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| Theme/subtheme | Illustrative quotations |
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| Theme 1: A downward spiral of service intervention |
| Needing support but fearing the consequences | “All mothers discussed feeling “scared” or “frightened” or having a fear of losing care of their child once CPS became involved. As a result this caused some mothers to be reluctant in seeking mental health services for the fear that their child may be taken away” [32] |
| “Every mother’s fear is that her children will be taken into care…if I did anything that made them think I was going crazy then they’d take my daughter away.” (mother) [16] |
| “The first social worker used to look at me like I was an alien…I don’t know if they have a full understanding… that even if someone’s got a mental illness, they can still be a good parent.” (mother) [70] |
| “When I asked for help from services, they just wrote down, “mum can’t cope, mum is saying this, mum is doing this.” And they use it against you.” (mother) [76] |
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| Social services involvement exacerbating mental health difficulties | “My daughter got taken away…that was probably the worst time for me. Cause she had been with me for seven years… she had always been in my care… and then she was gone and I couldn’t talk to her. I felt really bad. I just wanted to die, you know. It was really bad.” (mother) [57] |
| “It’s like you’re at the worst time of your life and they want you to be at your best, to show them that you are the, you know, and put these runs on the board…you’re at your absolute worst, and they’re expecting you to be the best you’ve ever been.” (mother) [66] |
| “Because there is a stigma when you are not looking after your children. People are looking at you and because you are washed and dressed and presentable and they can’t see a reason why you can’t look after your child, other than you must be a drug addict, you must be a dreg of society. So I feel stigmatised.” (mother) [16] |
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| Mental health treatment making parenting difficult | “Some mothers and staff members spoke about mothers refraining from taking their medication to take adequate care and meet the needs of their children. Staff members reported that this was often due to the side effects of medication (e.g., drowsiness) which greatly added to the challenges of parenting.” [32] |
| “Symptom management and engagement with mental health professionals and services are not in themselves indicative of recovery. Indeed, for many parents, having to engage with services was seen to be an indication of a setback, a lack of personal resources to cope, or a challenge to their recovery, rather than a support of it.” [79] |
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| Theme 2: Working with parents, not against them |
| Engaging parents through relationship building | “In the end social services will take (the children), because they’ll have no choice, quite honestly. I won’t work with them, I won’t engage, I won’t do absolutely anything that they tell me to and… I will get what I want in the end (referring to the children being removed) because it was the only way I saw out of it.” (mother) [15] |
| One mother described how she and social workers learnt to know and understand each other better. She attributed this to shifts in communication styles on both sides that resulted in social workers seeing her as a mother in need of support, rather than a risk: “I didn’t feel like anybody was listening to me…when they finally did listen everybody just kind of clicked…” (mother) [70] |
| “There’s nothing they could have done differently to engage me more, so in some ways, perhaps chasing me was a waste of time really” (father) [58] |
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| Working with trauma | There were repeated failures in caregiver and CWS responsiveness to the needs that mothers presented with. Sixteen of the 20 mothers stated that they had not even been asked about their histories or their trauma when interfacing with CWS workers. One mother stated, “no one wanted to hear about me. What I had been through did not matter to them.” [53] |
| “We take those individuals who already carry the shame and guilt of their own childhood. And then, they’re parents, and they’re wanting something different (for their children). I don’t believe that parents go into parenting wanting to mess up, wanting to ineffectively parent and harm their children.” (mental health clinician) [84] |
| “It’s still following me. It’s like they see these things of who I used to be and they’re not talking to who I am now. They’re not looking at what I’m doing now. Like I changed my life when I had children, I’m a completely different person.” (father) [79] |
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| Strengths-focused vs. deficit-focused | “One mother, who had a negative experience of professionals, previously, spoke eloquently about how social workers” belief in her ability to change motivated her to seek help and focus on the needs of her children: “they told me. I’ve got the potential to do it. I’ve just got to get my mind in the right place.” [62] |
| “How many sacrifices that those moms make to come to therapy is amazing. Some of them could leave hours before coming to therapy because they have to get a bus (and) wait for the next bus. The whole thing may take four hours just to come to therapy, but they did it every week. I’ve had people come in (when) there’re horrible rainstorms, waiting outside for the bus or having to walk to get to therapy, because they want to get their child back.” (mental health clinician) [84] |
| Statements such as “We’re not going to change the borderline personality disorder and were not going to change the bipolar’ (Mary: OT social worker) construct the problem as intractable and undercut any faith in clients’ ability to recover and eventually regain care of their children.” [79] |
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| The importance of transparency | “Some felt decisions were made before meetings started. One couple felt they could not contribute to decisions being made. They said “from her coming home… we were kept in the dark”. Another mother said: “They always asked us, but our view. They said “we still want to know your views”, but it never made a difference”. [62] |
| “I never in my wildest imagination dreamed that my children would be took for the period of time that they were took. I thought it was temporary – maybe a week or two until I got back up on my feet, got us another house, moved out of the area, moved away from the person that was causing us direct danger – and then my kids would be back. They told me to give up custody and you would get your kids back; so I am like – how long? He was like, maybe a month or two. But (that) turned into almost two years.” (mother) [65] |
| “It’s important that we, together with (child protection), are open to families about the concerns. They need to be told, and we need to be told, so it’s clear to everyone and we’re all on the same page. It’s our job to help parents understand the decisions child protection makes, but we can’t do that unless we understand them as well. It’s very important that families don’t receive conficting information, but unless we work closely, this happens and families get confused. They need to know clearly what’s expected of them.” (child protection worker) [39] |
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| Theme 3: Support wanted vs. support provided |
| Parenting support | “Five of the women did describe feeling able to talk about their experiences and difficulties as mothers to their keyworkers. Each of these had a consistent keyworker with whom she had felt able to establish a trusting relationship. This was seen as a substantial support in parenting.” [16] |
| “They value that we recognise that it’s (parenting) an important part of their lives …sometimes in the mental health system it’s very much about your diagnosis and medication. That sort of holistic picture of a person can get missed out …. It improves my relationship with them, talking about parenting.” (mental health clinician) [81] |
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| Financial support | “As far as the neglect and leaving (children) alone, many say “I had no other options. I have no help.” I had one (mother) who would leave her children locked in her apartment because she had to go work midnights because she had no options, no childcare” (mental health clinician) [84] |
| “The fact that I was unemployed at that time. I was very proud. I did not want to go to social services to get assistance, and when I finally went, they gave me such a hard time. They even went so far as to say I could sell my furniture and my car to take care of (my son).” (mother) [65] |
| “My kids aren’t in school and I’m supposed to have them for a few days. But because I’m broke until the end of the week and I don’t really have food or anything, he’s not going to help. So, I just don’t get to see my kids.” (mother) [77] |
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| Mental health treatment | “Several participants recognized that medication and mental health treatment and support are helpful in managing symptoms. However, they also stressed that medication and attending appointments can interfere with parenting and the level of interaction mothers have with their children.” [32] |
| “It was also clear that for the majority of these parents their acute symptoms abated with proper diagnosis and treatment. However, they continued to struggle with the handicap of being labelled mentally ill.” [34] |
| “(It) is just the temptation to pathologise the victim’s experience of domestic violence and put a diagnosis on it and focus specifically from a mental health point of view: diagnose, medicate, discharge - which doesn’t hold the perpetrator accountable whatsoever?” (mental health clinician) [67] |
| “I’ve been diagnosed everything.… one said I was a paranoid schizophrenic and the other one said no I wasn’t.… you know, when you get a different doctor, they see what they think they see, and do the best they can, you know … and some of them want to medicate you to death, and, you know, not deal with your problems and not talk to you.” (Parent) [34] |
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| Working with wider support networks | “They (family) did step in and help me out, but sometimes their good intentions were the worse thing for me. Sometimes they tended to take over and they had the children a lot … also they got on me a lot … (and told me to) snap out of it.” (mother) [34] |
| “The dad is a real asset, but he has not been allowed to participate… I have personally decided that the fathers should now be included, but I have really had to work on myself. We are not in complete agreement within the treatment group.” (Social worker) [83] |
| “Women told us how important it is to include their partners and/or the children’s fathers in any services offered, noting that it is “not just women. I know that there are men going through traumatic times”. [76] |
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| Theme 4: Constrained by service rigidity |
| Fragmented services | “Making contact (with mental health professionals) is a poor experience the majority of the time. I cannot recall any mental health provider who initiates and who is responsible for collaborative communication” (child protection worker) [72] |
| “They (social services) are only here for (the baby), you know…If you want (my baby) to do well, we need to be well as well. Well, I need to be well.” (mother) [70] |
| “I try to understand where child protection are coming from in their decision-making. But I’m not sure that they fully appreciate the impact of depression or anxiety on someone. I think they are extremely child focussed and that’s their job but there isn’t much room for an understanding of what’s actually driving the distress in the family.” (mental health clinician) [39] |
| “I can only do the mental health stuff—I cannot do the child care and I am finding more and more social workers who can only do one or the other” (social worker) [55] |
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| A heavy focus on risk | “You worry that you’re (pause) reacting too strongly to a situation. You are misjudging it. You know, you think you are seeing something that you are not. I suppose the other fear is that you’re missing something, and you’ll get blamed for it. That sort of thing.” (Psychiatrist) [78] |
| “A salient example of risk eclipsing other considerations is the experience McKayla recounts of being reduced to her mental illness and its attributed risks. “Nobody was taking any of that into consideration, they were just, this is who she is, these things what she is doing is who she is and she’s a risk. I was at risk, yes.” (parent).” [79] |
| “Clinicians explain that both individual and group supervision is critical in terms of enhancing objectivity and assisting them to tolerate the uncertainty and complexity of the work.” [58] |
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| Service inaccessibility | “I kind of feel betrayed by (child protection services) because I had already asked them for help prior to (the removal). They didn’t care. I’d asked a mental health worker to help and she didn’t care.” (mother) [66] |
| “All the women who cared for their children identified difficulties in attending appointments or using day care services as there were no crèche facilities and mental health service premises were not appropriate environments for children.” [16] |
| “The majority of clinicians comment that families should be referred “much earlier, not when it’s at the pointy end” (Alex). Clinicians argue that working with families earlier, before they have reached such high levels of risk, will impact positively on client outcomes as well as staff wellbeing.” [58] |
| “I’m trying to think about mental health, but they really feel quite distant and not—I really very rarely consider them, I guess…. it just seems that they have really, really strict, hard boundaries and that they’re very clear about that, and so I just don’t find them approachable.” (children’s social worker) [60] |
| “Mental health can only cover so much because of government funding now, so if you’re not in that category or criteria, you’ve got to go to general practitioners who are not trained on mental health issues, and they’ll quickly write you out a script, and you’re not getting the help you need. And there’s a really big failing in the mental health system at the moment… I feel you’ve got to fall before they’ll listen, and that’s that.” (social worker) [60] |
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