Dr. Joanne Fenton:

I am Dr. Joanne Fenton, consultant adult psychiatrist and a specialist perinatal psychiatrist in the Coombe Women and Infants University Hospital. In my role as a perinatal psychiatrist I have treated women attending the Coombe hospital over the past ten years. These women have had a wide variety of problems and difficulties including illnesses ranging from severe and enduring mental illness like schizophrenia to those with less severe illness like anxiety or depression, but which may cause equal levels of distress.

Suicide is a real risk in individuals who have mental illness and has a devastating impact on all those involved with the woman. As psychiatrists, and in particular in my role as a perinatal psychiatrist, we are trained to assess women who express suicidal ideation or intent. It is my role to provide non-judgmental, compassionate care and treatment to these women. The women who present with suicidal intent are in a great deal of distress and it is our aim to treat these women respectfully.

In my years in the Coombe hospital I have seen many women who have had a termination of pregnancy. Each woman has had a different experience and the effect has been different for each. I have never seen a woman where termination of her pregnancy was the treatment for her mental illness nor do I believe that a termination of pregnancy is a treatment for mental illness. However, that said, I cannot say that there will never be a situation where a woman is in such a state of distress and turmoil that for her, termination of pregnancy is a life-saving option.

The current legislation is very restrictive and many women will continue to travel abroad to seek terminations. There are a number of points which my colleagues and I will address further and are outlined in our written college submission. These include the under-18 age group and those who lack capacity. I believe that two psychiatrists, as outlined in the heads of Bill, should assess a woman who is suicidal and pregnant and be in agreement about their assessments, but should not have to see the patient at the same time. I believe that the obstetrician should assess the woman from an obstetric point of view but not be expected to assess suicidality, which is beyond his or her area of expertise. I believe that the timing between initial referral and assessment and the timing for appeal should be shortened as women in this situation are frequently distressed and a lengthening of time can cause a further deterioration in their mental health.

Many psychiatrists do not wish to partake in the assessments of these women for many reasons and their concerns must be respected. In my role as a perinatal psychiatrist I believe it is my responsibility to continue to assess pregnant women in distress and aim to provide the best and most compassionate care to them.