For professionals

As with suicidal thoughts (Dazzi et al, 2014), there is no evidence that clinicians increase the likelihood of parents acting on infant-related harm thoughts by enquiring about them. Acknowledging and encouraging talking about these kinds of thoughts can actually help new or recent parents to feel better. As my research shows, experiencing harm thoughts can evoke strong feelings of distress – and feelings of shame and fear that disclosure may lead to their baby being taken away from them. This means parents rarely volunteer their baby-related harm thoughts spontaneously, even when answering questions related to their low mood, anxiety or OCD (Lawrence et al, 2017). Supporting mums to share these thoughts and have them normalised can bring an enormous sense of relief.

What is key is understanding parents’ reluctance to share harm thoughts due to shame and fear. Create a safe space for mums to raise them – and be alert to their possibility and pick up on what mums say that might indicate these thoughts.

Infant-related, intrusive harm thoughts require careful, sensitive assessment by a GP, Health Visitor or mental health professional. Gentle inquiring about the harm thoughts is likely to reveal whether they are ego-dystonic – i.e. the thoughts clash with the person’s sense of self and therefore evoke anxiety, upset, horror or disgust. In themselves, these kinds of harm thoughts do not indicate risk; it is important for clinicians to be aware of this.

Normalising harm thoughts

Normalising harm thoughts help mums understand how common they are - and that experiencing harm thoughts makes them no more likely to harm their baby intentionally than any other parent is.  This can bring huge relief. In response to mums (or dads) sharing harm thoughts about their baby, healthcare professionals can validate their experience by acknowledging how upsetting or anxiety-provoking having these thoughts can be.

Professionals can also reassure mums by telling them what the research shows – that nearly all new or recent mums report some unwanted thoughts of accidental harm related to their baby, and half report unwanted intentional harm thoughts about the baby, even though they knew they never would harm their child. This is likely an under-estimation due to the taboo nature of harm thoughts, and mothers’ fears around sharing such thoughts.

Harm thoughts are grounded in people’s understandings of idealised motherhood. So it’s worth clinicians exploring those expectations and how these sit with their lived reality (and therefore womens’ experiences of harm thoughts).

Enquiring about intrusive harm thoughts

As with any individualised assessment, it is important to assess the context around the mother experiencing harm thoughts. An emotional response to the thoughts including the above feelings, together with no intention to act on them or a history of harming the baby, can suggest that the mother does not pose a risk of harm to her baby.

Possible questions to ask sensitively (Lawrence et al, 2017):

·      What is the mother’s emotional response to the thoughts (is she unaffected/ indifferent or do they elicit shame, horror or distress)?

·      Does the mother intend to act out the thoughts?

·      Does the mother try to trigger the thoughts?

·      Does the mother decline help to manage the thoughts?

·      Has the mother ever intentionally harmed her baby?

Negative answers to the above questions suggest a very low risk of a mother intentionally harming her baby. However, assessing the overall clinical picture is the clearest indicator. If the mother cites intention to act out the thoughts or has a history of previously harming her baby, then of course the risk needs to be taken seriously.