ASSESSING PARENTING CAPACITY IN PSYCHIATRIC MOTHER AND BABY UNITS: A CASE REPORT AND REVIEW OF LITERATURE

Aims and hypothesis: This review aimed to improve infant risk assessments in the context of maternal mental illness by identifying key predictors of poor parenting outcomes. Background: Inadequate parenting as a result of severe and persistent mental illness is a common reason for courts terminating parental rights. However, the current practice of parenting capacity assessments in the setting of perinatal psychiatry is fraught with risks and uncertainty. A well-recognised flaw in the assessment process is the lack of valid and reliable tools that have been specifically validated for assessing parenting capacity in mothers with a history of mental illness and the potential risk of harm to their infant. To date, there is only one instrument available. Methods: A systematic search of Medline, PsycInfo and Embase via the Ovid interface was conducted between September and December 2014. Citation snowball sampling was also used to identify further relevant studies. An additional search was performed in Google to access grey literature. Results: A total of 38 citations were identified, of which 8 publications focusing on the populations of England, France and Belgium met the eligibility criteria of this review. Evidence from existing research suggests that poor parenting outcomes in maternal psychiatric illness are strongly associated with correlates of socio-economic inequalities. However, evidence regarding the longterm implications of such factors is weak as only one follow up study and no longitudinal studies were identified in this review. Conclusion: Our review suggests that the use of standardised empirically validated risk assessment tools would benefit the current practice of parenting assessments by improving the process by which collected information is analysed. This would enhance the accuracy of decision-making, and improve the safeguarding of the infant. Further research is needed on medium to long-term parenting outcomes, particularly regarding its relations to: the type of maternal psychiatric disorder; the quality of maternal relationships; previous attachment experience; psychiatric illness or behavioural disorder in the partner and neonatal/infant medical complications. This would more accurately reflect the dynamic nature of parenting and would help to determine the effectiveness of specific interventions addressing risk factors associated with poor parenting outcomes

ASSESSING PARENTING CAPACITY IN PSYCHIATRIC MOTHER AND BABY UNITS: A CASE REPORT AND REVIEW OF LITERATURE

Aims and hypothesis: This review aimed to improve infant risk assessments in the context of maternal mental illness by identifying key predictors of poor parenting outcomes. Background: Inadequate parenting as a result of severe and persistent mental illness is a common reason for courts terminating parental rights. However, the current practice of parenting capacity assessments in the setting of perinatal psychiatry is fraught with risks and uncertainty. A well-recognised flaw in the assessment process is the lack of valid and reliable tools that have been specifically validated for assessing parenting capacity in mothers with a history of mental illness and the potential risk of harm to their infant. To date, there is only one instrument available. Methods: A systematic search of Medline, PsycInfo and Embase via the Ovid interface was conducted between September and December 2014. Citation snowball sampling was also used to identify further relevant studies. An additional search was performed in Google to access grey literature. Results: A total of 38 citations were identified, of which 8 publications focusing on the populations of England, France and Belgium met the eligibility criteria of this review. Evidence from existing research suggests that poor parenting outcomes in maternal psychiatric illness are strongly associated with correlates of socio-economic inequalities. However, evidence regarding the longterm implications of such factors is weak as only one follow up study and no longitudinal studies were identified in this review. Conclusion: Our review suggests that the use of standardised empirically validated risk assessment tools would benefit the current practice of parenting assessments by improving the process by which collected information is analysed. This would enhance the accuracy of decision-making, and improve the safeguarding of the infant. Further research is needed on medium to long-term parenting outcomes, particularly regarding its relations to: the type of maternal psychiatric disorder; the quality of maternal relationships; previous attachment experience; psychiatric illness or behavioural disorder in the partner and neonatal/infant medical complications. This would more accurately reflect the dynamic nature of parenting and would help to determine the effectiveness of specific interventions addressing risk factors associated with poor parenting outcomes

On The borderline? Borderline personality disorder and deliberate self harm in literature

This paper examines Borderline Personality Disorder (BPD) in two texts - Kristen Waterfield Duisberg\'s The Good Patient and Susana Kaysen's Girl, Interrupted. It argues that fiction that examines the types of behaviours associated with BPD depathologises BPD through its focus on experience, meaning and reasons rather than symptom. The label of BPD can be pejorative and as such individuals who have this diagnosis or meet the criteria for it run the risk of having many assumptions made about their acts of DSH. From the perspective of the functions, meanings and significations of acts of DSH, this paper suggests that learning to listen to these highly individual networks of meanings through the non-damaging medium of literature can be a valuable tool for clinicians

Madness in post 1945 British and American fiction.

This is one of the first books to comprehensively explore representations of madness in postwar British and American Fiction. The book looks at representations of madness in a range of texts by postwar writers (such as Ken Kesey, Marge Piercy, Patrick McGrath, Leslie Marmon Silko, William Golding, Patrick Gale, William Burroughs and J.G. Ballard, to name a few), and explores the ways in which these representations help to shape public perceptions and how they portray highly unique experiences of mental disorder. The five authors come from diverse backgrounds – literary studies, social psychology, medical psychiatry and psychiatric nursing – and as such the book's perspectives are informed through several discourses, making it a unique co-authored text in the discipline of Health Humanities. This book is of relevance to both those with interests in literary studies, and is a vital read for psychiatric clinicians and professionals who are interested in how literature can inform and enhance clinical practices. Those who have been affected by mental health issues will also find this book both relevant and empathic to such human experiences

Discourses of blame: accounting for aggression and violence on an acute mental health inpatient unit

The English National Service Framework for Mental Health stipulates that the highest quality of health care should be provided for mental health service users in the most efficient and effective manner. Incidents of aggression and violence militate against achieving that goal, yet such incidents are frequently reported in inpatient settings. Traditionally, research in this area has focused on the extent of the phenomenon, the individual characteristics of those involved and precursors to the incident. For the most part the literature reflects a dualistic, perpetrator/victim conceptualisation of incidents. This study aimed to address the lack of research undertaken from a more systemic perspective by examining how all those involved understood and attributed meaning to violent or aggressive situations and how these attributions justified individual perceptions, reactions and actions. Working from the position that all behaviour, including violent behaviour, has meaning to those involved and can be understood, 16 semi-structured interviews were carried out in one mental health unit. Because only one client was both willing and able to give a full account of an incident, we focus here on two incidents in which that client was involved. Discourse analytic techniques were used to examine her account of the two incidents and those of the staff members involved. Participants discussed key themes from the interviews in terms of several dilemmas: whether the violent or aggressive behaviour was 'mad' or 'bad'; predictable or unpredictable; and had resulted from 'personality' or ' mental illness'. The client and staff discourses were strikingly similar and in each case the central concern was with the attribution of blame. The findings have implications for the professional discourse of mental health care, including the discourse of the current policy agenda, a discourse itself constructed with the primary function of exoneration from and attribution of blame.Mental health services Violence Psychiatric inpatients UK