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.