Keeping close: mothering with serious mental illness

AIM: The aim of this paper is to describe the experiences of mothers with serious mental illness from their perspectives and how they attempted to manage their mothering circumstances. BACKGROUND: The desire to mother in women with serious mental illness is increasingly acknowledged by healthcare professionals. For these women, mothering is often framed as a pathological problem needing professional intervention. Yet little is known about mothering and illness from the perspectives of the mothers themselves. METHOD: Using Glaser's grounded theory approach and both purposive and theoretical sampling, interviews were conducted with 20 mothers who were receiving treatment for mental health problems. The data were collected in 2002. FINDINGS: We found the core category of Keeping close described mothers' efforts to have meaningful relationships with their children in the context of illness and suffering. To this end, mothers chose strategies that would hide illness for the sake of protecting their roles and their children. These strategies--masking, censoring speech, doing motherwork and seeking help--served to imitate ideal perceptions of mothering while making illness invisible to their children. Mothering in illness, however, became a vortex of contradictions, resulting in mothers 'hitting bottom', a point in time when they realized they could not keep close via pretences. To return to the valued place of mother, they sought treatment, hoping to learn how to be with their children authentically. CONCLUSION: To assist mothers with serious mental illness, healthcare professionals must be sensitive to the social and cultural context in which they mother in order to create healthier possibilities for nurturing their children.     

Support for teenage mothers: a qualitative study into the views of women about the support they received as teenage mothers

AIM OF THE STUDY: To gain insight into the support teenage mothers received during pregnancy, birth and their child's pre-school years and young women's perceptions of the usefulness of a support group for teenage mothers. BACKGROUND: Most qualitative studies have focused on teenage mothers around the time of the birth of their first child. For this study, women were recruited several years after the birth (median 8.5 years), so that they would have had time to reflect on the support they had received. DESIGN: The qualitative method of semi-structured interviews was chosen to obtain in-depth information and to allow teenage mothers' own views to be heard. Ten individual interviews and one paired interview were undertaken. FINDINGS: Recruitment was difficult because taking part in research was not a priority for many of the women. The study confirmed the strong link between deprivation and teenage pregnancy found in other studies, and suggested that mental health problems in teenage mothers may be more difficult to detect. Teenage women need more information on mental health and on services available to them. The fear, expressed by some of the women in this study, of becoming different from other women in their social network should be considered by health workers when establishing intervention programmes. CONCLUSIONS: Professional bodies of health workers should lobby government to provide a minimum standard of living and sufficient child-care to combat deprivation. Former teenage mothers should be involved in the recruitment, planning and implementation stages of research and interventions. Health professionals should be aware that mental health problems in teenage mothers may be particularly difficult to detect. Key community health workers or a support group may provide information on services, mental health and education facilities available that would benefit teenage mothers. A support group may also give emotional support.     

Intensive‐invisible mothering: The experiences of mothers of adult children with dual diagnosis

The experiences of mothers of adult offspring with a dual diagnosis have rarely been discussed in the literature, despite growing involvement and responsibility of mothers for daily care of their children. Interpretive phenomenological analysis of in‐depth interviews was used to examine the mothering experience of 12 mothers of adult offspring with dual diagnosis. The analysis revealed that the mothers’ experiences were intensive, abusive, and isolating, and simultaneously rendered them invisible, undervalued, or ignored by professionals, community, and family. Furthermore, the analysis indicated that this experience of ‘intensive‐invisible’ mothering was promoted or prevented by three intersecting mechanisms, identified here as discursive, institutional, and spatial. The research contributes to the fields of knowledge regarding family members of people with mental health problems, by adding a theoretical layer that takes into account how public discourses of motherhood mould women’s accounts of their mothering experience. Practical implications of these findings for professionals working with these mothers are discussed. Specifically, therapeutic intervention that focuses on identifying and modifying the underlying psychological and social processes associated with the ‘intensive‐invisible’ mothering experience could be useful.     

The mothering experience: perspectives of women from Indonesia married and living in Taiwan

The purpose of this study was to explore the mothering experiences of Indonesian women married to Taiwanese and living in Taiwan. Women with children aged from three to twelve years old were qualified to participate and we used snowballing to recruit participants. A total of 21 mothers agreed to participate in semi-structured interviews, the contents of which were recorded and immediately transcribed following each session. All 21 mothers completed their interviews, in which two common themes appeared. These were: (1) reflection: searching for self-worth through the mothering role and (2) projection: spending all of the "self" for their children. The results of this study provide valuable information necessary to understand the experience of Indonesian mothers in Taiwan.     

Mothers with a serious mental illness: a critical review of the literature

The desire to mother in women with a serious mental illness (SMI) is increasingly recognized by health care professionals. Defining women with an SMI strictly in terms of cause, course, and treatment overshadows the diversity of their role as a mother. A review of the literature reveals that limited published research exists on the subjective experiences of mothers with an SMI. Often, the reviewed studies reinforce mothers as pathological. Viewed as lacking mothering abilities, they are not recognized as mothers. This article critically examines how the literature about mothers with an SMI has contributed to their marginalized position. To this end, a literature review was undertaken and examined from Oliver's theoretical notion of subjectivity from the marginalized or "othered" position. Subjectivity based on witnessing a mother's self-identity creates possibilities that are not exclusionary because of her difference secondary to illness.     

Factors that influence Asian communities' access to mental health care

This paper presents the findings of a qualitative study to identify factors that influence Asian communities' access to mental health care and how mental health care is delivered to them. Semistructured interviews were completed with Asian community members/leaders and health-care professionals. Content analysis identified major themes. Participants also completed a demographic data sheet. The research aimed to provide health professionals with an increased understanding of the values and beliefs held by people from Asian communities regarding the cause and treatment of mental illness. Data analysis identified six main themes that influenced Asian communities' access to mental health care and how mental health care is delivered to them. They were: shame and stigma; causes of mental illness; family reputation; hiding up; seeking help; and lack of collaboration. The findings highlighted that people from Asian communities are unwilling to access help from mainstream services because of their beliefs, and that stigma and shame are key factors that influence this reluctance. The findings also highlight that the mental health needs of refugee women are significant, and that they comprise a vulnerable group within Australian society.     

Mexican immigrant mothers' expectations for children's health services

Women of Mexican descent living in the United States raise children who use health care services. What do immigrant Mexican mothers expect from children's health care services? And how do their expectations for children's health services compare to acculturated Mexican American mothers' expectations? This focused ethnographic study, based on repeated interviews with 28 mothers of varying acculturation levels, describes their expectations and experiences with children's health care services in the United States. Findings support a shared core of expectations for both Mexican immigrant and Mexican American mothers, and differences in health care access and financing, time spent in health care encounters, and cultural and linguistic expectations for care. Health care providers can use this information to approach Mexican-descent mothers and children with their expectations in mind, and craft a negotiated plan of care congruent with their expectations.     

A descriptive interview with 64 patients discharged from an acute-psychiatric-inpatient service

Background Acute‐mental‐health services receive hundreds of admissions every year. Some of these patients will continue to be case‐managed by community mental‐health teams on discharge from the acute unit while others will not remain in contact with the mental‐health service. This study compares the findings of comprehensive interviews conducted with current and past patients of the community mental‐health service 3 or more years following case closure from the community ambulatory service. Methods Between 1 July 1999 and 30 June 2001, there were 2245 closed cases identified at Barwon Health. Letters of invitation to participate in a research project were sent to people who had suffered from psychotic illnesses, and had been case‐closed by community mental‐health services between the above dates and had not been in contact with the Community and Mental Health Service for at least 6 months. A second group of participants was recruited from people who had also been case‐closed by community mental‐health teams in Barwon Health during the 1999–2001 2‐year‐time window but whose cases had been re‐opened and who were in case management with Barwon Health at the time of the study. All participants were interviewed using the Diagnostic Interview for Psychosis. Results Letter responses were received from 17 men and 18 women, aged 40.7 ± 12.0 (mean ± SD), who were interviewed. A second group of 17 men and 12 women, aged 40.9 ± 9.6 (mean ± SD) of currently case‐managed patients was interviewed. All interviewees reported a detailed history of mental illness. Persistent social dysfunction and impaired quality of life were reported in both groups. Conclusion Patients suffering from psychotic disorders who had been case‐closed by community mental‐health teams and had been discharged to the care of their general practitioners or elsewhere continued to show evidence of significant impairment due to mental illness 3 years after being case‐closed.     

Regulating migrant maternity: Nursing and midwifery’s emancipatory aims and assimilatory practices

In contemporary Western societies, birthing is framed as transformative for mothers; however, it is also a site for the regulation of women and the exercise of power relations by health professionals. Nursing scholarship often frames migrant mothers as a problem, yet nurses are imbricated within systems of scrutiny and regulation that are unevenly imposed on ‘other’ mothers. Discourses deployed by New Zealand Plunket nurses (who provide a universal ‘well child’ health service) to frame their understandings of migrant mothers were analysed using discourse analysis and concepts of power drawn from the work of French philosopher Michel Foucault, read through a postcolonial feminist perspective. This research shows how Plunket nurses draw on liberal feminist discourses, which have emancipatory aims but reflect assimilatory practices, paradoxically disempowering women who do not subscribe to ideals of individual autonomy. Consequently, the migrant mother, her family and new baby are brought into a neoliberal project of maternal improvement through surveillance. This project – enacted differentially but consistently among nurses – attempts to alter maternal and familial relationships by ‘improving’ mothering. Feminist critiques of patriarchy in maternity must be supplemented by a critique of the implicitly western subject of maternity to make empowerment a possibility for all mothers.     

Social attitudes towards smoking in pregnancy in East Surrey: A qualitative study of smokers,former smokers and non-smokers

A qualitative study was undertaken to explore social attitudes towards smoking by pregnant women, mothers of preschool children and their partners based in Merstham and Horley, East Surrey. All respondents felt that smoking in pregnancy was associated with considerable social stigma and negative social attitudes. Non-smokers were particularly negative in their views on smoking in pregnancy feeling that it was socially unacceptable. Women who smoked during pregnancy reported various negative social experiences such as receiving criticism from health professionals and community associates. They reported feeling under pressure to quit to achieve social acceptability as much as for health improvements. Some pregnant smokers denied smoking to health professionals, partners and colleagues and used private smoking places out of public view to reduce the chances of detection. Women who smoked or had a partner who smoked were more accepting of smoking in pregnancy than non-smokers and former smokers. Moreover, residents from the more socio-economically deprived area of Merstham were more tolerant of smoking in pregnancy and parenthood, compared to Horley-based respondents, regardless of their personal smoking status. They gave examples of local women they knew who had smoked in pregnancy without apparent complication. While all respondents were aware of health risks associated with smoking, smokers did not feel the risks were personally relevant to them and were exaggerated in an anti-smoking society. Health professionals need to be aware that pregnant women may not disclose smoking activity due to perceived social stigma and may require more intensive smoking cessation support services in socio-economically deprived areas.     

Severe postpartum distress in Icelandic mothers with difficult infants: a follow-up study on their health care

This article describes help seeking and health care of mothers with a difficult infant who suffered long-term depressive symptoms and a high degree of parenting stress. A subsample of severely distressed mothers (n = 37) was recruited from a cross-sectional national survey and followed up 2 months later by a semi-structured telephone interview. The survey included all Icelandic women who gave birth during a quarter of a year and had a live baby 2 months later (n = 1053). All distressed mothers with a difficult infant were selected from sample respondents on preset scores of two self-report distress measures. The study sample emerged during the selection process for an intervention study from which it was excluded on grounds of very high distress scores. Results showed that 5% of the surveyed population were postpartum severely distressed. Findings from this follow-up study revealed that only one woman of four received health care for severe distress by various professionals. One woman of six received help from others. Very few women utilized the services available at Health Care Centers. About half of the women held attitudes that hindered them in seeking help and health care. It is concluded that postpartum severely distressed women receive little primary health care for mental health problems and the majority of them show little initiative to seek out for help. More active outreach by health professionals is recommended.     

Factors influencing the use and provision of respite care services for older families of people with a severe mental illness

Family carers of people with a severe mental illness play a vital, yet often unrecognized and undervalued role in Australian society. Respite care services can assist these family carers in their role; however, little is known about their access to these services. The paper addresses this knowledge gap. An exploratory field study was conducted throughout the eastern suburbs of Sydney, Australia, to identify and examine the factors influencing the use and provision of respite services for older carers of people with a mental illness. Semistructured, in-depth interviews, and structured self-completed questionnaires were conducted with older family carers, mental health care professionals, and respite care service providers. Additionally, relevant documents (local policies, strategic plans and reports on respite care) were reviewed. It was found that current respite services are problematic for older family carers of Australians with a mental illness, signalling the need for concerted efforts by carers, health professionals, and service providers to improve access. Changes to respite provision and utilization are recommended.     

Mental Health Nurse Incentive Program: contributing to positive client outcomes

Mental health conditions are likely to affect almost half of the population at some stage in their lives. Despite the magnitude and potentially serious consequences of mental illness and disorders, access to services is a significant problem. In 2007, the Mental Health Nurse Incentive Program (MHNIP) was implemented to improve access to mental health care in Australia. Mental health nurses are engaged under the MHNIP to work with general practitioners, psychiatrists, and other mental health professionals to treat clients experiencing a mental health condition. This paper presents findings from a qualitative exploration of nurses working under the MHNIP in Australia. In-depth interviews were conducted with 10 nurses currently working under the MHNIP to gain an understanding of their roles and their perceptions of the effectiveness of this new programme. Data were analysed using NVivo. Four major themes emerged: developing the role, a holistic approach, working collaboratively, and benefits to clients. The findings suggest that mental health nurses have the potential to make a significant contribution to enhancing access to, and the quality of, mental health care through flexible and innovative approaches.     

Changing perceptions of womanhood: living with Parkinson's Disease

This study adopted a multiple case study design to develop our understanding of the experiences and adjustments made by women with Parkinson Disease in relation to womanhood. Nineteen women participated in this investigation telling their stories through a combination of individual interviews, group interviews, reflective diaries, reflective tapes and creative writing. Data were analysed using the framework of Intrapersonal, Interpersonal, Extrapersonal and Metapersonal health proposed by Boddy and Rice (Perspectives on Health and Illness, Dunsmore Press, Palmerston North, 1992). Women reported that major changes were required in their lives in each of these aspects of health. In particular women reported labile emotions, changing body images, changing lifestyles, changing relationships with partner, family and friends, increasing dependence, decreasing role fulfillment and the need for support versus increasing isolation. The findings are of particular relevance to nurses and other health professionals involved with women with Parkinson's Disease as well as social services and voluntary agencies.     

Health visiting and refugee families: issues in professional practice

AIM: This paper reports on the perceptions of experienced health visitors working with refugee families in Inner London. BACKGROUND: Women who are refugees and asylum seekers in the United Kingdom are more likely to experience depression than either non-refugee women or male asylum seekers. Health visitors provide a universal public health service to all women on the birth of a child, or with children aged under five, and as such are well placed to identify emotional and mental health problems of women who are refugees. Despite successive waves of refugees to the United Kingdom in the 20th century, there are no empirical studies of health visiting practice with this vulnerable group. There is also no body of evidence to inform the practice of health visitors new to working with asylum seekers and refugees. METHODS: An exploratory study was undertaken in Inner London in 2001. Semi-structured interviews were conducted with a purposive sample of 13 health visitors experienced in working with women and families who are refugees. FINDINGS: A range of structural challenges was identified that mediated against the development of a health-promoting relationship between health visitors and refugee women. With refugee families, who were living in temporary accommodation, health visitors were prioritizing basic needs that had to be addressed: in addition, they prioritized the needs of children before those of women. Health visitors were aware of the emotional needs of women and had strategies for addressing these with women in more settled circumstances. Health visitors considered themselves ill-prepared to deal with the complexities of working with women in these situations. CONCLUSIONS: This study identifies issues for further exploration, not least from the perspective of refugee women receiving health visiting services. Health visitors in countries receiving refugee women are framing their work with these women in ways that reflect Maslow's theory of a hierarchy of needs. This study suggests ways that public health nursing practice could be improved, and identifies issues for further study.     

白血病患儿母亲心理历程的质性研究

目的了解白血病患儿的母亲在陪伴子女诊断、治疗、康复过程中的真实心理感受,为临床护理人员对患儿家属进行心理支持提供借鉴.方法通过访谈形式,访问了16位白血病患儿的母亲,将获得的资料进行分析、整理,提出主题.结果患儿的母亲在子女患有恶性肿瘤过程中承受着巨大的心理压力和经济压力,表现过程为初诊时的震惊、困惑、拒绝,逐渐转变成无奈接受,对未来持悲观心理.支持系统主要来自母爱天性、丈夫和家人以及其他白血病患儿家长.结论白血病患儿母亲需要深切人文关怀和情感支持,护理人员应采取个性化的护理措施,帮助、指导患儿及其母亲提高生活质量,度过这一艰辛历程.