Chapter 8 208 study. Also, MHPs probably reported about their current practices, while patients and close ones often recalled treatment episodes from their past may play a role. Timing was key in making a conversation about family planning succeed or fail. Patients felt they could designate themselves the ideal moment to discuss family planning. According to patients, close ones and MHPs, heritability of (parental) psychiatric disorders, trauma, and offspring’s mental health were reasons to discuss family planning. Since these topics are embedded within the profession of MHPs, patients and close ones felt that MHPs are the prime health professional to initiate a conversation. MHPs were willing to initiate, but also showed reluctance to interfere in private matters and/or endanger the therapeutic relationship. In this study, we noticed that patients were occasionally looking for validation from MHPs in pressing life decisions. It is therefore crucial that MHPs are aware of the impact of their advises. Patients in our study preferred to discuss family planning and desire for children with MHPs, prior to general practitioners or gynecologists. Notably, patients also wanted to discuss it with people with lived experience, which is consistent with previous literature on peer support36. Strikingly, most patients and close ones did not want to discuss contraceptive care with MHPs. We lack a clear explanation for this. Based on the focus group data, we hypothesize that fear of mandatory contraceptive methods in previous times might play a role. Disaggregated survey results also showed that younger patients did more frequently report a desire to discuss contraceptive methods (12.8% vs. 5.7%), which supports that hypothesis. Our survey shows contradictive results regarding how competent MHPs feel about discussing family planning and their need for extra education. The American National Task Force on Women’s Reproductive Mental Health concluded that amongst residents in training to be a psychiatrist, education about reproductive health was inadequate and that all American psychiatrists should possess knowledge about the basics in reproductive psychiatry37. However, in the Netherlands this has not (yet) been implemented38. Strengths and limitations The strength of this mixed methods study lies in the triangulation of quantitative and qualitative data from different perspectives. Patients and close ones of the MIND panel varied in age, history of mental health issues and family planning experiences. The sampling strategy of the focus group yielded motivated and knowledgeable patients. However, we also encountered several methodological limitations. First, there is a risk for recall bias as the age range of the patients and close ones was rather
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