Chapter 8 206 One participant considered it valuable if an MHP asked her about contraceptive usage, menstrual cycle and desire to have children. She added that she continued birth control to prevent monthly bleeding, as the hormonal changes were too confronting for her: ‘’And perhaps that is a reason why I continued it [birth control pills] since I was eighteen. I can barely manage it. So there has never been anyone who asked me, well, how does that feel? And do you still support this, would you like guidance?’’ (Woman, 29 years). The perceived taboo on discussing sexuality or sexual side effects of medication were also highlighted in focus groups: ‘’You are in a relationship which is already under pressure, yes and one of the most fun aspects of being in a relationship, sex and intimacy, yes intimacy not that much because that continues, but… The technical sexuality is gone. Right at the time you need something like that to keep things going on between each other. And I think it’s not okay that that is not being discussed. Because the MHP should know the medicines you use and should know about the crucial side effects.’’ (Man, 37 years). Table 8.5 - Top-5 topics to discuss in a conversation about family planning according to mental health professionals and patients from survey data. Topic Mental health professionals Patients 1 Effect of medication on pregnancy Is there a desire for children, and if so, why (not)? 2 Impact of pregnancy on mental health of parent (to be) Parenting in relation to psychiatric vulnerability 3 Is there a desire for children, and if so, why (not)? Impact of pregnancy and parenting on own mental health 4 Impact of heredity Impact of heredity 5 Contraceptive usage (Grieving) not having children 6. Focus on competencies of MHPs For patients and close ones, the MHP was the preferred person to discuss family planning with (53.0%) followed by close ones (49.6%), persons with lived experience (43.7%) and general practitioners (34.3%) (see Table S8.2). The competency of psychiatrists to discuss family planning or desire for children was negatively reviewed by 28.4% of patients and doubtful by 60.8%. Only 21.6% of MHPs reported to be educated on family planning during residency, and only 10.8%
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