Tag Archives: recovery

Starting a family when you have a mental health diagnosis: unfit to be a mother?

30 Nov
Photo by Bicycle Bill

Photo by Bicycle Bill

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Scroll down to the web links section for links to all the coverage & commentary on the Essex forced caesarean & adoption story

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On starting a family when you’re managing a mental health problem: reality and scare stories

Earlier today, a story about a mother with a diagnosis of bipolar disorder broke which was so utterly grotesque that it has caused a storm of protest on twitter and elsewhere. Questions are to be asked in the House of Commons. Although so far we only have a story reported in the Telegraph newspaper (based on incomplete information), there appear to be 2 main aspects. These fall into familiar media narratives:

  1. “Evil social workers steal our children.” And, in this instance, rip a baby from it’s mother’s womb in an enforced caesarean the mother didn’t know about till she came round to find the scar in her abdomen. As reported in the Telegraph, a woman with a diagnosis of bipolar disorder, visiting the UK for two weeks from Italy, was sectioned and taken to a psychiatric hospital. Without informing her, social workers went to court and a judge made an order that a caesarean section could be performed on the woman and the baby taken away. Without warning, the woman was forcibly sedated and, when she woke up, a caesarean section had been performed on  her and her baby removed. She has never seen the baby.
  2. “Women with mental health problems are unfit mothers.” The Telegraph reports that, subsequently, the mother went to court to seek the return of her baby. The judge decided against returning her baby because – despite the fact she was currently well – he said her lifetime risk of relapse meant she was an unfit mother.

There are other troubling aspects to the news story too, but these are the two that relate to mental ill-health. I comment below on these aspects. In summary:

  1. We don’t yet know all the facts around the caesarean section in 2012. It seems so grotesquely barbaric and traumatising that there must be more to it. A c-section is a medical matter, not one for social services. Other seemingly plausible explanations have been put forward and what’s been reported doesn’t ring true. Court of Protection cases are not routinely reported, so we may never see the judgment in this case and the local authority involved may be unable to comment. The main source of information for media coverage is the original Telegraph report, which is based on information provided by only one source (the mother’s solicitor). As a comparison, the Telegraph report refers to a “panic attack”, whereas other commentary refers to a psychotic episode. And the Telegraph story is  written by a journalist who has been criticised for writing misleading court reports in pursuit of his cause. He is a journalist with an agenda. At best we can say for certain that the information we have is incomplete.
  2. As written, it appears that the fact that the woman had a diagnosis of bipolar disorder was the judge’s justification for refusing to return the child to its mother.  This is appalling. This – and the real problems women managing mental health problems face in accessing the support they need – are the real issues for debate.

This scare story contrasts sharply with the reality of women’s experiences of managing a mental health problem and wishing to start a family (for instance this by Erica Camus, 33, diagnosed with paranoid schizophrenia and contemplating whether she can become a mother; or these comments by Seaneen Molloy, in her twenties, diagnosed with bipolar disorder and also wishing to become a mother).

Many women’s mental health problems will start during child bearing years – so there are a lot of us affected. Women and couples make decisions every day about sex, contraception, psychiatric medication and abortion. With so many of us living this reality daily, the real conversations should be about the following issues:

Let’s hope that the furore generated by this seemingly sensationalised scare story provides a window of opportunity to discuss these real issues women face daily. And let’s hope that women who are wrestling with these very issues now will not decide to have a termination, or to not have children, or to not seek help with mental health concerns as a result of such scare stories.

Allesandra Pacchieri (Daily Mail, 4th December 2013)

Allesandra Pacchieri with her youngest daughter, Baby P (Daily Mail, 4th December 2013)

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Here are my thoughts (tweets edited only slightly due to the lateness of the hour) in response to the initial Telegraph story:

The Telegraph reports that a judge ordered – without even telling her – that a mother could be forcibly sedated & her baby delivered by caesarian section then taken. And that a new judge has ruled that a bipolar diagnosis – just the diagnosis – makes a mother unfit to have her child with her.

Can you imagine a mother with Crohn’s disease who experienced a relapse being forcibly sedated and having her baby removed by secret caesarean? Just like bipolar disorder, doctors diagnose Crohn’s as a lifelong relapsing and remitting condition. At times of relapse, a parent with Crohn’s may be unable to take care of their child. Would anyone say that a mother with Crohn’s was, by virtue of that diagnosis alone, unfit to keep her child just in case she relapsed? No. That judgment seems reserved for those of us with a mental rather than physical health diagnosis.

My impression is that society, doctors and the courts infantilise women who are pregnant. And that certainly happens to people with mental health problems. That’s a double whammy for pregnant women who are managing mental health problems if their case comes before a court.

One question that arises in reading the Telegraph story is where was the perinatal psychiatric service? The point of perinatal psychiatric services is to support mothers through pregnancy and delivery. Since pregnancy is linked to bipolar relapse, it’s all the more important for women to get proper perinatal psychiatric care. That doesn’t seem to have been the case with this mother, though there is a perinatal psychiatric service in Essex.

However, the scary message from these two legal cases, as reported, seems to be this: if you have a bipolar diagnosis, you shouldn’t tell anyone that you’re pregnant because, if you do, you could lose your baby. That you should steer clear of mental health services at all costs.

Wouldn’t a better message be that, if you have a bipolar diagnosis and you want to become pregnant, you should get in contact with a perinatal mental health service so you can plan the pregnancy? Wouldn’t a better message be that, if you’re already pregnant, you should make contact with a perinatal mental health service so they can support you during and after your pregnancy? Wouldn’t a better message be that, if a woman gets a bipolar diagnosis – or any other mental health diagnosis – she is still a full human being. She is not merely a womb. She is not merely a piece of meat to be sedated and sliced open without her knowledge. She is not merely a risk to children. She is a full human being.

At the moment, we know only a partial view of what has happened. The report is based on instructions the mother gave her solicitor. We don’t know why the caesarean was performed. There must have been some medical reason. We are told that the mother wasn’t warned about the planned caesarean and that the child was taken away without the mother seeing it. We are told that the child hasn’t been returned to the mother for the apparent reason of the mother’s bipolar diagnosis and therefore possibility of relapse.

Let’s hope this is just some really, really badly reported media story that’s actually a bit dull. That would be better than the alternative. It will be interesting to see what comes of this story when it’s reported fully. I wonder if either journalist has relevant expertise. I wonder if either has form for whipping up a storm of controversy for a story that turns out to be far more straightforward.

But basically, if you’re a woman with a bipolar diagnosis, you’re an unfit mother. What a sweeping generalisation that infantilises women & reduces us to no more than our diagnoses.

I can guarantee that, when this story is picked up more widely tomorrow, there will be people who will defend the court’s decisions purely on the basis that the woman had mental health problems. Some – who see a diagnosis, who see risk, rather than a person – will see mental health as a trump card, a byword for dangerousness and unpredictability.

Does a bipolar diagnosis make a mother unfit? No, not in and of itself. No more than would a diagnosis of another relapsing and remitting condition like Crohn’s disease. Yes, the mother might relapse. Maybe relapse is not a possibility but a certainty, so the only question is when the next relapse will happen, not if it will.  That’s equally true of Crohn’s disease.

If a mother has a bipolar diagnosis, that’s an argument for supporting the family, not removing her children. Supporting the family is a far cheaper option than taking children into care of putting them up for adoption. Both are astronomically expensive options financially. If a mother has a bipolar diagnosis, that’s an argument for supporting the family, not removing the children. That’s the humane and compassionate response.

Let’s hope this case receives such an outcry that women with a bipolar disorder will be viewed more realistically. Not infantilised.

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[15th April 2014] The final chapter for mother and child; and the Guardian

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Web links thumbnail.

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Related web links:

The following topics are covered:

  • Statements from the parties involved – including court judgments (including the judges’ reasons), Essex County Council, the mother’s solicitor & MP, and the hospital where she was treated
  • Other court cases related to pregnancies
  • Mainstream media coverage
  • Commentary and blogs – Birthrights charity, British Association of Social Workers, blogging barristers & others
  • Other relevant material – Eg research, perinatal mental health, Court of Protection, twitter conversations

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Statements from the parties involved:

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Other court cases relating to pregnancies:

Case 1 (1998): Forced caesarean was unlawful, despite High Court judge’s ruling

Case 2 (May 2013): Court upheld autonomy of woman with bipolar diagnosis who had changed her mind and wanted abortion

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Mainstream media coverage:

Saturday 30th November:
  • ‘Operate on this mother so that we can take her baby’ – “A mother was given a caesarean section while unconscious – then social services put her baby into care” – Telegraph newspaper, by Christopher Booker – the original story
  • Woman has child taken from her womb by social services“Essex social services have obtained a court order against a woman that allowed her to be forcibly sedated and for her child to be taken from her womb by caesarean section”Telegraph newspaper, by Colin Freeman – follow up a few  hours later
Criticism of Christopher Booker:

Christopher Booker is the journalist who wrote the original Telegraph piece.

  • Must journalists attend court hearings to report accurately?I posted last week on a judgment given by His Honour Judge Bellamy in a family court case involving a mother’s abuse of her baby The judge took the unusual step of criticising media reporting of the case. He said the Telegraph’s Christopher Booker’s reporting was “unbalanced, inaccurate and just plain wrong”. UK Human Rights blog (May 2011)
  • The superhuman cock-ups of Christopher Booker – “The journalist makes so many errors that you would be forgiven for thinking he did it deliberately to waste everyone’s time” – Guardian newspaper (October 2011)
Sunday 1st November
Monday 2nd December
Tuesday 3rd December:
Wednesday 4th December:
Thursday 5th December:
Friday 6th December
Saturday 7th December:
  • Judge must unravel saga of baby snatched from womb – “In the shocking case of an Italian mother whose child was removed by caesarean, the head of Britain’s family courts will be looking closely at social workers’ actions.”Telegraph newspaper, Christopher Booker. He’s back.
  • Father of caesarean scandal woman: Why I DON’T believe she should keep the baby “Alessandra Pacchieri’s baby was taken into care from forced caesarean birth. Controversial decision was approved by secretive Court of Protection. Father Marino has backed the court’s decision to put child up for adoption. Says daughter is a ‘threat’ to the baby because she suffers ‘manic delusions’.” – Daily Mail
Sunday 8th December:

Saturday 14th December:

 

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Commentary & blogs:

Sunday 1st December:
Monday 2nd December:
Tuesday 3rd December:
Wednesday 4th December:
Thursday 5th December:
  • The Court of Protection and the new Family Court: can publishing judgments prevent moral panics?Cardiff Law School, by Julie Doughty and Lucy Series
  • Comment: Forced C-sections and stolen babies“The Alessandra Pacchieri case looks like the ‘stuff of nightmares’, but the problems it highlights are real.” By Jennie Bristow for BPAS (British Pregnancy Advisory Service)
  • One flew over the Hemmings nestMinistry of Truth blog (twitter @Unity_MoT)
  • Views on the forced cesarean judgmentBirthrights (“Birthrights is the UK’s only organisation dedicated to improving women’s experience of pregnancy and childbirth by promoting respect for human rights”) by barrister Elizabeth Prochaska ‏(twitter @eprochaska) – “All in all, a depressing case for anyone concerned with modern maternity care and the rights of people with mental illness. The comment by Lucy Series on twitter best sums up my reaction: “If you were trying to convince somebody the Mental Capacity Act was progressive, empowering, person-centred, the caesarean judgment would not help you.””
Saturday 7th December:
Sunday 8th December:
Monday 9th December:

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Other relevant material:

The Court of Protection:
  • Revealed: How UK justice is dispensed out of hours down the phone line“The Court of Protection is facing fresh questions about transparency, as The Independent reveals that its judges are making life-or-death decisions over the phone, with incomplete evidence, in proceedings that are not always recorded.” – Independent newspaper (June 2013)
Perinatal mental health:
Research:
  • McPin Foundation – Recruiting women participants for a study on pregnancy and anti-psychotic medication“Have you used psychotropic medication and had a child in the last three years? If so, we would like to speak to you. When women with a severe mental illness want to start a family, or find that they are pregnant, they may have to make decisions about whether to keep using medication, change it or stop it altogether. This can be a difficult decision. We want to find out more about how women decide what they want to do and what could have helped them to make that decision.”
Twitter conversations:

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Help yourself! What are your favourite free online mental health resources?

9 Oct
My photo of Souzou: Outsider Art from Japan at Wellcome Collection

My photo of Souzou: Outsider Art from Japan at Wellcome Collection

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More links have been added below (scroll down) – please keep them coming!

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In the resources section of my website, I have a little page tucked away entitled self help. It’s where I’ve posted links to useful online resources to help you manage your mental health. It’s a random collection of what I happen to have stumbled across, mostly on twitter. I have to admit that I haven’t tried any of them personally – but they come highly recommended.

I’d like the page to be as helpful as possible – and I also know there will be things out there that I’d find useful myself, if only I knew about them! – so I’m inviting suggestions of free online resources that you have used and found helpful – or, alternatively, ones that you’d recommend people steer clear of! I’d like to mine the hive mind and see what we can come up with to help ourselves – so we can side-step those pesky waiting lists for treatment or do our best whilst waiting for treatment.

So far, my self help page includes links to three areas:

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Free online cognitive behaviour therapy (CBT)

What is CBT? As Living Life to the Full describes it, “CBT is a structured form of psychotherapy that aims to alter the unhelpful thinking (cognitions) & behaviour that commonly occur during times of distress.” The 4 resources I’ve come across so far are:

  • e-couch – An online programme for preventing and coping with depression, generalised anxiety disorder and social anxiety
  • Living Life to the Full (twitter @llttfnews) – This was recommended to me during a ward round. It’s a free life skills resource teaching practical skills using CBT. The strapline is, “Be happier, sleep better, do more, feel more confident” – which sounds pretty good to me!
  • MoodGYM – An Australian National University training programme that teaches CBT skills for preventing and coping with depression.
  • Moodjuice – A site developed by Choose Life Falkirk and the Adult Clinical Psychology Service, NHS Forth Valley. The site is designed to offer information, advice to those experiencing troublesome thoughts, feelings and actions.

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Free online mindfulness

What is mindfulness? It’s a method of mental training, a simple form of meditation that can be quite quick to do – and can be done any time, any place, anywhere. The resources below include guided mindfulness exercises you can listen to online or download for later.

  • Frantic WorldFree meditations from mindfulness, taken from the book ‘Mindfulness: Finding Peace in a Frantic World’. The book contains the complete 8 week mindfulness course developed at Oxford University.
  • Free Mindfulness – A collection of free-to-download mindfulness meditation exercises.“
  • MindfulFree online audio and video mindfulness instruction, online courses in mindfulness and other resources
  • UCLA Mindful Awareness Research CentreFree guided meditations

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Free online bipolar disorder resources:

  • Beating Bipolar“Beating Bipolar is an interactive internet based programme that aims to improve understanding of the condition. It includes video of professionals and people with lived experience of bipolar disorder and discuses various approaches that many have found to be beneficial.”

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Have you used a free online resource that’s helped (or hindered!) you to manage your mental health? If so, I’d really appreciate it if you could share that with me – so I can share that with the lovely twitter people and readers of this blog. I know you’ll have some great ones, so I’m really looking forward to being able to add them to this blog … and thank you in advance!

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UPDATE: Here are some of the fab links I’ve been sent already (they’ll be added to the self help page shortly):

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When I came out of hospital, I thought I’d be focussing on getting better …

23 Mar

Way out sign

Here are some tweets about the bumpy road I’ve been on since being discharged from hospital. I thought I’d be focussing on getting better.I thought I’d be resting my mind and doing things to nurture myself mentally and physically. Instead, I’ve had to focus on lots of other things.

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Twental Health Awards for the best in mental health tweeting

13 Jan

TWOM logo batshit crazy smileyThis morning, I was very pleased to learn that I’d won not just one but two Twental Health Awards for the best in mental health tweeting from the World of Mentalists blog. Woo hoo!

The lovely Twitter people had voted for me to win both the Patient Experience tweeter and Subversive tweeter categories. The last time I won two prizes at the same time was at school … which was some time ago! It certainly brought a smile to my face on a crisp sunny winter morning.

I tweet abTwo trophiesout patient experience a lot. I’m very interested in seeing improvements in psychiatric inpatient care –  so that staff love their jobs, the environment is therapeutic and patients recover. Based on my own experience, there’s still some way to go (to say the least).

But I also know that there is excellent mental health inpatient care out there, as well as people who really care about making improvements, and that gives me hope. What an honour that tweeps think my ramblings on patient experience are worthwhile.Subversive

The award for Subersive mental health tweeter left me pleased of course … but a tiny bit puzzled. I’m not quite sure what “subversive tweeter” means, but it sounds pretty cool! Especially for someone who can be quite timid and conservative. Looking at the dictionary definition, amongst other things a subversive is someone who intends to overthrow or undermine the establishment. It seems a lot to live up to!

The best thing about the Twental Health Awards is they contain a whole list of interesting tweeps to check out. They’ve won the hearts and minds (or at least the votes) of mental health tweeps, so they’re well worth a look.

You can see the full list of winners and runners up here, but here are my top 12:

  • Patient experience runner up @PatientOpinion
  • Campaigning winner @Rethink_ and runner up @TimeToChange
  • Informative winner @MarkOneinFour and runner up @MentalHealthCop
  • Helpful winner @VictoriaBetton
  • Nursing winner @nurse_w_glasses
  • Social work winner @Ermintrude2 and runner up @444BlackCat
  • Occupational Therapy winner @ClaireOT
  • Academic joint winners @Neuro_Skeptic and @MentalElf

Congratulations to all the winners and runners up, as well as the nominees. The awards have certainly given me some interesting and informative new tweeps to follow and I hope they do the same for you.

I can also recommend the World of Mentalists blog. As the website says:

“The World of Mentalists is a e-zine of news, commentary and blog digests in the arena of mental health. Our blog digests are known as This Week in Mentalists (TWIM) […] TWIM is a weekly digest of selected writings from blogs across the Madosphere, our affectionate name for the mental health blogosphere. […] A group of volunteer authors take it in turns to write the digests, which enables a wide base of mental health blogs to be reviewed. We cover blogs from professionals and patients alike.”

Well worth reading.

Finally, thank you to the World of Mentalists co-editior Zarathustra (@thus_spake_z) for organising the Twental Health Awards, and to all the lovely tweeps who voted for me.

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Twental Health Awards winner 2013

 

Update smallIn January 2014, I was bowled over to win the following awards in the 2013 World of Mentalists Twental Health Awards:

Twental Health Awards runner up 2014In.

Twental Health Awards winner 2013

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