Patients' Perception of Possible Child Custody or Visitation Loss for Nonadherence to Psychiatric Treatment

Busch, Alisa B.; Redlich, Allison D.

doi:10.1176/appi.ps.58.7.999

Cited by 18 publications

(6 citation statements)

References 19 publications

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“…MHPs tend to rely on relatives who are “allowed” to raise severe doubts on the appropriateness of a relative’s desire for children. This finding is in line with results from a study with outpatients which found that one in five mothers perceived that she might lose child custody or visitation rights if she did not adhere to the treatment - 2/3 of them perceived family members as the source of such messages [ 28 ]. De-professionalisation also means that MHPs, rather than relying on guidelines or recommendations, refer to their “private” attitudes when dealing with the desire for children.…”

Section: Discussionsupporting

confidence: 85%

The attitudes of mental health professionals towards patients’ desire for children

et al. 2014

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BackgroundWhen a patient with a serious mental illness expresses a desire for children, mental health professionals are faced with an ethical dilemma. To date, little research has been conducted into their strategies for dealing with these issues.MethodsSeven focus groups with a total of 49 participants from all professional groups active in mental health (nurses, psychologists, social workers and psychiatrists) were conducted in a 330-bed psychiatric hospital. Group discussions were transcribed verbatim and analysed by the documentary method described by Bohnsack.ResultsMental health professionals did not feel that their patients’ desire for children was as important in daily practice as were parenting issues. When discussing the desire for children on the part of patients, the following themes emerged: “the patient’s own decision”, “neutrality”, “the patient’s well-being”, “issues affecting the children of mentally ill parents” and “appropriate parenthood”. In order to cope with what they perceived as conflicting norms, mental health professionals developed the following (discursive) strategies: "subordination of child welfare", "de-professionalisation", "giving rational advice" and "resignation".ConclusionsThe theme of “reproductive autonomy” dominated mental health professionals’ discourse on the desire for children among psychiatric patients. “Reproductive autonomy” stood in conflict with another important theme (patient’s children). Treating reproductive issues as taboo is the result of the gap between MHPs’ perceptions of (conflicting) norms when dealing with a patient’s desire for children and the limited opportunities to cope with them appropriately.In order to support both patients with a desire for children and mental health professionals who are charged with providing counselling for such patients, there is a need to encourage ethical reflection and to focus on clinical recommendations in this important area.

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Section: Discussionsupporting

confidence: 85%

The attitudes of mental health professionals towards patients’ desire for children

et al. 2014

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“…This difference is more pronounced when childcare and access leverage is removed (overall leverage 31% of English participants, 9% with more than one form) as this was not reported in the US reference paper, although it has been reported subsequently from the same sample. 13 Formal coercion in the community was available in the USA but not in the English context at the time of the study. It was experienced by 12–20% of the US sample 4,14 but, as it is formal coercion, is not included in our comparison with the US study.…”

Section: Discussionmentioning

confidence: 99%

Pressures to adhere to treatment (‘leverage’) in English mental healthcare

et al. 2011

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BackgroundCoercion has usually been equated with legal detention. Non-statutory pressures to adhere to treatment, ‘leverage’, have been identified as widespread in US public mental healthcare. It is not clear if this is so outside the USA.AimsTo measure rates of different non-statutory pressures in distinct clinical populations in England, to test their associations with patient characteristics and compare them with US rates.MethodData were collected by a structured interview conducted by independent researchers supplemented by data extraction from case notes.ResultsWe recruited a sample of 417 participants from four differing clinical populations. Lifetime experience of leverage was reported in 35% of the sample, 63% in substance misusers, 33% and 30% in the psychosis samples and 15% in the non-psychosis sample. Leverage was associated with repeated hospitalisations, substance misuse diagnosis and lower insight as measured by the Insight and Treatment Attitudes Questionnaire. Housing leverage was the most frequent form (24%). Levels were markedly lower than those reported in the USA.ConclusionsNon-statutory pressure to adhere to treatment (leverage) is common in English mental healthcare but has received little clinical or research attention. Urgent attention is needed to understand its variation and place in community practice.

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“…This includes proper diet, a healthy sleep schedule, an exercise program, regular physician and mental health visits, and adherence to a prescribed regimen of medication. When questioned, most mothers with schizophrenia do understand that custody can be lost if prescribed treatment for their condition is not adhered to [ 26 ].…”

Section: Preventing Custody Loss: Recommendations For Mothers Andmentioning

confidence: 99%

“…When women deny psychiatric illness, the intense desire to retain custody of their children can be used as a form of leverage, a controversial but effective strategy [ 26 – 28 ].…”

Section: Preventing Custody Loss: Recommendations For Mothers Andmentioning

confidence: 99%

Intervention to Prevent Child Custody Loss in Mothers with Schizophrenia

Seeman

2012

Schizophrenia Research and Treatment

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Depending on jurisdiction, time period studied, and specifics of the population, approximately 50 percent of mothers who suffer from schizophrenia lose custody of their children. The aim of this paper is to recommend interventions aimed at preventing unnecessary custody loss. This paper reviews the social work, nursing, psychology, psychiatry, and law literature on mental illness and custody loss, 2000–2011. Recommendations to mothers are to (a) ensure family health (b) prevent psychotic relapse, (c) prepare in advance for crisis, (d) document daily parenting activities, (e) take advantage of available parenting resources, and f) become knowledgeable about legal issues that pertain to mental health and custody. From a policy perspective, child protection and adult mental health agencies need to dissolve administrative barriers and collaborate. Access to appropriate services will help mothers with schizophrenia to care appropriately for their children and allow these children to grow and develop within their family and community.

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Patients' Perception of Possible Child Custody or Visitation Loss for Nonadherence to Psychiatric Treatment

Cited by 18 publications

References 19 publications

The attitudes of mental health professionals towards patients’ desire for children

The attitudes of mental health professionals towards patients’ desire for children

Pressures to adhere to treatment (‘leverage’) in English mental healthcare

Intervention to Prevent Child Custody Loss in Mothers with Schizophrenia

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