La parentalité des mères présentant un trouble psychotique est devenue une réalité sociale croissante et qui nécessite une prise en charge spécifique. Le but de la présente étude était d’explorer le point de vue des professionnels de santé exerçant en psychiatrie sur la parentalité de ces mères et leur prise en charge.

Seize professionnels de santé en psychiatrie ont répondu à un entretien semi-directif.

Les entretiens mettent en avant des représentations contrastées de la parentalité des mères psychotiques. Alors que les difficultés parentales sont nommées majoritairement, les ressources parentales semblent plus difficiles à évoquer. Bien que la parentalité semble peu prise en compte dans les services de psychiatrie adultes en raison de représentations négatives, de craintes, d’un manque de formation et du cloisonnement des services, la psychiatrie demeure, pour ces professionnels, un lieu où cette question devrait être traitée. Ces éléments invitent à discuter sur de nouveaux modèles d’accompagnement basés sur l’empowerment et le rétablissement, ainsi que sur les questions éthiques et déontologiques associées.

Cette recherche apporte un nouvel éclairage sur une problématique peu étudiée et pourtant importante, compte tenu du nombre croissant de parentalités en situation de maladie mentale rencontrées dans les services de psychiatrie.

Parenthood of mothers with a psychotic disorder has become a growing social reality that requires specific care. This study was carried out to shed light on an understudied topic that raises a number of ethical questions. The purpose of this study was to explore the point of view of healthcare professionals working in psychiatry services about parenthood of psychotic mothers and what they are offered in terms of support and care.

Sixteen health professionals working in psychiatry services responded to a semi-directive interview. They were recruited on a voluntary basis. Anonymity was ensured and all professionals gave their written informed consent to participate in the study. Interview's content was transcribed verbatim then examined through a qualitative thematic analysis.

The interviews highlighted contrasting representations of these mothers’ parenthood. Whilst the weaknesses and difficulties in parenting and education were predominantly mentioned, mothers’ resources and skills were hardly acknowledged. Although attachment to the child was one of the few resources noticed, the professionals named 25 items relating to parenting problems. The main ones related to the impact on the child of the symptoms of the maternal mental disorder, and to difficulties in coping with daily tasks. A lack of empathy was also observed in these mothers. The parent's difficulties appeared to be more significant depending on the child's developmental stage. Family support was described as essential in helping these mothers with parenting. However, parenting issues seem to be very seldom taken into account by adult psychiatric services, as most health professionals believe these questions do not fall within their field of activity. A lack of training and information on this issue is seen as one of the main barriers regarding this topic. Besides, the organization of psychiatric services in France, with its child and adult sectors, appears to be a barrier to a joint work of child psychiatry and adult psychiatry. However, for these professionals, psychiatry in general remained the place where the issue of parenthood should be addressed. Children of psychotic mothers were perceived as suffering from the parent's difficulties, yet reporting situations where the children were in danger remained an unusual practice in adult psychiatry. This was considered as belonging to the realm of other institutions, or of child psychiatry. Lack of knowledge about existing procedures and partners appeared to limit assessments of situations of concern that should be reported. These results invite to discuss on models of support, for instance based on empowerment and recovery approaches. These models build on the strengths and resources of people who are seen as stakeholders in their own care journey. Given the impact of parenting on the mental health of these mothers, implementing recovery programs that focus on sexuality and parenthood could be effective. Providing health professionals with information might raise their awareness of their role in taking charge of the patients in a comprehensive perspective that includes parenthood issues. Professionals’ practices seemed to be more focused on the patient and his symptoms rather than on all aspects of their personal life (family, children, work). Finally, some ethical issues are discussed. Parenthood of psychotic mothers deserves a global approach, including work in partnership. Although the law lays down the principle of shared secrecy, some professionals still remain reserved about sharing relevant information, given the medical confidentiality principle. These issues also appear to be an argument for refusing to report a child as requiring a child protection intervention.

Although its limitations, in particular the low number of professionals who agreed to participate, this study sheds new light on a scarcely studied issue that deserves more attention given the increasing number of patients with children who are cared in psychiatric services.