Best practice in maternity and mental health services? A service user's perspective

The birth of a baby is a much-anticipated event. However, for some women diagnosed with mental health needs their pregnancy and potential parenting are seen as problematic. Even if the child is much wanted and the pregnancy is planned, this news can be greeted with uncertainty and concern by the medical and maternity services. They need to plan how they will “manage” the mother’s behavior and protect the child from her potentially risky behavior. Most literature focuses on the negative impact that mental illness has on the development of the baby and the young child.1,2 It emphasizes the risk factors that specific mental illness diagnoses might have and the mother’s potential for abuse of her offspring.3,4 However, qualitative literature, which has been undertaken with mothers with a diagnosis, introduces a different perspective. Indeed fear of removal of the child,5 a perception of the intrusiveness of services5,6 and the stigma of mental ill health dominate their contact with mental health and child development services.7,8 In this article, I use a synthesis of first person narrative and research to explore the experience of being a both a pregnant woman and new mother who has a diagnosis of schizophrenia and my relationship with both mental health and maternity services. I describe the best practice care I received from the mental health services and the reactive, diagnosis led service that was set in motion by the maternity services. I intertwine the 2 elements of research and experience to explore how service provision can be more effective when it is built on a model that promotes shared decision-making and a sense of trust with shared responsibility. I seek to challenge the process led nature of care that leads professionals to become unquestioning actors in a game of risk management and discuss how practitioners can work with people as individuals. In this discussion, I highlight the importance of the strengths led approach, which is underpinned by a belief in clients’ capabilities and strengths, not their deficits.