As ambivalent or decisive as they have felt, psychiatrists have engaged in a formalized, sometimes cynical ritual of providing women with safe care. Dr. Alan F. Guttmacher, former president of Planned Parenthood, wrote that more than 85% of abortions performed at Mt. Sinai Hospital in the mid-1950s (when he chaired the OB-GYN department) “at least broke the law , if they didn’t fracture it.
In the year before the Roe decision, maternal mental health was the most common indication for an in-hospital abortion, accounting for more than 85% of all cases in the 12 states that reported the stated reason. of abortion, according to the government’s annual abortion monitoring summary. .
The Roe case saved psychiatry from these dilemmas. It spared a woman the degrading ordeal of lying about her sanity and the prospect of being branded a “manipulative and fake” if her deception failed or she was questioned by an unsympathetic or conflicted doctor.
Today, as the nation seems to be heading into a post-Roe world, we don’t know exactly what kind of patchwork of restrictions will be applied in different states. Oklahoma Gov. Kevin Stitt has already signed a bill whose wording seems purposefully designed to take psychiatry out of the picture. The state’s new abortion ban excludes a life-threatening ‘medical emergency’ resulting from a ‘physical disorder, physical illness, or physical injury, including a life-threatening physical condition at risk caused by or resulting from the pregnancy itself”.
Presumably, some states will have a mental health exception to their abortion laws, but there is only a patchy network of psychiatrists to meet potential needs. According to a 2015 estimate based on data from the Bureau of Labor Statistics, there are 76% more psychologists or psychiatrists per capita in blue states than in red states. According to a 2017 report, approximately 60% of counties in the United States, including 80% of rural counties, do not have a single practicing psychiatrist. Most of us are in the northeast and some counties along the west coast.
Telepsychiatry and reciprocal licensing laws could allow out-of-state psychiatrists to perform assessments and thus compensate for their skewed national distribution. It will also depend on the restrictiveness of the state in which the woman lives, particularly whether criminal liability is extended to those who counsel the women or coordinate with the doctor who would terminate the pregnancy.
I live in Washington, DC, which will surely take a liberal approach. But if I was asked to assess a woman seeking an abortion, I would apply a broad definition of mental health. Where state law limited its definition of “mental health,” I would follow the law.