinking about that, what impact you're seeing there?

Tina Keshani:
Oh gosh, absolutely. Well, this is so huge and fundamental for us, and we've really seen the impact in a number of different ways. Actually, literally just last week, I got a note from one of our referring providers that literally said, "Seven Starling has been such a critical support system," because in their rural area in Texas, they have no resource to share with their patients.
And it's been such a lifesaver for them to be able to refer to us and make sure they're getting really good high-quality care. And so that's just one of many examples of how as a virtual provider, we can show up for those patients and for those OB-GYNs that want to do the right thing, that want to be screening, having those difficult conversations, but just don't have the resources. And so that's been absolutely amazing to show up in those ways.
And actually we've been pretty focused as we've expanded geographically on those more rural areas, not the coastal cities, but really thinking about where we can bridge those gaps and have had so much success there. What I will say is one of the really unique parts of our model is not just connecting our patients with specialized therapists, but also connecting patients with a small group of other women in the same stage.
And oftentimes, especially in a rural area, you might not know who's around going through the same thing. You might not be going through the same journey with a friend or someone that you're able to really open up to. And so that additional support via community through this virtual lens is so helpful to just hear that you're not alone and to really be in community in that way and get that additional peer support.
And so again, it's not just the access to care, but it's access to community through this really unique resource. Last but not least, it's also covered by insurance. You don't have to necessarily seek out a local provider in your town that accepts your insurance. We really accept it all. And now Medicaid as well.

Jennifer Sargent:
Last question. So as you are in the space and understand broader maternal health, outside of mental health specifically, what other opportunities do you think there are to reimagine maternal care?

Tina Keshani:
Yeah. Well, I will speak to our partnership because I think that it's so exciting. There are so many areas of maternal health and the needs around maternal health and gaps where I think collaboration and partnership goes a long way. And so as I said, oftentimes mental health issues can come up with feeding challenges. And so we get so many of our patients asking about resources for lactation support and just working through...
Oftentimes that's a very difficult journey. I know I leaned a lot on my lactation consultant, and she was a major resource for me. And so I think it goes hand in hand. And then again, working with doulas during the birthing process can be such an additional support system as you're going through what often can be for 40% of women a traumatic experience. Let's be upfront about that.
And so having that person in the room that's advocating for you, that's supporting you along the way, that's helping you navigate some of those really tricky questions and decisions, again, can be monumental in terms of outcomes. And so I think there is so much we can do in terms of partnering together. The way I love to think about women's health is that it's not a monolith.
No company can do everything. And that certainly hasn't been the case in other parts of healthcare. So why should we accept that as women? And so really where I see so much potential in innovation is around partnerships where we can really fill the gaps together. And finding like-minded, outcomes-driven companies that are focused on providing great experiences is a great place to start.

Jennifer Sargent:
Couldn't agree more. Well, Tina, I think our listeners are going to really enjoy this conversation. Thank you for the important service that you and Seven Starling and your team and providers provide to our new and expectant parents. And just thank you for taking time today.

Tina Keshani:
Of course. Thank you so much. And Happy Maternal Mental Health Month.

Jennifer Sargent:
Yes, you too. Thank you for listening to Maternity Reimagined. I'm your host, Jennifer Sargent. If today's conversation resonated with you, please subscribe and listen wherever you get your podcasts. And be sure to share this episode with those who, like us, are passionate about reshaping the future of maternal health. Until next time, as we continue to build bridges and transform maternal care together.