The conversation about family planning and desire for children in mental healthcare 207 had protocols at their workplace. Although most MHPs reported to be competent to discuss family planning (59.0%), 64.0% expressed a desire for further education. A focus group participant demonstrated her desire for MHPs to learn skills to discuss family planning: “You can actually learn this, like ‘how is that for you? How do you feel about this?’ Without immediately judging.” (Woman, 70 years). Discussion Key results Qualitative findings from this mixed methods study suggest that amongst patients and close ones, there is a need to discuss family planning and desire for children in relation to mental health. Survey findings illustrate that a considerable group of MHPs (64.0%), patients (40.9%) and close ones (50.0%) found that this topic should be discussed by a psychiatrist. Various obstacles impede a conversation about family planning in mental healthcare, and contributing factors to overcome these obstacles were discovered. A conversation about family planning should be held after obtaining consent from the patient (or close one) in a safe environment: sufficient time, an open attitude and knowledgeable MHP are key elements. To enable this, MHPs should receive education about psychiatric vulnerability in relation to family planning and desire for children. Interpretation of findings Literature suggests that the prevention of unwanted childlessness and unwanted pregnancies starts with an explorative conversation about desire for children1. However, studies with surveys30-32, interviews33,34 and focus groups20 amongst MHPs and residents in psychiatry demonstrate that this topic is not routinely discussed. Previous studies on patient experiences, including a recent study of our group, confirm this25,35. Lack of knowledge30, experience of taboo20, moral concerns33, limited appointment time31, and lack of confidence in expertise impede discussing family planning or desire for children with patients. This aligns with our data. Interestingly we found a discrepancy between the initiative to undertake a conversation as reported by MHPs and the perceived amount of attention that was given to it from the patient perspective. Possible factors that may relate to this discrepancy is that MHPs participating in this study were not the MHPs of the patients who participated in the
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