General discussion and future directions 251 It is important to take note of the reluctance to discuss contraceptive methods by patients with psychiatric vulnerability (Chapter 8). A specific role should be put in place for prevention. Discussing pregnancy intentions could lead to better preparation for a future pregnancy. There is a growing interest in methods to improve the reproductive health of psychiatric inpatients, especially for persons with serious mental illness who might perceive loss of capacity to make reproductive decisions during disease episodes67. MHPs fear that patients experience a loss of autonomy and mentioned this fear as a reason not to address family planning with their patients (Chapter 8). However, we hypothesize that supporting patients in articulating their preferences regarding reproduction and pregnancy may increase their autonomy in family planning decision-making, as it can only be reached when patients are informed about their options (Chapter 6). Based on findings from this thesis (Chapter 3,6,7,8), a discussion tool was designed that includes relevant aspects to the conversation about family planning and desire for children in psychiatric healthcare (see Figure 9.5). Attention should also be paid to the fact that patients often encounter taboos when discussing sexuality and mental health in general. By normalizing a conversation about family planning, stigma on having psychiatric disorders and parenting (Chapter 3,6,7,8) can be reduced. The psychiatric curriculum: reproductive health matters! In the United States, The National Task Force on Women’s Reproductive Mental Health has directed that all psychiatrists should acquire essential knowledge and skills in reproductive psychiatry68. The Task Force also identified that among psychiatry residents, education on reproductive health was insufficient. In their perception, all psychiatrists should have basic knowledge in reproductive psychiatry69. Indeed, literature is conclusive that preconception care, pregnancy and the postpartum period, perimenopause and menstrual disorders in relation to psychiatric vulnerability should be basic knowledge for psychiatrists70. Unfortunately, up to date, similar goals have not yet been set in the Netherlands (Opleidingsplan Psychiatrie). To facilitate optimal preparation for pregnancy for women with psychiatric vulnerability, it is important to integrate education in which psychiatrists and gynecologists (in training) work together71. Patients and MHPs both underscored that psychiatrists should receive training in how to counsel women with psychiatric vulnerability on reproductive health matters (Chapter 8). Training of psychiatrists could be achieved by including reproductive health matters in the psychiatric curriculum for residents. Moreover, research also indicates that midwives could benefit from education on discussing perinatal mental health72. Like psychiatrists, they lack confidence, training and
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