The impact of serious mental illness on mothers has received little attention when compared to the study of outcomes for children of parents with mental illness. Mental health providers may not routinely inquire about the parenting status of seriously mentally ill women, or consider whether they have ongoing contact with their children. Although individualized, recovery-oriented care is often sought for our patients, the special service needs of mentally ill mothers have been only rarely addressed in the medical literature. Given the fact that mothers with serious mental illness have more unplanned pregnancies, less stable partnerships, and more frequently lose custody of their children, the experiences of this population is worthy of increased attention.
A 1993 study on policies of State Mental Health Authorities across the country for the identification and treatment of mothers with serious mental illness revealed that only 16 states routinely collect data on mentally ill mothers (Nicholson J, et al: State Policies and Programs That Address the Needs of Mentally Ill Mothers in the Public Sector. Hospital and Community Psychiatry 44(5): 484-489, 1993). Even this data collection varied considerably and was not necessarily entered into a statewide information management system. In order to get a more current picture of patients as mothers at one hospital, we did a study here at Rockland Psychiatric Center. Data was collected via electronic medical records, face-to-face interviews, and focus groups to determine both the number of female inpatients who were mothers, as well as the perceived needs of this group.
Although the study is ongoing, preliminary results have been surprising. Despite long-term hospitalized women being a subgroup of the most seriously ill, at least 38% of female inpatients at the hospital were identified as being mothers. The mothers showed a mean age of 54.7 years, and most were diagnosed with Schizophrenia or Schizoaffective disorder. The average length of hospitalization for all mothers was 30 months. Thirty six percent of mothers were never married, and 54% were either separated, divorced, or widowed.
We have also found that mothers at this hospital have more contact with children than we might have guessed, with 50% reporting they have at least weekly contact with their children (of that 50%, half reported contact multiple times per week). Focus groups and face-to-face interviews revealed the motherhood role to be an important source of pride, and also served as a motivating factor for getting and staying well. Patients voiced a real interest in being educated about resources available to them as mothers, as well as interest in being a source of support for one another.
The number of women with serious mental illness who are mothers is greater than we might have guessed, and is likely being overlooked in many cases as the question is often not posed. This forgotten role of motherhood among the seriously mentally ill has resulted in mental health professionals becoming involved only at the point of crisis management or child removal. As our data continues to come in, we will be thinking about how to better serve our patients who are mothers at Rockland Psychiatric Center. Promoting roles for the people we serve aside from that of “patient” is just one component of recovery-focused and person-centered treatment. Hopefully this study can make us all pause and remember to ask our patients about whether they have children, and consider the potentially great impact of parenting on mental illness treatment and outcomes
