Women with Disabilities: Barriers and Facilitators to Accessing ...

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WOMEN WITH DISABILITIES: BARRIERS AND FACILITATORS TO ACCESSING SERVICES DURING PREGNANCY,CHILDBIRTH AND EARLY MOTHERHOODSchool of Nursing and Midwifery, Trinity College Dublin5.8. Barriers to acceptability of services for women with mentalhealth difficulties: Fear of loss of custody5.8.1. Feeling the need to prove themselvesWomen reported constantly feeling under pressure to prove their motheringcompetence and were very reluctant to reveal a mental health difficulty or seekhelp with parenting for fear of allegations of poor mothering practice, whichcould result in loss of custody of, or access to, children (Hendrick and Daly,2000; Montgomery et al, 2006; Davies and Allen, 2007). While some motherswith enduring mental health difficulties may have difficulties, it is possible, ifprovided with adequate resources, for many such women to care successfullyfor their children (Mullick et al, 2001). The literature provides evidence ofcustody loss rates of between 38% and 89% (Mowbray et al, 1995b; Cogan,1998; Joseph et al, 1999; Sands et al, 2004). Hollingsworth (2004:pg. 199)asserts that a diagnosis of persistent mental illness (schizophrenia,schizoaffective disorder, bipolar disorder with or without psychosis, and majordepression with or without psychosis) is increasingly being used to ‘fast track’the termination of parents’ right to the custody of their children.5.8.2. Fear of servicesViewing services as a source of power over their lives, as opposed to a sourceof help and support, appears to be a major barrier to women’s willingness toaccess services and help. Fearing the power of agencies to take children intocare constitutes one of the most serious barriers to women being open abouttheir distress. Throughout the research women spoke of the risks of admittingthe need for mental health care, as they perceived that this would giveprofessionals the idea that they were not coping adequately and were ‘unfit’mothers. In the current context of mandatory reporting, which requires healthcare professionals to report any concerns regarding child abuse, this fear isincreasing.105
WOMEN WITH DISABILITIES: BARRIERS AND FACILITATORS TO ACCESSING SERVICES DURING PREGNANCY,CHILDBIRTH AND EARLY MOTHERHOODSchool of Nursing and Midwifery, Trinity College DublinAnderson et al (2006) conducted interviews with 127 low income mothers inAustralia and reported that fear of custody loss resulted in a major reluctanceamong these women to accessing help from mental health professionals.Seventeen of the 22 women (77%) in Diaz-Canjela and Johnson’s (2004) studyalso reported a reluctance to initiate any discussion with health or childcareservices on their struggles as a mother, for fear of loss of custody. Fears aroundcustody loss were especially acute for women who had previously lost custodyof a child, as they lacked trust in the health professionals, especially if they hada past role in their loss. Montgomery et al (2006) studied the motheringexperiences of 20 women with enduring mental health difficulties in Canada.The women in this study described how seeking help or acknowledging theneed to take medication or agree to a hospital admission was a precariousbalance between risks and benefits. An admission to an inpatient service couldoffer time for healing, rest and recovery; on the other hand it meant being awayfrom home, having others care for children, and increasing the risk of ‘havingthe kids taken away from you’ (Montgomery et al, 2006:pg. 25). Hser and Niv(2006) highlight the multiple fears experienced by pregnant women withsubstance abuse problems. Not only does the fear of loss of custody of childrenact as a barrier to prenatal services, but these women also have to contend withthe fear of criminal action and the stigma associated with substance abuse.5.8.3. Trust in health professionalsEffective and empathetic communication is a core aspect of quality healthservice delivery, and is a significant issue in building trust with women whoexperience mental health difficulties. If women experience sensitive, trusting,empathetic relationships with health professionals they are more likely todisclose their distress. However, lack of trust of health care providers was oneof the most frequently cited barriers to seeking help by the 30 women in Jesseet al’s (2008) study. Nineteen (63%) of the women in this study were of the viewthat health care professionals were not to be trusted with information and wereconcerned about confidentiality. The lack of trust was more pronounced amongAfrican American women than Caucasian women. Suspicion around thetrustworthiness and professionalism of counsellors was also an issue for Black106
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