Context and opportunity: multiple perspectives on parenting by women with a severe mental illness.

Parenting holds out the promise of a unique and valued life project not defined by mental illness for homeless mothers whose mental illness often co-occurs with substance abuse and other disadvantages, yet separations from children and custody loss are common realities (David, Styron, & Davidson, 2011). Those who retain custody of some of their children may be eligible for family shelters that include parenting supports among the services provided. But for homeless mothers whose children are cared for by relatives or in nonkin foster or adoptive homes, parenting issues remain invisible, despite research documenting their hopes to reunify with their children (Hoffman & Rosenheck, 2001). As noted in a review of evidence-based practices supporting parenting, “the most obvious outcomes, for example, parenting or not, reunification with children or not, may not be the desired outcome for some women … innovative measures of outcomes must be developed” (Nicholson & Henry, 2003, p. 128). Developing approaches that acknowledge and support a more differentiated set of parenting possibilities requires understanding how service settings and policies support or impede diverse parenting needs and goals. A human development approach, the capabilities framework (CF), argues that justice should be measured by the real opportunities—capabilities—available to all members of a society to choose to do and be what they value, despite complications posed by personal capacity, material constraints, and by the context of law, custom, and policy (Nussbaum, 2000; Sen, 1999). Further applications of this approach toward people with marginalized identities, including women (Robeyns, 2008) and people with disabilities (Hopper, 2007; Mitra, 2006; Nussbaum, 2011), argue that health is a foundational social good, central to achieving a cluster of opportunities for well-being (Venkatapuram, 2011). From a capabilities perspective, functioning as a parent is a realization of a basic capability, affiliation (Nussbaum, 2000), and agency or self-determination is a critical ingredient (Sen, 1999). Despite emerging practices to support parenting, custom and regulation may still impede access to parenting agency for women with psychiatric disabilities. At times, over a lifetime of material and mental health challenges, sustained affiliation with their families may be foundational to the hope and dignity of mothers with complex mental health conditions. This study was part of a broader project on the Contexts of Parenting, developed and implemented with provider and peer partners in the Center to Study Recovery in Social Contexts (http://recovery.rfmh.org). Because CF is predicated on both “opportunity freedoms” (e.g., parenting and social inclusion) and “process freedoms” (e.g., self-determination and agency), we used community-based participatory research (CBPR; Minkler & Wallerstein, 2008; Wallcraft, Schrank, & Amering, 2009) to work out the critical questions implied by a capabilities approach to recovery, to develop and conduct studies, and to reflect on and disseminate findings. The questions we pose here about parenting reflect issues of real concern to our center’s community of people with serious mental health conditions, whose knowledge and values focused us on parenting as a life project, providing a lens that is critical to exploring and understanding sensitive issues. Because CBPR is action oriented, it challenges us to work toward policy and regulatory contexts that will support parenting interventions that even include mothers at the most marginalized points in their lives. Prompted by prior work with mothers, service providers, and a community of mental health service users, the study reflects mothers’ determination to have the freedom to participate in the unique and valued functioning of child rearing—the dignity of life “outside mental illness” (Davidson, 2003; Ware, Hopper, Tugenberg, Dickey, & Fisher, 2007).