Objective: Psychosocial treatments that address the unique needs of mothers with schizophrenia and their children are
sorely lacking. In striving to explore and understand treatment of maternal schizophrenia, this paper focuses on two ob-
jectives: 1) to identify and examine specialty psychosocial interventions for parents, notably mothers with schizophrenia
and their offspring; and, 2) to describe recommendations for the development of specialty psychosocial treatment for
this population. Methods: A systematic literature search of peer-reviewed articles was conducted in PsycINFO, MED-
LINE, CINAHL, Social Work Abstracts, and Social Service Abstracts databases prior to January 1, 2010. The authors
reviewed each article for psychosocial interventions treating mothers diagnosed with schizophrenia and their children.
Forty-three (n=43) studies were identified. Results: Two areas of specialized psychosocial interventions designed to
treat maternal schizophrenia and their children were identified: 1) inpatient interventions programs, primarily Moth-
er Baby Units (MBU); and, 2) outpatient interventions programs. Conclusions: Interventions targeting mothers with
schizophrenia spectrum illnesses and their children are lacking. Women with schizophrenia are at risk for not engaging
in treatment due to fears of barriers and losing their children. Although scarce, inpatient MBUs offer focused treatment,
but services are limited to the baby’s first year. Minimal outpatient psychosocial treatments are available to this popula-
tion. Flexible treatment approaches that incorporate environmental supports, childcare resources, child welfare systems,
and family involvement are highly recommended.
Maternal Schizophrenia: Psychosocial
Treatment for Mothers and their Children
Robin E. Gearing 1, Dana Alonzo 1, Caitlin Marinelli 1
1Columbia University, School of Social Work, New York, NY
Address for correspondence: Robin E. Gearing, PhD,
Columbia University, 1255 Amsterdam Avenue, New York, NY 10027
Phone: 212-851-2246; Fax: 212-851-2206;
Submitted: June 16, 2010; Revised: October 17, 2010;
Accepted: January 7, 2011
Key Words: Maternal Schizophrenia, Mother, Offspring, Serious Mental Illness, Psychotic Disorder,
Psychosocial Treatment, Mother Baby Units, Intervention
Schizophrenia is a chronic, serious mental illness (SMI)
that has devastating consequences for millions of individu-
als and families (1-4). Over the past three decades, women
diagnosed with schizophrenia spectrum disorders are in-
creasingly having children (5-7), and the management and
treatment of schizophrenia remains a challenge to moth-
ers and their children. Available psychosocial treatments
Clinical Schizophrenia & Related Psychoses April 2012 • 27
specifically targeting the distinct needs of this vulnerable
population and their offspring remain largely nonexistent.
Further, the impact of accessing and engaging services may
be a discernable barrier to existing treatment for this under-
served population, as mothers receiving treatment fear be-
ing judged as poor parents and may be exposed to the risk of
losing custody of their children (8, 9).
The research objectives of this review are: 1) to iden-
tify and examine the specialty psychosocial interventions
for parents, notably mothers, with schizophrenia and their
offspring; and, 2) to describe recommendations for the de-
velopment of specialty psychosocial treatment for this popu-
Background and Significance
The average age of onset of schizophrenia for females
ranges between 25 to 35 years (10, 11), which parallels
the age range for childbirth (12). In the past, women with
schizophrenia were less likely to marry, be sexually active,
and, therefore, to have children (13, 14). Recent research,
however, indicates that women with schizophrenia have the
same fertility rates as women in the general population (6)
and are just as likely to have children (5, 15, 16). Research
also proposes that between 50 and 59% of women with a
serious mental illness (SMI) are mothers (8, 17), and that
54 to 80% of mothers with schizophrenia are raising at least
one of their own children (18, 19). According to Hearle and
colleagues’ (1999) study, almost 40% of women with a psy-
chotic disorder had children who were under the age of 16
years (8). In Craig and Bromet’s (2004) study on parents with
psychosis, over 77% of the mothers’ youngest child at time of
first admission was under the age of 16 years (20).
men to actively parent their children (20) and are less likely
than fathers to have someone help them raise their children
(5). Women with serious mental illnesses lose custody of
their children more frequently than those without a psy-
chiatric illness (5, 14, 15, 17, 21). Also, women with serious
mental illnesses are three times more likely to have involve-
ment with the child welfare system or experience out-of-
home placement of a child (7). Additionally, 25 to 50% of
offspring with a mentally ill parent are placed in institutions
or foster care (20, 22). Joseph and colleagues (1999) found
that only 25% of mothers with a serious mental illness had
contact with their children in the past week, and only 20%
maintained full custody (17). Studies report that 50% of
mothers with schizophrenia will lose custody of at least one
child (18, 23).
Given this evidence, it is not surprising that one-third of
parents with a psychotic disorder are reluctant to seek child-
care assistance for fear that their children might be taken
away from them (8). Indeed, research has found that per-
vasive in the minds of these women is the specter of being
judged unfit by child protective services and the court and
having their children removed from their care (9). Thus,
the real and perceived negative consequences of seeking and
receiving treatment may act as a barrier to engagement in
Women with a psychotic disorder are twice as likely as
treatment and may serve to further isolate these vulnerable
High-risk (HR) studies is a field of research that inves-
tigates the offspring of women with schizophrenia; however,
these studies have been largely limited to examining the bio-
logical transmission and development of schizophrenia in
offspring of women with the disorder, rather than the avail-
ability and effectiveness of treatment for this population (24-
A number of maternal factors exist that influence off-
spring functioning and highlight the unique needs of this
group that merit recognition when considering treatment
aimed at supporting mothers with schizophrenia. Mothers
with schizophrenia are more likely to experience greater
emotional, financial and social deprivation than mothers
without this condition (18, 35, 36). Low socioeconomic sta-
tus (SES) of mothers has been found to be a stronger predic-
tor of developmental problems and psychiatric disorders in
children than maternal diagnosis alone (37-40). In addition,
mothers with schizophrenia often have weak social support
networks and provide less stability for their children, which
have lasting impacts on cognitive, emotional, behavioral and
social development (14, 41, 42).
The psychotic symptoms of schizophrenia may affect
the mother-child relationship through a number of mech-
anisms including: involvement of the child in delusions,
hallucinations or passivity experiences; by rendering the
mother unavailable to her infant when her symptoms de-
mand preferential treatment; behavioral disorganization;
abnormal expressions of emotion; and, blunted or perplexed
affect (35, 41, 43). Mothers with schizophrenia may be less
responsive, sensitive or energetic, and more remote, silent,
demanding, self-absorbed or intrusive with their child emo-
tionally (36, 42, 44). Research suggests that this poor parent-
child interaction results in offspring rating their mothers
with schizophrenia as less caring and overprotective (45).
Also, the child-rearing environment of mothers with schizo-
phrenia has been found to be significantly poorer than with
mothers with other mental illnesses or controls (32, 46).
Although not all offspring of maternal schizophrenia
will experience negative outcomes (47), HR studies have
identified several areas of increased risk for functional im-
pairment. In their seminal review of HR studies, Niemi and
colleagues (2003) concluded that the development of chil-
dren at high risk for schizophrenia differs from that of con-
trol children; specifically in that HR children have poorer de-
velopmental outcomes (32). Offspring born to parents with
serious mental disorders repeatedly perform poorer than
control children in motor and sensorimotor areas of func-
tioning during their first year of life (48), and significantly
poorer in language development in their first four years (49).
28 • Clinical Schizophrenia & Related Psychoses April 2012
In the past, women with schizophrenia were
less likely to marry, be sexually active, and,
therefore, to have children. Recent research,
however, indicates that women with schizo-
phrenia have the same fertility rates as
women in the general population and are
just as likely to have children.
Furthermore, Yoshida and colleagues (1999) found that in-
fants of mothers with schizophrenia are more likely to have
impaired cognitive development (50). Notably, HR studies
indicate that children of mothers with schizophrenia have
more difficulty and are slower to become friendly or open
when compared with children of mothers who are not men-
tally ill (14, 42). Eack and colleagues (2009) noted that indi-
viduals at familial high risk for schizophrenia demonstrate
significant social cognition deficits in emotion recognition,
an early precursor to the development of positive symptoms
of this mental illness (51). These impairments may result in
mothers with schizophrenia experiencing greater difficulties
in raising their children than non-mentally ill mothers (14,
52). Conversely, a good parent-child relationship, stability
in the parental home, high-level involvement with a non-
patient parent, good social support network in young ado-
lescence, and high IQ have been identified in research to be
protective factors for offspring of mothers with schizophre-
nia (24, 53, 54).
Despite the unique challenges associated with parenting
that exist for mothers with schizophrenia, a large sample of
child protection and mental health professions tend to be-
lieve that parents with mental illness can raise their children
safely as long as they have ongoing support (55). However,
inadequate services are a major problem area for this client
group (55). The HR literature investigating this population
does not address treatment specifically; literature that does
examine interventions designed to attend to the needs of
mothers with schizophrenia is sorely lacking; and this defi-
cit of literature is reflective of the shortage of options avail-
able to this vulnerable population. Seeman’s 2008 review of
preventive services for women with schizophrenia describes
both the lack of services and the specific need for programs
to include mothers and their children (56). The remainder of
this article is an examination of the findings of this body of
Research studies were identified through a search of the
electronic databases PsycINFO, MEDLINE, CINAHL, So-
cial Work Abstracts, and Social Service Abstracts prior to
January 1, 2010. Each database was independently searched
for peer-reviewed published articles matching the following
criteria: 1) child, children, adolescent, adult children, adult
offspring, offspring, and children of parents with a mental
illness (COPMI); 2) serious and persistent mental illness,
serious mental illness, chronic mental illness, Psychotic
Disorder, Schizophrenia, and Schizoaffective Disorder; 3)
evidence-based medicine, evidence-based practice, treat-
ment, therapeutics, intervention, and therapy; and, 4) ma-
ternal, paternal, parent, paternal behavior, maternal behav-
ior, mother, and father. The search was limited to the English
language and human subjects. A total of 971 articles were
located across the five databases. The research team, com-
posed of 2 PhD level and 2 Master level clinicians, reviewed
the articles for interventions treating families in which the
mother was suffering from a schizophrenia spectrum disor-
der. Non-intervention studies, individual case studies, and
articles targeting the treatment of pregnant mothers were
excluded, resulting in the inclusion of 43 research studies in
the review. The authors independently reviewed each article;
discrepancies were resolved through discussion and consen-
Overall, this search highlights the disturbing lack of
research that has been conducted on mothers with schizo-
phrenia and their offspring, particularly as it pertains to in-
terventions developed to treat this specific population. Two
main areas of interventions for mothers with schizophrenia
and their offspring were identified: 1) inpatient interven-
tions programs, primarily in the form of Mother Baby Units
(MBU) that serve mothers and their newborns; and, 2) out-
patient interventions programs, either through family treat-
ment programs or home treatment, focusing on mothers and
their children. These studies were examined for their effec-
tiveness at addressing maternal mental health outcomes (i.e.,
rates of rehospitalization, length of hospital stays, length of
psychotic episodes), parenting outcomes (i.e., ability to bond
with offspring; level of sensitivity and responsivity to baby’s
needs), and offspring outcomes (i.e., meeting developmental
Inpatient Intervention Programs
Inpatient interventions centering on mothers with
schizophrenia and their offspring focused solely on Mother
Baby Units (MBU). No other inpatient interventions were
identified. Although 59 MBU studies were identified, only
34 investigations had samples that included mothers diag-
nosed with a schizophrenia spectrum disorder. Five of these
articles did not match review criteria and were excluded.
Robin E. Gearing et al.
Clinical Schizophrenia & Related Psychoses April 2012 • 29
Despite the unique challenges associated with
parenting that exist for mothers with
schizophrenia, a large sample of child
protection and mental health professions tend
to believe that parents with mental illness can
raise their children safely as long as they
have ongoing support.
30 • Clinical Schizophrenia & Related Psychoses April 2012
Two of these were reviews (41, 57), two focused on diag-
nostic classifications (58, 59), and another on pathoplastic
The remaining 29 MBU studies employed a range of
methodologies, but no randomized controlled trials (RCT)
were identified. Five studies used a comparison group or
case controls to examine the characteristics and outcomes
of women admitted to MBUs (61-65) and four studies used
registry or archival data (44, 66-68). Thirteen articles em-
ployed naturalistic case study methodologies to examine the
characteristics and outcomes of women admitted to MBUs
(36, 69-75), of which three investigations also had a follow-
up assessment (43, 76, 77). Seven descriptive studies focused
on unit characteristics, as well as maternal characteristics
Mother Baby Units (MBU), also referred to as Mother
Baby Psychiatric Units or Mother Baby Facilities, are spe-
cialized units established in adult or pediatric psychiatry
hospital departments specifically targeted to those moth-
ers who experience a psychotic episode severe enough to
require hospital admission within the first year following
giving birth. A milieu intervention first employed in 1948
(80), MBUs currently exist mainly in Europe, specifically in
England, France, Belgium, Australia and New Zealand (71).
The rationale for these units is that women are more likely
to suffer from mental illness following childbirth than at any
other time in their lives (85), and that the risk of psychotic
illness is greatly increased in the first thirty days following
childbirth (85, 86). In addition, research has found that
mothers separated from their infants during hospitalization
for a psychiatric disorder experience a longer period of ill-
ness and greater difficulty bonding with their infants than
mothers jointly admitted with their infant to a specialized
unit (65). Admission criteria, length of stay, and treatment
philosophy vary across these units; however, all aim to pro-
vide specialized psychiatric care for women experiencing
postnatal psychiatric disorders, to provide a space for their
infants (up to one-year old) to promote the child’s develop-
ment, and to assess the mother’s parenting skills (68, 70, 71,
Results from case control and comparison studies
of MBUs provide some, albeit limited, evidence for their
effectiveness (65). Specifically, these studies found that more
than half of mothers with schizophrenia and other psychot-
ic disorders had good outcomes at discharge in terms of
developing adequate parenting behaviors (caretaking
abilities) and symptoms management (65). Furthermore,
most women with schizophrenia spectrum disorders
indicated that they were satisfied with the services they
received while on the MBU.
However, these studies also indicate that a diagnosis of
schizophrenia was associated with the highest risk of poor
parenting and psychiatric illness-related outcomes (61, 65).
One study found that five out of seven mothers diagnosed
with schizophrenia relapsed within one month of child-
birth (61). Women with schizophrenia or chronic delusional
disorders, personality disorders, or intellectual disability
remained hospitalized longer, improved less (44, 71), and
were more often separated from their babies at discharge
(73, 75) or discharged with supervision (44, 71) than women
admitted with other diagnoses. Furthermore, women with
schizophrenia were less likely to be living with their children
4–6 years post discharge from an MBU (77). These mothers
displayed more interaction deficits with their infants, spe-
cifically decreased responsivity and sensitivity, than mothers
with mood disorders (43, 74, 77). In addition, these women
shared other vulnerabilities, such as low social class and
poor social skills (65).
Among the mothers with schizophrenia, those with
positive social networks, higher socioeconomic status, and
non-mentally ill partners exhibited the most positive par-
enting outcomes (88). Conversely, women with behavioral
disturbances, low social class, a poor relationship with the
partner, or a partner who also had a psychiatric illness have
poorer outcomes (44). Mothers most likely to require fur-
ther inpatient care were those assessed as having poor par-
enting skills or being more likely to self-harm or harm their
infants, and those separated from their infants at discharge
Similarly, findings from the seven descriptive studies
indicate that mothers with schizophrenia have impaired re-
lationships with their offspring (83) and were hospitalized
sooner after the birth of their child than mothers without
schizophrenia (82). Also, the greatest demand for an MBU
was for young women suffering from psychosis post child-
birth (82-84). Nevertheless, these studies conclude that a
psychotic mother with the proper supports in place can ful-
fill her infant’s developmental needs and is capable of mater-
nal competence to some extent (78).
There was only one study that examined patient sat-
isfaction with an MBU, but it was not exclusive to women
with schizophrenia. Neil et al. (2006) surveyed 41 women
discharged from an MBU over the course of one year, 66%
of whom had a psychotic disorder (89). The average length
of stay was 41 days. Overall, findings indicated that women
were highly satisfied with waiting time for admission, unit
environment, facilities and equipment, multidisciplinary
care, problem discussion, and partner involvement. How-
ever, half of the respondents were dissatisfied with their in-
volvement in planning and decision making (89).
Overall, while Mother Baby Units demonstrate some
positive support and help for mothers suffering from schizo-
group therapy. The program ended with a nutritious lunch.
Although engagement by mothers was a concern, with over
40% refusing admission to the program, preliminary results
from the program indicate success in improving parent-
ing skills of participants and mother-child interactions, as
reported by staff, as well as enhanced treatment adherence
(91). Unfortunately, the program was limited by resources
and attempts by courts to use the program for custody evalu-
home treatment designed for mothers living with schizo-
phrenia and their dependent offspring. Khalifeh and col-
leagues (2009) explored the treatment preferences and needs
of mothers who were treated at home as an alternative to
hospital admission (9). As part of the introduction of cri-
sis resolution teams (CRT) in the United States, the United
Kingdom, and Australia, patients in a mental health crisis
were offered intensive home treatment as a substitute for
admission whenever possible. Overall, mothers receiving
home treatment reported satisfaction with good quality care
and avoided unwanted hospital admission, but neverthe-
less struggled to provide adequate parenting (9). Mothers
described difficulties meeting children’s physical needs, feel-
ing emotionally distant, being dependent on children dur-
ing the crisis, and struggling to protect the children from
exposure to symptoms or distress (9). Results indicated that
mothers preferred the home treatment; however, during a
crisis their children preferred parental inpatient treatment as
it relieved worry. During a crisis, home treatment may meet
patient’s treatment needs, but children may be exposed to
risks, such as parental violence, poor communication, and
lack of access to professional support. Mothers recognized
the child’s need for support, but reported often being reluc-
tant to seek professional help because of fear about custody
loss. Consequently, Khalifeh and colleagues (2009) recom-
mended access to alternate support from sources other than
the agencies that implement child protection; that may limit
the impediment of the fear of losing custody to the mothers’
willingness to seek help. Nevertheless, the findings from this
study pertained to a population of mothers with a variety
of mental illnesses, and the results were not differentiated
The third outpatient intervention identified was a
Robin E. Gearing et al.
Clinical Schizophrenia & Related Psychoses April 2012 • 31
phrenia, given that women with schizophrenia were less
likely to be living with their children 4–6 years post dis-
charge from an MBU, this treatment modality clearly does
not provide sufficient support to mothers with schizophre-
nia to keep families intact. More long-term service options
are necessary to provide continued parental assistance to
Outpatient Interventions Programs
Outpatient interventions centering on parents with
schizophrenia and their offspring were very limited. Only
three outpatient interventions were identified that serve
parents with a serious mental illness, including a subsample
of parents with schizophrenia spectrum disorders and their
The first outpatient intervention program focused on
family treatment for children and their parents with chronic
psychiatric illnesses, including fathers with schizophrenia.
According to Rosenheck and Nathan (1984), this was the
first program of its kind. The study found that adults were
afraid to have their children treated due to concerns of be-
ing misunderstood and harshly judged as parents; however,
these parents were willing to bring their children into the
VA setting where they were being treated themselves. The
intent of the program was that treatment for the children
would reduce stress and, thereby, positively influence the
chronically ill parents (90). Also, productive participation
in parenting would lessen stigma and enhance self-esteem.
The provision of direct treatment services for children ap-
peared to be a useful addition to the broad-based treatment
approach, but specific details were provided. The treatment
led to a reduction in the level of overall psycho-physiologi-
cal stress, an improvement in medication adherence in par-
ents, and improved functioning of the family, and further
strengthened the relationship of the family with the hospital
treatment team (90). Overall, this program found that treat-
ing parents along with their offspring enhanced their own
family life and self-esteem and further facilitated their own
The second outpatient program taught parenting skills
to mothers, monitored children’s development, and pro-
vided early intervention as required (91). This supplemental
specialty program for women offered treatment to a limited
number of mothers with schizophrenia and their preschool
offspring. The Mothers’ and Children’s Project provided
transportation and 2.5 hours of programming each week.
Mothers and children joined together in small groups that
focused on developmental education, directed play, lan-
guage development, and role modeling (91). Following a
transitional break with snacks, children went to a thera-
peutic nursery, allowing mothers to continue in their own
There are few specialized psychosocial treat-
ments that exist for mothers diagnosed with
schizophrenia spectrum disorders, to address
their unique parenting needs and provide
the support necessary to allow them to keep
their families intact.
32 • Clinical Schizophrenia & Related Psychoses April 2012
specifically for schizophrenia. Therefore, as these findings
deal with an umbrella of mental health issues, they must be
viewed cautiously when creating intervention programs tai-
lored to maternal schizophrenia.
There are few specialized psychosocial treatments that
exist for mothers diagnosed with schizophrenia spectrum
disorders, to address their unique parenting needs and pro-
vide the support necessary to allow them to keep their fami-
lies intact. Excluding hospital admissions of index patients
during periods of crises, the only inpatient interventions
serving their needs are Mother Baby Units (MBU). However,
MBUs are not common in the United States and are limited
to mothers with children less than one year of age. It is un-
fortunate, but apparent, that forming a loving attachment
within a structured hospital setting such as an MBU does
not necessarily result in a mother with schizophrenia being
able to manage raising a child outside of hospital without
a substantial network of support (78). Unfortunately, such
psychosocial supports for mothers living with schizophrenia
become less available and more inaccessible as their children
Outpatient interventions jointly treating parents with
schizophrenia and their offspring were found to be very
limited. One study that examined an outpatient family treat-
ment service found that parents were often worried about
involving their children in treatment out of fear that they
would be misunderstood and harshly judged as parents (90).
Families who engaged in the program found the provision of
direct treatment services to be a useful addition, with reduc-
tion of overall stress, improved medication adherence, better
family functioning, and a stronger relationship between the
hospital and the family (90). Home treatment as an alterna-
tive to inpatient admission during a crisis appeared to meet
the mothers’ own needs better, but offspring were found to
remain at increased risk (9).
Identifying the existing psychosocial treatment inter-
ventions for mothers with schizophrenia and their offspring
has yielded few peer-reviewed articles. MBUs provide some
programming to assist this population, but do not provide
service for older children or adolescents. Outpatient psy-
chosocial services were even more limited, with only three
interventions identified in the literature. Clearly identified in
this review is a pronounced lack of treatment options avail-
able to this underserved and vulnerable population.
Research has clearly found that for the past three de-
cades women with schizophrenia spectrum disorders are
increasingly having children (5-7). Despite the need to clini-
cally engage and treat these mothers and their children, there
remains a paucity of psychosocial treatments for this vulner-
able population. While treatment and clinical research have
advanced in similar populations, such as maternal depres-
sion (92, 93), parents diagnosed with a psychotic condition
remain underserved. Further exacerbating this issue are the
fears and concerns that parents managing these conditions
consider before engaging in treatment. Specifically, parents
reaching out for treatment may lose custody of their chil-
dren (8, 18, 23), and perceived barriers and limited services
may further exacerbate feelings of isolation and stress for
mothers managing a schizophrenia spectrum disorder (9,
This review is limited by the search parameters, includ-
ing the exclusion of non-English language articles. Also,
the focus on peer-reviewed journals excludes any treat-
ments or interventions that are unpublished manuscripts, or
published in conference abstracts, dissertations, and book
chapters. A majority of the study samples are comprised of
heterogeneous groups of SMI clients, thereby limiting find-
ings. As this review focused on mothers with schizophrenia,
interventions that provide general mental health treatment
without identifying participant diagnosis may have been ex-
cluded. In addition, we excluded studies depicting treatment
programs for other at-risk non-identified populations, non-
intervention studies, individual case studies, and articles tar-
geting the treatment of pregnant mothers in general.
Mothers with schizophrenia and their offspring have
distinctive needs. Current research indicates that these
mothers demonstrated improved parenting skills from par-
ticipation in clinical treatment with their child, including
enhanced early parent-child bonding (65), and improved
ability to fulfill their children’s developmental needs (78).
Also, parents with schizophrenia were found to have reduced
levels of stress, enhanced self-esteem, improved medication
adherence, and stronger relationships with healthcare pro-
fessionals through their involvement in appropriate inter-
Despite the scarcity of research, the literature offers
several recommendations for working with this unique and
underserved population. A number of areas of intertwined
clinical recommendations emerge from the literature. One
area focuses on the provision of practical parenting, skills
training, and the ongoing availability of services. In particu-
lar, the onset and length of treatment are essential to consid-
er for interventions to be effective with mothers with schizo-
phrenia and their children. Early interventions, such as
MBUs that provide puerperal aftercare service that supports
the ongoing bonding of mother and child, are strongly rec-
ommended in the literature (68, 77). In order to improve the
relationship between mother and child, Wan and colleagues
Robin E. Gearing et al.
Clinical Schizophrenia & Related Psychoses April 2012 • 33
(2007) recommended that treatment focus on improving
maternal sensitivity and involvement by teaching practi-
cal techniques to enhance maternal responsiveness, infant
stimulation and mutual enjoyment (77). In addition, longer
term treatment approaches beyond the first year are neces-
sary in order to have an ongoing impact on mothers with
schizophrenia and their offspring. Interestingly, research
has found that mental health and child welfare professionals
believe individuals with a mental illness can safely parent
with ongoing support (55).
Treatment for mothers with schizophrenia may have
improved outcomes in terms of parenting related skills
and symptom management if they incorporate partners,
support networks and environmental supports. Research
recommends that treatment should include the patient’s
larger support network; specifically, the women’s partner
and/or coparent can positively contribute to improved
maternal mental health and family outcomes (44). Also,
incorporating family supports into treatment approach-
es may help in reducing parental distress and risks to the
children, particularly for
Another recommendation centers on the need to
include practical and flexible components to treatment.
It is recommended that treatments adopt more flexible
approaches to the provision of care for—and support
of—children of mothers with schizophrenia, such as easy
access to nursery day care, financial support, and home
child care (9, 55). In addition, Lagan (2009) argued that
enhanced coordination within the healthcare system is
required in an approach that is collaborative between
disciplines (94). For example, Waldo and colleagues
(1987) recommended the importance of specific programs
for this population that augment services provided by a
psychiatrist and/or mental health clinic (91).
Lastly, treatments that assist in positively bridging
mothers with available services may improve access and
ongoing engagement. Park and colleagues (2006)
recommended the development of appropriate coordination
to meet the needs of women with mental health problems
who are at risk of losing their children (7). For example,
mothers may need support negotiating with the child wel-
fare system. In addition, more in-depth training for child
welfare workers may help sensitize frontline professionals
to the unique fears and needs of mothers with schizophre-
nia, enabling these underserved women to feel less judged
and more able to access services during times of need.
Oluwatayo and Friedman (2005) advocated for national
minimum standards in allocating these services, so that the
approach to assisting this population is no longer in “no
man’s land” (95).
more socially isolated
tent reference in the literature is the call for more research
in treating mothers with schizophrenia and their children.
Existing research is also limited by the lack of longitudinal
investigations that can follow the needs of mothers and their
children over time, and a lack of rigorous RCT research of
Mothers with schizophrenia have unique needs. Fur-
ther development of specialty programs and evidence-based
interventions that work with this population are of great im-
portance. Research has found that these women and their
children benefit from participation in clinical treatment;
lack of treatment options and fear of accessing the system
are among the areas that we need to tackle to improve care
for this marginalized high-risk population.
Beyond clinical recommendations, the most consis-
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