Women can’t win: Mental health in crisis

// 25 October 2012

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7777777777777777777777497892348_386ed38770_b.jpg I’ve just read a report that a psychiatrist and Professor of women’s health has advised that women of childbearing age should not be given anti-depressant or anti-psychotic drugs. This is because of the chance that they will accidentally become pregnant while taking drugs that could harm the developing foetus.

Now, I don’t know about you, but undergoing ~30 years of untreated psychiatric problems on the offchance that a sperm will accidentally fertilise an egg sounds like an absolute nightmare to me.

On World Mental Health Day last year I wrote about how certain anti-anti-depressant campaigning is actually very stigmatising to those of us who take psychiatric medication, but if the report above is true it adds highly unpleasant layers to the stigma. It appears that Professor Howard is advocating putting your entire life on hold from age 15 to age 45, because your highest priority at all times should be the small possibility of an unknown, unplanned pregnancy. There is already a strong societal expectation that women give up all sense of themselves once they have children, but now we are to do so if we are technically fertilisable?

I have no intention of ever having children. I do have every intention of trying to stay as mentally well as possible. My priorities are therefore clear, and I will continue to take the meds that I know help. But what are women to do if they take Professor Howard’s advice?

Be admitted to hospital for treatment and support, perhaps? Have a read of this article by a police officer about how frequently vulnerable people in a mental health crisis are sent to police cells as a supposed “place of safety” when there are no beds on psych wards. S/he writes,

“The levels to which this applies varies from area-to-area. Some forces, like West Midlands, have managed to get 97% of their section 136 detainees into a clinical place of safety after many months of hard strategic work. Other forces are nearer 50-60%.

“The remainder go to cells. This is abhorrent. The Independent Police Complaints Commission have recommended more than once that a police cell should never, ever be used as a place of safety apart from as a last resort”.

Ok, so there are no hospital beds, what about the Crisis Team? These were set up at a time when beds on wards were being reduced, as a way to reduce the number of admissions needed. Let’s read the words of APt in Camden:

“I was terrified and asked the crisis team worker what I should do. They told me they didn’t have time to talk to me as had listened for 10 minutes and had to be elsewhere and I could either go to A&E or take all the tablets – it was up to me. I couldn’t manage and took a major overdose, did not alert anyone and was then found unconscious on the street.

“I feel there is particularly an attitude towards women in crisis. As a woman I don’t feel safe working with them so would rather be admitted to hospital. It does not surprise me that while ward suicides go down in number, suicides of patients under crisis team care has risen dramatically” (emphasis mine).

Women experiencing mental distress are being advised to not take medication, with a potential foetus’s needs subsuming her own; if she needs to be admitted to hospital she may well end up in a police cell; and if there are no beds and she is referred to the Crisis Team, then after her allocated 10 minutes are up she may be told that she can take an overdose if she wants to.

None of this is acceptable. The figures of people with mental health problems are vast, and women are being passed around with nobody offering decent and respectful care. Cuts are hitting mental health services deeply, and benefit changes are causing many people with mental health problems extra distress and fear. Everybody thinks it is somebody else’s problem, but until mental illness is taken seriously by those who have the power to make changes, and those who speak to the media on the subject, women’s crises will be prolonged and exacerbated unnecessarily in ways such as this.

Edited to add: Professor Howard has clarified her position here

[The image is a photograph of the profile of a woman looking sad. It was taken by Andrea Guerra and is used under a Creative Commons Licence]

Comments From You

The Goldfish // Posted 25 October 2012 at 11:27 pm

Discussing options with a pain specialist a few years back, I was told that there were certain drugs that couldn’t be considered while there was the possibility I might get pregnant. I explained that this wasn’t on the cards. I didn’t want children, I wasn’t sure that I could carry a pregnancy to term, and my health and life circumstances made that all kinds of undesirable. Well, the doctor said, my plans might change.

Sure, and if they did, I’d be back to talk through with a doctor about what do to about my drugs. After all, pregnant women are advised against taking more than a few paracetamol and any aspirin or other anti-inflammatory. Plus any opiate use in pregnancy is pretty problematic – baby could be born with dependence, at the very least.

I realise some pregnancies are unplanned, but usually when people aren’t taking any precautions. I don’t see why it’s not possible for doctors to have a serious conversation with patients and make it crystal clear that some drugs are incompatible with healthy pregnancy, opening the opportunity to talk that through, without having to pry or ask personal questions (and if, for example, someone is celibate or otherwise not having PIV sex, to take their word for it). And of course, make sure there’s an open invitation for another talk if a woman’s plans do change.

I think with so much around pregnancy, as well as mental health, this stuff is about treating women like children, incapable of managing their own lives and reproductive choices.

Quinn Capes-Ivy // Posted 25 October 2012 at 11:55 pm

I had a couple more thoughts about this, couldn’t get my comment-posting-ness to work, so I wrote about it here. For those leery of links, I basically said that a) not all women of childbearing age can get pregnant and some men can, and b) this doctor has obviously never seen a copy of Hale’s. :oP

Sarah Kate // Posted 26 October 2012 at 12:03 am

Wow. Once again women are reduced to mere baby-pods, whether or not they want to have children. I was talking with my friend ( a children’s nurse and trainee health visitor) just this evening about mental health and pregnancy, and she was telling me what she’s been learning about the potential harm to a developing foetus caused by stress and anxiety, so even if you are going to ignore the adverse effects for women of leaving mental health conditions potentially untreated, what about the adverse effects of anxiety for the foetus (or potential for a foetus)? Of course there are other treatment options available but medication often plays an important role, I have been on anti-depressants for 7 years to treat depression and severe anxiety, and although I have had both CBT and counselling which have both helped me, I still function better on medication than I do without.

For me it is about weighing up all the factors involved, I do want to have children but feel the potential risk to both me and my unborn child of stopping my medication completely may be greater than the risk of continuing to take a low dose of medication whilst pregnant (obviously this is something I both have and will discuss with my GP to make as informed a decision as possible). I just read the article linked above and Prof Howard does make a similar point about weighing up the risks and benefits, it’s a shame the Telegraph went for the ‘should not be allowed to take antidepressants’ headline.

Also the focus on mental health medication seems bizarre. Might as well outlaw smoking and drinking for women of a childbearing age for the same reason.

femmeunpleurs // Posted 26 October 2012 at 4:47 am

this already happened to me last year, my phyciatrist said i couldnt switch to sodium valporate in case I got pregnant and it harmed a foetus, i was taking another drug for bipolar disorder and i hated the side-effects….after telling him I a)don’t want children and b)am a lesbian. There is some evidance that some anti-depressant’s men should avoid taking while trying to conceive, but the slogan ‘men who are of the age to have children should be denied anti-depressants and anti-phycotics,’ sounds ridiculous.

Jackie Bather // Posted 26 October 2012 at 11:07 am

This issue of medication versus reproductive potential is something which I’ve encountered previously, both as a mental health nurse and a private individual. There is a drug which is used for the treatment of severe acne, which requires a mandatory test for pregnancy to be carried out, on a woman, before each supply of medicine is given every month. Men are not controlled in this way and can be given the drug more freely. I can only conjecture that the drug companies are so frightened of litigation, because of reported foetal abnormalities associated with the drug, that this regime is stipulated by them. A signature is required each month by the patient, agreeing to these terms, in writing and refusal results in the drug being discontinued. Totally gross.

With reference to mental health medication, this constant reference to a woman’s uterine potential is offensive and outmoded. Again, I am assuming that drug companies and psychiatrists are afraid of being sued but would be interested to hear of alternative interpretations, from anyone who has more information known to them.

sohcahtoa // Posted 26 October 2012 at 11:46 am

Yes, I’d seen that about the acne drug (Roaccutane?) although I didn’t know it was quite so strictly controlled. Is the test required even if the woman is not sexually active?

What I find particularly alarming is that in none of these scenarios is the possibility that a woman becoming pregnant in such circumstances might have an abortion really allowed for. Obviously, some women who become pregnant accidentally decide to keep the baby, and if in that case (or the case of a planned pregnancy) foetal abnormalities meant that an abortion was the only viable option than that would be a very sad outcome. But it is accepted by most people that abortion is ONE possible choice if someone gets pregnant without meaning to; why implicitly rule it out here?

sohcahtoa // Posted 26 October 2012 at 5:23 pm

*obviously in the above comment I meant ‘heterosexually active’. But then, doctors don’t tend ever to make that distinction!

Clodia // Posted 26 October 2012 at 8:10 pm

Sounds exactly like “The Handmaid’s Tale” (Margaret Atwood). Very frightening that men seek to control women in this way, denying them drugs that might benefit them and their health, because they are deemed to be baby-pods! We haven’t come nearly as far as I thought we had; indeed this is serious regression.

RadLib Fem // Posted 27 October 2012 at 11:40 am

You know there’s a long way to go in terms of fighting for bodily autonomy when even the needs of *theoretical* foetuses are put before those of the fully formed human beings who could potentially carry them!

@sohcahtoa. I’d suggest doctors need to go beyond even that because some people are “heterosexually active” without including pregnancy risking (i.e. PIV) sex in their sexual activities. My guess is that doctors would still require the test in those circumstances because of the conventional view that people with vaginas who have sex with people with penises must do it in a way that could make a baby and that, if they don’t, it’s inevitable they will.

Jackie Bather // Posted 27 October 2012 at 8:31 pm

@sohcahtoa Yes, the drug is ‘Roaccutane’. A female teenager in my wider family, was seen by a Consultant Dermatologist (female), who would not accept a verbal or written confirmation of no sexual activity, by the girl concerned. Basically, if the patient accepted ‘Roaccutane’, she was required to take the contraceptive pill simultaneously (which she had not previously taken) and undergo a pregnancy test prior to each supply of the drug being issued. As a result of these conditions and after reading up re: the side-effects of the drug, she declined to take it, so the matter was not pursued.

So, the girl’s confirmation of her sex-free lifestyle was not believed by the doctor concerned and frequent, totally unnecessary pregnancy tests, would have been carried out on her. I agree that we are coming very close to ‘The Handmaid’s Tale’ here….

Dr Sarah // Posted 3 February 2013 at 10:01 am

I’ve read the quotes from Dr Howard in the original article (http://www.telegraph.co.uk/women/womens-life/9631088/Women-of-childbearing-age-should-not-be-allowed-to-take-antidepressants.html), and they certainly don’t look to me as though she’s advocating that women of childbearing age be banned from taking any psychiatric meds under any circumstances:

‘The risks of taking most antidepressants are very, very small and only a small number of treatments for severe mental health problems are known to cause significant side effects.’

‘The thing to weigh up is the risks and benefits of drugs… It’s a matter of weighing up her illness risks with the risks of the medication and also what her values are… Before you get pregnant you actually need to have these discussions… Clinicians are careful to give women information to weigh up the risks of the illness against the risk and benefits of treatments’.

So, yes, she thinks it’s best to avoid the particularly teratogenic drugs in women of childbearing age – which I agree is sensible. But, unless I missed something from elsewhere, she *isn’t* saying that this applies to all drugs used in psychiatry, and she *isn’t* saying that it should be a blanket ban with no thought given to individual circumstances. Quite the contrary.

And, speaking as a doctor, I can tell you that the issue with pregnancy risk isn’t that we’re assuming that every woman is going to have a penis in her vagina at some point. It’s that we don’t know who is and who isn’t. People can change their minds, or experiment, or get carried away. And, sadly, as we all know, there’s also rape and the pregnancies resulting from that (which some women choose to keep). Barring situations like a previous hysterectomy*, you just can’t look at the woman in front of you and know for certain that there is zero chance of her getting pregnant at any time in the coming years**. There are too many uncertainties, too many things that can’t be predicted.

*Technically a woman who’s had a hysterectomy also doesn’t have zero chance of getting pregnant, because there are recorded cases in the medical literature of ectopic pregnancies in women with previous hysterectomies. Still, I think that in that situation the chances of getting pregnant and carrying it to term really would be close enough to zero that that woman could be considered at zero risk for practical purposes.

**Though, of course, a woman may feel certain that she wouldn’t *continue* a pregnancy if she became pregnant. This is one of several reasons why a woman and her clinician may feel it appropriate to make an exception to this rule in her case, as part of precisely the discussion and weighing-up process that Dr Howard clearly said doctors and patients should have.

Jess // Posted 24 February 2013 at 10:12 pm

Just found this clicking back through the archives and had to comment. I was sent home twice from hospital last year after becoming suicidal, and in one case cutting myself. I was told to pull myself together, had my notes lost, and was blamed for being traumatised by my own rape by the Crisis Team. No treatment offered. They also wanted to forcibly admit me to the ward after what notes they had got scrambled and they believed I was from Colchester, and I corrected them. After the second time, I made my boyfriend promise not to take me back there, no matter how bad I got. I’ve been trying to get some kind of treatment for my condition for the last 8 years.

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