The conversation about family planning and desire for children in mental healthcare 203 the patient to carry a pregnancy and become a parent. In other situations, MHPs valued the autonomy of patients in discussing family planning, or not. When asked about the preferred timing, a focus group participant explained that by asking it regularly, patients’ autonomy regarding when to have this conversation increases: ‘’Sure, you should ask for it, many people should. This way you can join in at all kinds of moments in your life or not. I mean, now they do this with the question: Do you ever think about ending your life? That is now a standard procedure in an intake.’’ (Woman, 40 years). In focus group conversations, participants explained that they had been occupied with merely surviving for so long, or with fighting symptoms, that they would only be ready to have the conversation after reaching a place of stability. Others were very decisive about not desiring children. They were not interested in having the conversation: ‘’No, it is not lacking, because for me it was a pretty done deal so… I had a very clear point of view [regarding desire for children], so there wasn’t a lot of doubt or need to talk to someone about this. I had it all figured out myself.’’ (Man, 37 years). 4. Need and responsibility Mental health problems influenced the desire for children in most patients (67.5%). However, family planning and desire for children were also not regarded as topics most patients and close ones needed to discuss: 36.6% of the patients felt a need to discuss family planning with an MHP, and 44.8% did not (others opted not applicable). A total of 40.9% of all patients agreed that psychiatrists should have a conversation about family planning with their patients in the reproductive phase of life, versus 64.0% of the MHPs. Table 8.4 presents reasons to agree or disagree with this statement according to MHPs, patients and close ones. In the focus groups, knowledge about transgenerational transmission of psychiatric vulnerability and family trauma were reasons a psychiatrist should ask about desire for children:
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