CHRONIC PSYCHOSIS AND REPRODUCTIVE HEALTH

Health professionals who provide reproductive health care for clients with chronic psychoses will face particular challenges. Ethical issues must be addressed and staff should be specifically recruited and trai ned. Preconception counselling should include the offer of information on the genetics of schizophrenia and manic-depressive disorder and a review of the client's mental state and any medication. Although paren tal mental disorders may have adverse effects on children, there is li ttle objective evidence on how parenting competencies can be assessed or predicted. Contraceptive choices can be constrained by the relapsin g nature of the chronic psychoses and may mean that the client is best served by long acting, highly effective, reversible methods such as t he IUD, injectables or implants. Sterilisation may offer a permanent s olution. Clients may be at increased risk of sexually transmitted dise ase and difficulties in their general and sexual relationships. They s hould have access to education and counselling to help them enjoy heal thy sexual lifestyles. Clients with chronic psychiatric disorder may f ear being stigmatised and meeting negative sexual attitudes. Caring pr ofessionals need to be proactive in offering help and in building up e ffective cross-disciplinary links between hospitals, general practice and community care.