A delicate balance: intervention with mothers with dual diagnosis and their infants

Abstract

Purpose – Women with mental illness, substance-dependence or dual diagnosis are at increased risk of losing care of their children which leads to poorer outcomes for mothers. The purpose of this paper is to explore the service response to substance-dependent mothers, many of whom had a dual diagnosis, and reports outcomes for their infants from the perinatal period to the end of each infant's first year. Design/methodology/approach – This was a longitudinal case study of 20 women substance-dependent women and their associated care. Semi-structured interviews were held with mothers recruited from a specialist alcohol and other drug obstetric service at infant age six weeks, six and 12 months. Structured interviews were also held with counsellors from the obstetric service at infant age six weeks. Child protection (CP) workers were interviewed at infant age six weeks, six and 12 months regarding mothers involved with the service. Findings – By 12-month follow-up, CP services had been involved with 14 mothers and eight had lost the legal care of their infant. Mothers who retained legal care were more likely to have addressed their drug use and less likely to be in a domestically violent relationship. Domestic violence, homelessness and maternal recidivism to crime tipped the scales in favour of protection of the infant through removal from maternal care, essentially leaving mothers with minimal support for reunification and reduced incentive for treatment. Research limitations/implications – Reliance on mothers’ self-reports was a limitation of the study. The small sample size restricts generalisability of findings. Practical implications – Key workers should engage women (and their partners) during the perinatal period to provide support, advocacy and case-management to enable substance-dependent mothers to safely parent. Originality/value – This is one of few studies to report long-term outcomes for mother/infant dyads when substance-dependence and/or mental health are present that allows women to speak for themselves. The prospective design provides a contemporaneous account of events as they unfolded in situ.

A critical interpretive synthesis of the intersection of domestic violence with parental issues of mental health and substance misuse

“…There is also evidence of an emerging gendered lens in some AOD and MH services. In addition to the aforementioned newly emerging programs addressing DFV-perpetrating fathers' substance misuse, there are also programs for women as mothers with substance issues (Tsantefski, Jackson, & Humphreys, 2015),…”

“…As one young person put it, "no one has ever asked me about how I feel in any of this" (Templeton et al, 2009, p. 145). Thus, a heightened focus on children living with the intersecting complexities of DFV and parental AOD and MH emerges, while attention towards mothers' needs and wellbeing is diminished (Frederico et al, 2014;Radcliffe & Gilchrist, 2016;Tsantefski et al, 2015).…”

Engagement in help-seeking of dual diagnosed mothers at a low-threshold service: grasping life through co-created opportunities

“…In general, mental ill health and substance use can create delayed help-seeking and may result in negative outcomes with more symptoms, poorer functioning, and less satisfactory quality of life (Clement et al, 2012;McKee, 2017;Nutt et al, 2017). Persons with a dual diagnosis may not know where to look for help, since the services may seem bureaucratic or the system complex, and they may have difficulties in engaging with the services (Coombes and Wratten, 2007;Motta-Ochoa et al, 2017;Ness et al, 2014;Staiger et al, 2011;Tsantefski et al, 2015). People, who do not seek help in questions related to dual diagnosis, do so because of economic constraints, inconvenient opening hours, and unavailability of help (McKee, 2017;Motta-Ochoa et al, 2017;Nidecker, et al, 2009).…”

“…Clients may want to avoid being labelled mentally ill and addict (Motta-Ochoa et al, 2017), and thus mothers may not seek help (Blegen et al, 2010;Sorsa and Åstedt-Kurki, 2013). Women may avoid services for practical reasons due to lacking childcare or on emotional basis, as a fear of their children being taken into custody (Blegen et al, 2010;Tsantefski et al, 2015). However, attendance in services has been recognised as one of the most important predictors of positive outcomes in addiction treatment (Schulte et al, 2010).…”

“…Mothers with a dual diagnosis (mental ill health and substance use) and vulnerable backgrounds of abuse and experienced violence may have delays in accessing services (Blegen et al, 2010;Tsantefski et al, 2015). As their life problems may be rooted across generations (Wilson et al, 2013), the mothers may feel different, rejected, lonely, and experience exclusion from everyday activities such as relationships and employment (Chorlton and Smith, 2016).…”