In/visibility of mothers with mental illness
Reprinted from "Parenting" issue of Visions Journal, 2004, 2 (2), p. 10
The BC Centre of Excellence for Women’s Health has been engaged in women and mental health research since 1998, when it launched its first mental health research project, Hearing Women’s Voices: Mental Health Care for Women. The centre employs a unique involvement model that brings together researchers, health providers, policy makers and community stakeholders, to develop action-oriented, policy-relevant, feminist research in women’s health. The Women and Mental Health discussion group is one such network at the centre, which has focused its attention on projects that examine the ways that mental illness and mental health are experienced differently by men and women. As such, issues related to mothering, substance use and mental illness have been a focus of a number of the centre’s research projects. What follows is a description of one of these projects, and its implications for policy development and service provision in mental health as it relates to mothering. The Mothering Under Duress project was funded by Status of Women Canada’s Policy Research fund and was published in 2002 as A Motherhood Issue: Discourses on Mothering Under Duress. This project took as its starting point a growing concern that the specific experiences of women, especially those of mothers in crisis, are not being taken into account in service delivery and policy decision-making. Indeed, mothers are often obscured by a public focus on the rights and safety of children and in gender-neutral policy language that talks about ‘parents.’ What this ignores is that women are still overwhelmingly the primary caregivers of children, and that the needs of children are intimately tied to the needs of mothers.
The project explored three situations of mothering where women are most likely to be scrutinized by the mental health and child welfare systems and to lose their children to apprehension: women who are using substances while pregnant or as mothers, women who are mothers and experience intimate violence from their male partners, and mothers with mental illness. This project examined women’s experiences with systems of supports and looked at the prevailing attitudes about mothers embedded in key policy documents and in the media. The discussion below highlights the findings with respect to mothers with mental illness.
Women with mental illness face a variety of challenges during pregnancy and in their role as parents. While some women may experience remission of their symptoms during pregnancy, others will experience worsened symptoms. Psychotropic medications may pose a risk to the fetus, making decisions about medication difficult. Many of the challenges that the women in this study mentioned were those that are echoed by single mothers more generally: for example, struggles with poverty; finding affordable, safe housing; and the need for child care assistance and respite services. However, women in this study indicated that they often faced discrimination and/or difficulties in accessing existing resources for single mothers, such as those set up to reduce the isolation of women and children. Additionally, women with serious mental illness often have interrupted education and work histories, which makes it even more difficult for them to obtain full employment and maintain relationships with partners, family and their children. Each of these factors brings this group of women into contact with the mental health and child welfare systems
Although mothering, no matter what form it takes, is always under public and professional scrutiny, it is even more so for women with mental disorders. That women with diagnoses of mental illness are seen as a risk to their children is evident in some professional literature and in practices related to child protection, where women are often scrutinized and monitored to ensure they do not physically harm or neglect their children. Media representations of women with mental illness frequently invoke stereotypes about mental illness and emphasize women’s danger to their children over stories about successful mothering. In contrast, research suggests that women with mental illness often place a high value on parenting, and that a woman’s ability to maintain a relationship with her children is often critical to her recovery. For example, experts in the field suggest that assisting mentally ill mothers in maintaining contact with their children increases their self-esteem, provides them with a sense of normalcy, and promotes personal growth.
The cyclical nature of mental illness – with periods of wellness and periods of illness – means that in order to mother successfully, women require different kinds of supports throughout their pregnancies and after their children are born. Some professionals have begun using advance care plans (‘Ulysses Agreements’) to assist women in planning for their children during periods of illness (see Visions article on p.32, by Sharon Van Volkingburgh). Such advance planning gives women more control over who will take care of their children and allows them to provide specific instructions about their children’s care needs. Most importantly, this kind of careful care plan relieves much of the trauma that women and children often experience during a mental health crisis, when children are sometimes removed from the home. To this end, women felt that better recognition was needed of the kind of grieving that women and children experience when they have been permanently separated due to a mother’s mental illness. They also identified a need for grief counselling and mechanisms for assisting women to have an ongoing relationship with their children after separation.
There was evidence in all three of the case studies that mental illness, substance use, and experiences of violence and trauma frequently overlap in women’s lives. Despite this, systems of support, especially those in mental health, are currently not set up to assist women who face all these complex issues at once. Recognizing these intersections is critical for delivery of care and treatment planning.
Mental health reforms involve an increased awareness of how the stigma and discrimination surrounding mental illness affect people’s abilities to recover and reintegrate into their communities. Reforms throughout the mental health and social welfare system are also closely connected to cost cutting and the implementation of efficiency models, which save time and money. This raises concerns that punitive and coercive policy and legislation will be used instead of better and more comprehensive service delivery for both mothers and their children.
The Mothering Under Duress research suggests that the biomedical focus of mental health treatment planning – together with the fragmentation of services for women and their children – functions to reinforce the ‘invisibility’ of the day-to-day struggles of women with mental illness who are mothers and creates a context where women’s needs are not seen as integrally connected to those of their children. Further, the negative attention paid to mothers diagnosed with mental illness renders the strengths that women may bring to their mothering invisible. This reinforces a reactive policy stance that has serious implications with respect to the kinds of supports available to assist women with mental illness in maintaining caring relationships with their children.
Although a number of important initiatives have been undertaken in BC with respect to developing support systems for parents with mental illness and their children (e.g., Supporting Families with Parental Mental Illness: A Community Education and Development Workshop) the needs and concerns specific to mothers are frequently overlooked. That women with mental illness are visible only in times of stress or duress is problematic, with respect to the ultimate goal of supporting women in their parenting roles and in supporting the needs of their children. Instead, what is needed is a proactive policy and service provision approach, which, instead of focusing on women’s deficits, builds on their positive capacities to mother.
About the Author
Marina is a research associate with The BC Center of Excellence for Women's Health. Marina is currently working with a team of researchers investigating first generation South Asian and Chinese immigrant women's experience of postpartum depression in a project funded by the BC Medicial Services Foundation
selected relevant publications
Greaves, L Varoe C, Poole, N. Morrow, M Johnson, J, Pederson, A, Irwin, L (2002) A motherhood issue: Discourses on mothering under duress. Ottawa: Status of Women Canada
Morrow, M (2003). Demonstrating progress: Innovations in women's mental health. Vancouver: BC Centre of Excellence for Women's Health
Morrow, M (2003). Violence and trauma in the Lives of women with serious mental health problems: Current practices in service provision in British Columbia. Vancouver: BC Centre of Excellence for Women's Health
Morrow, M with Monika Chappell.(1999). Hearing voices: Mental health care for women. Vancouver: BC Centre of Excellence for Women's Health