Rachel Rowan Olive is 26 years old and would like to have children one day, but she’s worried her mental health won’t make that possible. "If I knew I would have access to timely support for as long as I needed it, I wouldn’t think twice about conceiving once I met the right person to start a family with. But in the age of austerity, I can’t really see that happening," she says.
The London-based illustrator has received several mental health diagnoses over the years, and is currently under the care of a team of professionals. "I know women with problems like mine who are fantastic mums, but people need support to manage, and that’s hard to come by these days."
According to a recent study, one in four women in the UK experience a mental health problem during pregnancy, and while it’s admirable that new perinatal services have been developed, availability is still patchy and resources remain inadequate. But Rachel worries about discrimination from children’s social services, too: "You’re automatically seen as a risk to your kids if you’ve got a mental health history." And being gay, she fears she would face an extra layer of stigma.
Women with a diagnosis of mental illness – like severe depression, anxiety, bipolar or schizophrenia – worry more about being competent parents, confirms Dr. Gertrude Seneviratne, chair of the perinatal faculty at the Royal College of Psychiatrists: "[In the UK,] they worry hugely about [their] children being taken away by the social care," she says. And although that doesn’t happen in the majority of cases, she explains, some women conceal symptoms, avoid asking for help and possibly relapse, for fear of losing their children if they were to seek treatment.
"There are very dangerous misconceptions that you can’t be a parent because of your mental health problem," adds Dr. Seneviratne, although she says she has had patients who decided not to have children. In her experience: "It’s usually been people [that] maybe have a chronic relapsing illness, where throughout their lives they’ve had several episodes, [where] they relapse if the stress has become really high, and they have questions on whether they should embark on the journey of becoming a parent." From a medical point of view, she admits, severe, chronic mental health problems – with significant and recurrent psychotic episodes, for example, or self-harming or suicidal behaviours – could make it quite hard to deal with being a parent.
Fiona Thomas was about 27 when she realised having children might impact her depression and anxiety. "Something that huge would definitely trigger a relapse for me, and I think, 'I find it hard to manage a relapse on my own, so [imagine if] I have a child to look after and manage a really raw period in my mental health' – that thought was just really scary," she says.
Now 31, Fiona has never particularly wanted to become a mother and her diagnosis just reinforced this decision; she is married to a partner that supports her choice: "[H]is number one concern is that my mental health is taken care of, and he also thinks that it wouldn’t be impossible, but certainly [very] stressful."
There may also be a concern about inheritability. It isn't clear if, or how, mental illness runs in families, but it's understandable that this could be an issue some women may worry about. As Fiona explains: "There’s a history of mental health issues in my family. [The] thought that maybe, in 20 years, my child would display the same symptoms as me, I would feel responsible for passing that down."
Despite having written about her diagnosis putting her off having children, she admits she’s still uncomfortable talking about it: "Even with friends and acquaintances, I wouldn’t necessarily feel like bringing up [mental health] as a reason not to have kids. And the fact that I’m not willing to talk about it – and I’m a mental health blogger, that’s what I do for a job – [speaks volumes]." After her column came out, only a couple of people approached her saying they had made the same choice, but she believes it’s mostly because people don’t want to talk about it.
There’s a tendency to dismiss the issue as if it is not a real concern, she thinks: "When it comes to pregnancy, they would just think: 'Oh, you know, you want to have a baby? Have a baby! It’s not a big deal.' Especially older generations, they think: 'Stop whining for something that hasn’t happened yet!' but that’s what you do when you have a mental illness."
Fiona has been on medications since 2012, when she had a mental breakdown that forced her out of work for almost a year: "I don’t think I will ever be able to stop taking them. For me, managing has been taking medications and maintaining good lifestyle changes, like exercising and eating well, and trying to take rest when I need to and trying to minimise stress, [which] is a big trigger."
Medications are a concern for many women who are pregnant or thinking about having children. "Another serious misconception is that women can’t take medications when they’re pregnant or breastfeeding, and actually there are a lot of healthcare professionals giving the wrong advice," admits Dr. Seneviratne. "It’s perfectly possible, in 2018, to be on medication that is a bit safer in pregnancy and that you can breastfeed on." But women would need an appointment with a specialist able to guide them through their options. "It’s not the sort of information that any general practitioner would be able to tell you about."
Even hunting down information on the internet is not always helpful, she points out: "I might read on a website that, you know, if you have bipolar there’s a 50% risk of relapse [after childbirth] and that’s really scary, and so I might think: 'I’m not going to have a baby, I don’t want to get psychotic or manic', or my partner might be terrified of that," but that’s actually a perfectly manageable risk, she explains, if you receive the right support and treatment.
"Women can come for a pre-conception appointment for some advice, sit with a specialist psychiatrist who focuses on what the impact of having babies might be, and what to do with medications," Dr. Seneviratne advises. "There is no one that should be completely ruled out of parenting without having a good conversation like that."
That sounds very reassuring, of course, but resources remain insufficient. In an ideal world, you'd be able to be referred by a GP to a psychologist or one of the new special perinatal mental health services. Even in a country like the UK, or England specifically, the NHS’ investment in new services for mothers and babies has taken a generation of research. There's also the economic argument that if you don’t invest in the mother's mental health, there is an impact not only on suffering but on the development of the child as well, Dr. Seneviratne points out.
"I know that many women still won’t be able to get help in time, or have specialist advice in time," she admits. "Mental health teams, generally, in the UK are inadequately resourced, GPs are inadequately trained, symptoms might be minimised or not taken seriously, so there’s a huge amount to do."
It’s not surprising, then, that not everyone would feel confident about managing being a parent with a mental illness. And as an increasing number of young women in the UK are reporting mental health problems, it is crucial to raise awareness about their needs and, especially, to act upon them.
If you are in need of support, you can contact the following organisations: