I 

108TH CONGRESS 

1ST SESSION H. R. 846

To provide for research on, and services for individuals with, postpartum 

depression and psychosis. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 13, 2003

Mr. RUSH (for himself, Mrs. JONES of Ohio, Mr. GUTIERREZ, Ms. KAPTUR, 

Ms. SCHAKOWSKY, Mr. TOWNS, Mr. FATTAH, Ms. LEE, Mr. PAYNE, Mr. 

OWENS, Mr. MCDERMOTT, Mr. WAXMAN, Mrs. MALONEY, Mrs. CAPPS, 

Mr. JACKSON of Illinois, Ms. JACKSON-LEE of Texas, Ms. MILLENDERMCDONALD, Mr. OLVER, Mr. ENGEL, Ms. WOOLSEY, Mr. HINCHEY, Mrs. 

CHRISTENSEN, Mr. GEORGE MILLER of California, Mr. ISRAEL, Mr. KILDEE, Ms. MCCARTHY of Missouri, Mr. WYNN, Mr. CONYERS, Ms. CARSON of Indiana, Ms. NORTON, Mr. BOEHLERT, Mr. CUMMINGS, Ms. HARMAN, Mr. HOLDEN, Mr. DINGELL, Mr. MCNULTY, Mr. CASE, Mr. 

COSTELLO, Mr. DAVIS of Illinois, Mr. STARK, Mr. TIERNEY, Ms. 

DELAURO, Mr. ETHERIDGE, Mr. NADLER, Mr. LANTOS, Mr. WATT, Mrs. 

BIGGERT, Mr. BISHOP of Georgia, Mr. LAHOOD, and Mr. MORAN of Virginia) introduced the following bill; which was referred to the Committee 

on Energy and Commerce 

A BILL

To provide for research on, and services for individuals with, 

postpartum depression and psychosis.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,
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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Melanie Blocker3 Stokes Postpartum Depression Research and Care Act’’. 

4 SEC. 2. FINDINGS. 

5 The Congress finds as follows: 

6 (1) Postpartum depression is a devastating 

7 mood disorder which strikes many women during 

8 and after pregnancy. 

9 (2) Postpartum mood changes are common and 

10 can be broken into three subgroups: ‘‘baby blues,’’ 

11 which is an extremely common and the less severe 

12 form of postpartum depression; postpartum mood 

13 and anxiety disorders, which are more severe than 

14 baby blues and can occur during pregnancy and any15 time within the first year of the infant’s birth; and 

16 postpartum psychosis, which is the most extreme 

17 form of postpartum depression and can occur during 

18 pregnancy and up to twelve months after delivery. 

19 (3) ‘‘Baby blues’’ is characterized by mood 

20 swings, feelings of being overwhelmed, tearfulness, 

21 irritability, poor sleep, mood changes, and a sense of 

22 vulnerability. 

23 (4) The symptoms of postpartum mood and 

24 anxiety disorders are the worsening and the continu25 ation of the baby blues beyond the first days or 

26 weeks after delivery. 
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1 (5) The symptoms of postpartum psychosis in2 clude losing touch with reality, distorted thinking, 

3 delusions, auditory hallucinations, paranoia, hyper4 activity, and rapid speech or mania. 

5 (6) Each year over 400,000 women suffer from 

6 postpartum mood changes, with baby blues afflicting 

7 up to 80 percent of new mothers; postpartum mood 

8 and anxiety disorders impairing around 10–20 per9 cent of new mothers; and postpartum psychosis 

10 striking 1 in 1,000 new mothers. 

11 (7) The causes of postpartum depression are 

12 complex and unknown at this time; however, theories 

13 include a steep and rapid drop in hormone levels 

14 after childbirth; difficulty during labor or pregnancy; 

15 a premature birth; a miscarriage; feeling over16 whelmed, uncertain, frustrated or anxious about 

17 one’s new role as a mother; a lack of support from 

18 one’s spouse, friends or family; marital strife; stress19 ful events in life such as death of a loved one, finan20 cial problems, or physical or mental abuse; a family 

21 history of depression or mood disorders; a previous 

22 history of major depression or anxiety; or a prior 

23 postpartum depression. 

24 (8) Postpartum depression is a treatable dis25 order if promptly diagnosed by a trained provider 
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1 and attended to with a personalized regimen of care 

2 including social support, therapy, medication, and 

3 when necessary hospitalization. 

4 (9) All too often postpartum depression goes 

5 undiagnosed or untreated due to the social stigma 

6 surrounding depression and mental illness, the myth 

7 of motherhood, the new mother’s inability to self-di8 agnose her condition, the new mother’s shame or 

9 embarrassment over discussing her depression so 

10 near to the birth of her child, the lack of under11 standing in society and the medical community of 

12 the complexity of postpartum depression, and eco13 nomic pressures placed on hospitals and providers. 

14 (10) Untreated, postpartum depression can lead 

15 to further depression, substance abuse, loss of em16 ployment, divorce and further social alienation, self17 destructive behavior, or even suicide. 

18 (11) Untreated, postpartum depression impacts 

19 society through its affect on the infant’s physical 

20 and psychological development, child abuse, neglect 

21 or death of the infant or other siblings, and the dis22 ruption of the family.
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1 TITLE I—RESEARCH ON 

2 POSTPARTUM DEPRESSION 

3 AND PSYCHOSIS 

4 SEC. 101. EXPANSION AND INTENSIFICATION OF ACTIVI5 TIES OF NATIONAL INSTITUTE OF MENTAL 

6 HEALTH. 

7 (a) IN GENERAL.—The Secretary of Health and 

8 Human Services, acting through the Director of NIH and 

9 the Director of the National Institute of Mental Health 

10 (in this section referred to as the ‘‘Institute’’), shall ex11 pand and intensify research and related activities of the 

12 Institute with respect to postpartum depression and 

13 postpartum psychosis (in this section referred to as 

14 ‘‘postpartum conditions’’). 

15 (b) COORDINATION WITH OTHER INSTITUTES.—The 

16 Director of the Institute shall coordinate the activities of 

17 the Director under subsection (a) with similar activities 

18 conducted by the other national research institutes and 

19 agencies of the National Institutes of Health to the extent 

20 that such Institutes and agencies have responsibilities that 

21 are related to postpartum conditions. 

22 (c) PROGRAMS FOR POSTPARTUM CONDITIONS.—In 

23 carrying out subsection (a), the Director of the Institute 

24 shall conduct or support research to expand the under25 standing of the causes of, and to find a cure for, 
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1 postpartum conditions. Activities under such subsection 

2 shall include conducting and supporting the following: 

3 (1) Basic research concerning the etiology and 

4 causes of the conditions. 

5 (2) Epidemiological studies to address the fre6 quency and natural history of the conditions and the 

7 differences among racial and ethnic groups with re8 spect to the conditions. 

9 (3) The development of improved diagnostic 

10 techniques. 

11 (4) Clinical research for the development and 

12 evaluation of new treatments, including new biologi13 cal agents. 

14 (5) Information and education programs for 

15 health care professionals and the public. 

16 (d) AUTHORIZATION OF APPROPRIATIONS.—For the 

17 purpose of carrying out this section, there are authorized 

18 to be appropriated such sums as may be necessary for 

19 each of the fiscal years 2004 through 2006. 
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1 TITLE II—DELIVERY OF SERV2 ICES REGARDING 

3 POSTPARTUM DEPRESSION 

4 AND PSYCHOSIS 

5 SEC. 201. ESTABLISHMENT OF PROGRAM OF GRANTS. 

6 (a) IN GENERAL.—The Secretary of Health and 

7 Human Services (in this title referred to as the ‘‘Sec8 retary’’) shall in accordance with this title make grants 

9 to provide for projects for the establishment, operation, 

10 and coordination of effective and cost-efficient systems for 

11 the delivery of essential services to individuals with 

12 postpartum depression or postpartum psychosis (referred 

13 to in this section as a ‘‘postpartum condition) and their 

14 families. 

15 (b) RECIPIENTS OF GRANTS.—A grant under sub16 section (a) may be made to an entity only if the entity 

17 is a public or nonprofit private entity, which may include 

18 a State or local government; a public or nonprofit private 

19 hospital, community-based organization, hospice, ambula20 tory care facility, community health center, migrant health 

21 center, or homeless health center; or other appropriate 

22 public or nonprofit private entity. 

23 (c) CERTAIN ACTIVITIES.—To the extent practicable 

24 and appropriate, the Secretary shall ensure that projects 

25 under subsection (a) provide services for the diagnosis and 
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1 management of postpartum conditions. Activities that the 

2 Secretary may authorize for such projects may also in3 clude the following: 

4 (1) Delivering or enhancing outpatient and 

5 home-based health and support services, including 

6 case management, screening and comprehensive 

7 treatment services for individuals with or at risk for 

8 postpartum conditions; and delivering or enhancing 

9 support services for their families. 

10 (2) Delivering or enhancing inpatient care man11 agement services that ensure the well being of the 

12 mother and family and the future development of 

13 the infant. 

14 (3) Improving the quality, availability, and or15 ganization of health care and support services (in16 cluding transportation services, attendant care, 

17 homemaker services, day or respite care, and pro18 viding counseling on financial assistance and insur19 ance) for individuals with postpartum conditions and 

20 support services for their families. 

21 (d) INTEGRATION WITH OTHER PROGRAMS.—To the 

22 extent practicable and appropriate, the Secretary shall in23 tegrate the program under this title with other grant pro24 grams carried out by the Secretary, including the program 

25 under section 330 of the Public Health Service Act. 
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1 SEC. 202. CERTAIN REQUIREMENTS. 

2 A grant may be made under section 201 only if the 

3 applicant involved makes the following agreements: 

4 (1) Not more than 5 percent of the grant will 

5 be used for administration, accounting, reporting, 

6 and program oversight functions. 

7 (2) The grant will be used to supplement and 

8 not supplant funds from other sources related to the 

9 treatment of postpartum conditions. 

10 (3) The applicant will abide by any limitations 

11 deemed appropriate by the Secretary on any charges 

12 to individuals receiving services pursuant to the 

13 grant. As deemed appropriate by the Secretary, such 

14 limitations on charges may vary based on the finan15 cial circumstances of the individual receiving serv16 ices. 

17 (4) The grant will not be expended to make 

18 payment for services authorized under section 

19 201(a) to the extent that payment has been made, 

20 or can reasonably be expected to be made, with re21 spect to such services—

22 (A) under any State compensation pro23 gram, under an insurance policy, or under any 

24 Federal or State health benefits program; or 

25 (B) by an entity that provides health serv26 ices on a prepaid basis. 
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1 (5) The applicant will, at each site at which the 

2 applicant provides services under section 201(a), 

3 post a conspicuous notice informing individuals who 

4 receive the services of any Federal policies that 

5 apply to the applicant with respect to the imposition 

6 of charges on such individuals. 

7 SEC. 203. TECHNICAL ASSISTANCE. 

8 The Secretary may provide technical assistance to as9 sist entities in complying with the requirements of this 

10 title in order to make such entities eligible to receive 

11 grants under section 201. 

12 SEC. 204. AUTHORIZATION OF APPROPRIATIONS. 

13 For the purpose of carrying out this title, there are 

14 authorized to be appropriated such sums as may be nec15 essary for each of the fiscal years 2004 through 2006.

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