Chapter 8 202 all. And not think: ‘well never mind, I don’t even dare to, I am not going anymore.’’’ (Woman, 40 years). Table 8.3 - Obstacles and catalysts appointed by patients and close ones. Obstacles Patients Close ones Fear of judgement and condemnation by the MHP, fear of being seen as a bad parent/unable to raise a child or being rejected in therapy Topic too sensitive Feeling vulnerable talking about a topic so sensitive, which could lead to avoidance No space/room for conversation offered by MHP The topic of desire for children was associated with taboo and stigmatization Feelings of shame Feelings of shame to discuss desire for children as the conversation inevitably addresses vulnerabilities of the patient There was no room for discussion of this topic in treatment Catalysts Patients Close ones Initiative comes from MHP Desire for children as a routine topic of discussion Desire for children as a routine topic of discussion Knowledge about desire for children in relation to psychiatric vulnerability is necessary Conversation should be open with a safe space to speak freely Professional and empathic attitude Knowledge transfer about desire for children in relation to psychiatric vulnerability Normalisation of the topic and acceptance irrespective of which reaction patient gives MHP, mental health professional. In case of prescriptions of medication, a desire for children was often not considered: 30.2% of the patients never talked about family planning when medication for psychiatric symptoms was prescribed (see Table S2). Focus groups illustrated that for patients, timing of the conversation about family planning and desire for children was important. For instance, patients felt it should be addressed briefly at every intake, it should be discussed more in-depth if relevant (when there was an actual desire for pregnancy), and a trustful relationship between the MHP and patient should first be established. Some patients argued that they should feel mentally stable (enough), and not in crisis. MHPs reported that discussing family planning depended on the age and life phase of the patient. It should only be discussed if relevant (patient was sexually active, had a life partner, it was relevant for the treatment). Different from the patient perspective, MHPs felt a need to address when they had concerns about the ability of
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