to private insurers for prenatal and postpartum mental health treatment. 4
The PCMMH defines“ Maternal Mental Health Dark Zones” as counties with a Risk Factor Score( RFS) of 25 or higher and a Provider / Program Shortage Gap( PSG) of three or more. 5 In 2025, the number of Dark Zones nationwide decreased from 157 to 146. 5 Several high-risk, low-resource counties in Kentucky were identified, including Jefferson, Hardin, Christian, McCracken, Pulaski, Laurel and Pike. 5 The PSG calculation estimates the number of additional maternal mental health providers and programs needed to meet county needs, with one provider or program required per 200 births. 5 For example, Jefferson County, with a risk factor score of 29, would need 28 more providers to eliminate its shortage. 5
The PCMMH identified several counties in Kentucky with severe risk, including Bell, Laurel, Harlan and Knox. 5 Counties assigned this category demonstrated“ increased rates of domestic violence, lack of emotional support, parental unemployment, poverty, low educational attainment, high rates of unintended pregnancy, single motherhood, teen births and preterm births. More women also reported poor mental health and struggles coping with child-rearing.” 5, 6 These severe risk counties are predominantly rural and continue to demonstrate steady birth rates without adequate resources to meet maternal mental health needs. 5
The state of Kentucky is not immune to health disparities. Rural areas of Kentucky are disproportionately affected, as access to appropriate care may not be feasible, or might require lengthy trips. 2 On a national level, maternal mortality negatively impacts Black women, with a rate that is estimated to be approximately two to three times greater than white women. 2 In Kentucky, the Black maternal death rate is approximately twice the rate of white maternal death rate from any cause. 2
Advocacy and quality improvement metrics have been the mainstay of perinatal mental health promotion. At the time of writing, there are six live bills addressing various aspects of maternal mental health in Kentucky. 7 Three of six live bills are aimed at addressing postpartum depression awareness, mental health coverage in connection with pregnancy and coverage for the treatment of postpartum mood disorders. 7 The Kentucky Perinatal Quality Collaborative was established in 2019 as a statewide network of hospitals and other stakeholders to collect data, improve the quality of care and reduce maternal mortality / neonatal abstinence syndrome. 8 While the state continues to slowly improve, there is still work to be done, and a greater emphasis should be placed on access and collaboration during the perinatal period.
The state of Kentucky is lucky to have introduced its very own Perinatal Psychiatric Access Program, KyCOMPASS( Kentucky Consultation and Outreach for Maternal Psychiatry and Support Services). Perinatal Psychiatry Access Programs aim to improve workforce capacity to deliver mental health and substance use disorder care for women during the perinatal period. KyCOMPASS is a free-of-charge service available to clinicians and staff within Kentucky who may need guidance for the management of mental health conditions in the perinatal population. While KyCOMPASS does not offer direct patient care, the program provides assistance with diagnosis, treatment planning, medication management and local mental health resources for patients. The program also facilitates connecting the patient with a mental health clinician and / or therapist more quickly, further eliminating wait times and the added stress of finding a clinician. The KyCOMPASS consultation service launched December 1, 2025. For more information about KyCOMPASS, go to kycompass. org.
References
1
Bastos MH, Furuta M, Small R, McKenzie-McHarg K, Bick D. Debriefing interventions for the prevention of psychological trauma in women following childbirth. Cochrane Database Syst Rev. 2015 Apr 10; 2015( 4): CD007194.
2
Kentucky Department for Public Health( KDPH). Maternal Mortality Review 2024 Report. Frankfort, Kentucky: Cabinet for Health and Family Services, Kentucky Department for Public Health, 2017-2021 Cohort data.
3
Policy Center for Maternal Mental Health.( 2025, September). Maternal Suicide in the U. S.: How the Government is Improving Data Collection and Continued Opportunities for Health Care System Change [ Issue Brief ]. https:// policycentermmh. org / maternal-suicide-issue-brief-2025 /
4
Policy Center for Maternal Mental Health.( 2025, May). Maternal Mental Health State Report Card( 2025). https:// www. policycentermmh. org / state-report-cards
5
Policy Center for Maternal Mental Health( 2025, May). 2025 U. S. Maternal Mental Health Risks and Resources by County. https:// policycentermmh. org / 2025-usmaternal-mental-health-risk-and-resources /
6
Policy Center for Maternal Mental Health.( 2024, September). Maternal Suicide in the U. S.: Opportunities for Improved Data Collection and Health Care System Change [ Issue Brief ]. https:// policycentermmh. org / maternal-suicide-issue-brief /
7
Policy Center for Maternal Mental Health.( 2025). Live Bills Addressing Maternal Mental Health. https:// policycentermmh. org / live-bills-addressing-maternal-mental-health /
8
Kentucky Injury Prevention and Research Center. The Kentucky Perinatal Quality Collaborative. https:// kiprc. uky. edu / programs / kentucky-perinatal-quality-collaborative-kypqc.
Chelsae Nugent is a third-year medical student at the University of Louisville School of Medicine and former Women’ s Health Nurse Practitioner.
Dr. Audrey Summers is an Assistant Professor of Psychiatry at the University of Louisville and serves as the director of Women’ s Mental Health and Reproductive Psychiatry. She also serves as the medical director for KyCOMPASS, which is Kentucky’ s first and only perinatal mental health access program.( non-member)
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