The conversation about family planning and desire for children in mental healthcare 201 treatment is finished. This way you do not have time for [discussing] other things with an MHP.” (Woman, 40). And: “Then, at least, they help you to get rid of your problems, but with that you have not learned how to live and inquiring desire for children and providing information is part of that.” (Woman, 53). The MHP survey showed that obstacles experienced by MHPs were lack of time, lack of expertise and simply forgetting this topic. MHPs feared that discussing family planning would negatively impact the therapeutic relationship. According to patients and close ones, who shared their preferred attitude of an MHP in a survey question (see Supplementary file 8.2), MHPs should be openminded, neutral, advising, accepting, understanding, engaged, curious, honest, realistic, equal, informative, listening, critical, cooperative, positive, supportive and/or attentive when discussing family planning and desire for children. 3. Timing matters in a conversation about family planning and desire for children According to MHPs, MHPs initiated a conversation about family planning with some (55.4%) or many patients (26.6%) (see Table 8.2). According to patients and close ones, 23.1% had been invited by an MHP to talk about family planning at some point, and 30.6% had taken initiative to start a conversation about family planning themselves. Focus group participants clarified that the ability to initiate a conversation about family planning and desire for children depended on the severity of the mental health situation and stage of recovery. From their perspective, it was challenging to address this topic during a period of feeling mentally unwell: ‘’But because I was really very depressed and suicidal, I was in fact glad they were able to keep me alive. …So I was not used to be demanding at all too reflect on my needs ...But that was not stimulated.’’ (Woman, 62 years). And: ‘’In psychiatric healthcare they say ‘the sooner you ask for help the better’. And then I think, okay, apparently you, and those are people who work in psychiatric healthcare, have no idea how mentally healthy and strong you must be to get help at
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