The conversation about family planning and desire for children in mental healthcare 205 Table 8.4 – (continued) Reasons for disagreement MHPs Patients Close ones Not always judged as necessary, mostly related to (severity of) psychiatric vulnerability Patient should take initiative in this conversation, not a psychiatrist Should only be discussed if patient expresses desire to discuss this topic Responsibility of other health professionals to discuss desire for children Theme is not part of a psychiatrist’s role Theme is not relevant to patients Patronization Theme is not relevant to patients Patient should take initiative in this conversation, not a psychiatrist Endangers therapeutic relationshipPatronization Lack of time Discussing desire for children can trigger traumatic experiences MHP, mental health professional. 5. Personalized content In the survey, patients, close ones and MHPs addressed various subjects to discuss in a conversation about desire for children and family planning (Table 5). In focus groups, impact of pregnancy on mental health of parent (to be), psychological consequences for offspring, contraceptive usage, transmission of psychiatric disorders, maternity, and fear to become pregnant were considered important topics in a conversation about family planning. In addition, participants first wanted to be asked with whom they wished to have a conversation about family planning and desire for children, and what this discussion should entail. Other topics for discussion were the desired amount of support for future parents, strengths of the family system, the impact of mental health issues on close ones and what conditions need to be met before becoming a parent. Last, MHPs could help patients to generate trust to live one’s life (with or without children). Most patients did not discuss contraceptive care with an MHP (86.6%) and had no desire to discuss it (84.0%), although a desire was more frequently reported by patients ≤45 years (12.8%) compared to patients >45 years (5.7%). This contradicts with MHPs who reported to discuss contraceptive care with patients in 58.3%. A fear of mandatory usage of contraceptive methods was clearly expressed in focus groups: ‘’But that is what they [MHPs] do and they do not listen. And they label you. And if you have that stigma then you feel that immediately. And if you hear these new political discussions about people mandatory this and mandatory that. Well then, I think be careful.’’ (Woman, age unknown).
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