By examining the number of survey participants who reported that the ‘role as a parent’ life domain was applicable to them (1047/2026, 51.6%) we can estimate that approximately half the sample were parents. After excluding those who said the life domain was not applicable to them, 22.5% (196/873) reported being treated unfairly in starting a family due to their mental illness. With regard to being a parent 28.3% (296/1047) reported being treated unfairly in the past year. Twenty seven participants had experienced discrimination in both domains during this time frame. A total of 304 survey participants were eligible for the framework analysis as they reported experiencing some level of mental illness-based discrimination in the previous 12 months regarding starting a family (n
89), and/or being a parent (n
215) and gave an example of this. The characteristics of the framework analysis participant’s characteristics are shown in Table . The participants gave a total of 317 examples of experienced discrimination, 89 in relation to starting a family and 228 about being a parent.
Characteristics of participants in the framework analysis sample
A final ten-theme conceptual model was constructed from the data, as shown in Figure . Two themes were classified as precursors and eight as consequences, and three themes had subthemes. The ten themes were further grouped into five superordinate themes. A core theme of People have not appreciated what I need was agreed.
Community psychiatric service users’ reports of discrimination in relation to parenthood: conceptual model and typology.
In nearly all themes respondents experienced stigma and discrimination from both the professional and personal spheres of their life. The professional sphere included maternity services, family doctors (GPs), mental health services, health visitors, emergency department staff, social workers, courts and schools. The personal sphere involved partners, ex-partners, friends, family, children and other parents.
The first of two precursor themes-both attitudinal-was People see me as an unfit parent. This was the largest theme and incorporated four subthemes. The participants in this theme spoke about how people from both spheres perceived they would be, or were, incapable and inadequate in a parental role. The subthemes in this theme were: People assume I’m not safe or trustworthy; They come in guns blazing (reflecting participants feeling that professionals were being overly protective); I am judged; and Others make decisions (reflecting a view that other people made decisions about their children and they were not consulted). The second precursor theme was People are not understanding or sympathetic. The themes, subthemes and typical quotes can be seen in Table .
Reported experiences of mental illness-based discrimination in relation to parenthood: illustrative examples
The two largest consequence themes were both about barriers to parenthood: I am stopped from having children and I am not allowed to see my children. Respondents spoke about both professionals and family being disapproving or discouraging about them starting a family. Subthemes related to not being helped to come off or change medication to enable a pregnancy, lack of access to IVF and adoption, discouragement due to relapse concerns, and not being able to have a child due to fears or knowledge that the baby would be taken away from them.
The theme of Not being allowed to see my children was reported by both mothers and fathers, and was the largest theme for male respondents although men were represented in all other themes too apart from one (My children are affected). The subthemes in the category I am not allowed to see my children related to children being taken into care by social services or no longer seeing them because of loss of custody to ex-partners or to family members. Participants also spoke about feeling unfairly treated by having restricted access to their child due to not being allowed to be alone with them or by ex-partners making access difficult. Some described how they were stopped from seeing their grandchildren or undertaking usual grandparent roles with them such as caring for them alone. Participants also described having problems and delays in getting their children back after periods in care during illness episodes. The final subtheme relating to seeing ones children was about people using participants’ mental health against them to gain access or custody of their children.
The remaining six themes did not have subthemes. The largest theme without subthemes was I am not getting the support I need and focused mainly on a lack of support from social services and in health care as well as there being little support available beyond social services. Three themes were child-related. One related to participants’ children being treated negatively because of their parent’s mental illness. Another was about the participants’ own children treating them unfairly, specifically a tendency for them to avoid the parent. A further issue relating to the children was the children’s health, behavioural and educational difficulties being blamed on the parent’s mental illness. The two final themes were interpersonal. In one participants believed they were not listened to or taken seriously as parents, particularly by the school, by doctors, partners and children. The other theme was about the parents feeling that they were undermined in their role as a parent either by the children themselves, ex-partners or by other relatives.