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A theoretical model of individuals' experiences before, during and after involuntary admission has not yet been established.
To develop an understanding of individuals' experiences over the course of the involuntary admission process.
Fifty individuals were recruited through purposive and theoretical sampling and interviewed 3 months after their involuntary admission. Analyses were conducted using a Straussian grounded theory approach.
The ‘theory of preserving control’ (ToPC) emerged from individuals' accounts of how they adapted to the experience of involuntary admission. The ToPC explains how individuals manage to reclaim control over their emotional, personal and social lives and consists of three categories: ‘losing control’, ‘regaining control’ and ‘maintaining control’, and a number of related subcategories.
Involuntary admission triggers a multifaceted process of control preservation. Clinicians need to develop therapeutic approaches that enable individuals to regain and maintain control over the course of their involuntary admission.
Susan, a 27-year-old single mother, had an unplanned pregnancy. She was worried about how she would cope with another baby. She had recently left her partner because of domestic abuse. Six weeks after her baby was born, she started to feel low, was unable to get to sleep and lost her appetite. She had less interest in her children and found everything a struggle. She felt guilty that she did not love her baby. She considered taking an overdose but did not want to harm herself because there was nobody else to look after her children.
Her health visitor asked her how she was feeling, but she was scared to tell her – she thought it would show she was a bad mother and that her children would be taken away. When she took her baby to her general practitioner (GP), she burst into tears and told the GP how she felt. The GP referred her to a psychologist and her health visitor invited her to a support group for mothers with postnatal depression. She found this really helpful and gradually recovered.
Postnatal depression (PND) is an illness that affects 10–15% of women who have a baby. It often starts 1–2 months after birth, but can begin several months later. For a third of women with postnatal depression, their symptoms start in pregnancy.
Some women feel ashamed or guilty about feeling depressed when everyone expects them to be happy about having a baby. PND is nobody's fault. It can happen to anyone. Having a baby is one of the biggest life changes women experience and can be stressful. Women often feel under pressure to live up to their own or others’ expectations.
There are many causes of PND; previous mental illness, lack of support, previous abuse, domestic abuse, stressful life events (e.g. relationships ending) and physical illness (e.g. underactive thyroid) can all contribute. Many different mental health problems can affect women in pregnancy and after birth, not just PND. It is important to get the diagnosis right so that the right treatment can be obtained.
There have been a large number of studies in recent years reporting on the reproductive safety of antidepressant medication. Some studies, but not all, have reported an association of antidepressant exposure in pregnancy and the subsequent development of autism spectrum disorders. It remains difficult to know whether the modest increase in risk is due to the medication, to the mood disorder itself, or to other confounding factors. For any individual woman the decision to commence or continue antidepressant medication in pregnancy must be made after a full consideration of the potential risks and benefits of all options, including non-pharmacological treatments. In making these difficult decisions it is important to recognise that episodes of severe psychiatric illness may have very serious negative consequences for the woman, her baby and her family, and these must be weighed against what is known about the risks of taking medication.
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