Context and opportunity: multiple perspectives on parenting by women with a severe mental illness.

OBJECTIVE

The capabilities framework and a community-based participatory research (CBPR) approach frame this study. We consider the real opportunities for parenting available for women with serious mental health diagnoses, despite complications posed by their own capacity, material constraints, social network disruptions, and, by law, custom and policy related to mental health conditions and child custody decisions.

METHOD

We convened focus groups with mothers currently living in shelters apart from their children, service providers in supported housing programs, grandmothers caring for children of mothers with mental health and substance use problems, and a policy discussion with mental health administrators. Qualitative analyses explored common and divergent perspectives on parenting experiences and aspirations of particularly marginalized mothers.

RESULTS

Perspectives of mothers and other stakeholders converged in recognizing the parenting challenges facing mothers experiencing homelessness and mental health and substance use problems, but their views on the implications of this diverged sharply. Mothers' current aspirations were limited by contextual obstacles to maintaining contact with children; other stakeholders saw contact as risky and reunification as improbable. All stakeholders described systemic barriers to supporting contact and ongoing mothering roles.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Evidence-based parenting interventions require facilitating policy contexts that do not foreclose parenting possibilities for mothers whose current challenges dictate modest immediate parenting goals. CBPR amplifies voices of lived experience to demonstrate what is possible over time for mothers with complex lives and histories. These become possibilities that a person can imagine for herself and are essential to inform the evidence base for practice and policy.