Mental health assessment

What does “mental health” mean in the current penal code section relating to abortion? Are mentally ill women, or women taking prescribed pyschiatric drugs, the only ones entitled to an abortion?
No. The World Health Organization (WHO) definition of mental health is a “state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.”

A woman-centered or client-centered interpretation of laws that permit abortion for reasons of mental health takes into account the woman’s social and economic circumstances and the impact that an unwanted pregnancy and denying her a legal abortion can have on her mental health. Interpreting the law in this way can ensure that women have access to safe abortion services and help prevent death and injury from unsafe abortion. Legal abortion for mental health grounds, in the 24 countries where it exists, is interpreted in a variety of ways that can either restrict or facilitate access. (Sources: Brenda Major et al. 2009. “Abortion and Mental Health: Evaluating the Evidence.” American Psychologist 64 (9): 863-890;  IPAS. 2008. “Access to Abortion for Reasons of Mental Health.”)

If a woman requests an abortion but her examination and discussion reveals no physical or mental grounds for it, should the physician refer her to someone else or turn her away?
The physician should not dismiss the woman. Mental health is not an easy assessment. The level of mental health that is to be assessed in accordance with the penal code section relating to abortion should be based on what the woman says she is experiencing mentally and psychologically and is afraid of in terms of risk to her mental health. If the provider feels unable to make a full assessment, s/he might refer the woman to someone more senior or with whom s/he feels more comfortable with. The provider is duty bound by a professional ethic of care to refer the woman to someone who will be able to provide the required services in a timely manner.

What is the timeframe given for mental health assessment?
There is no specific timeframe. The normal practice is that the medical practitioner needs to understand or have an insight into the woman’s mental state, present and future. Sometimes s/he may need to follow-up by scheduling a second client visit, but it should not take more than one week or cause the woman’s pregnancy to fall outside of the legal gestational limit for an abortion.

How do you determine the mental health status of a woman requesting an abortion?
The doctor can form his or her opinion in good faith based on the woman’s experience and/or case history, as provided for by law. If the doctor has difficulty forming an opinion, s/he may consult a social worker, psychologist or psychiatrist, although this is not mandatory under the law. These professionals are also bound by an ethic of care to provide unbiased opinions and to act in good faith.

Mental health can encompass, for example, psychological distress suffered by a woman who has an unwanted pregnancy due to coerced sex, rape or incest; or is in an abusive relationship with a man; or is in the process of a divorce; or under severe strain caused by social or economic circumstances.

Who is in the better position to assess “mental health”, a doctor or psychiatrist?
Some people view mental health as a clinical condition that needs to be assessed by a psychiatrist and that needs treatment and follow-up, but mental health in a strict sense does not really need that qualification. The WHO definition of mental health does not require extreme drug treatment or psychiatric therapy. The family doctor is therefore better able to assess the mental health of the woman.

On assessing whether a patient can have an abortion, with regards to “injury to mental health”, is an assessment/consent needed from a psychiatrist before terminating the pregnancy?

No, a psychiatrist’s evaluation or assessment is not needed. The law only requires that one registered medical practitioner, acting in good faith, determine that. Whether the registered medical practitioner determines this alone or in consultation with a colleague, is up to the medical practitioner.

Is a psychiatrist’s report required to determine the “mental health” criterion of abortion law?

No, a psychiatrist’s report is not needed. Only a registered medical practitioner acting in good faith is required to determine if the continuation of the pregnancy would result in injury to the mental health of the woman greater than if she were to terminate the pregnancy.

Mental health is a much broader concept than mental illness, which psychiatrists treat. A woman does not need to be suffering from depression or other mental illnesses to have her mental health compromised by an unplanned pregnancy.

These are questions asked at state seminars held by RRAAM from 2007 thru to the present, primarily for health care providers serving in hospitals and clinics. The answers provided are by RRAAM presenters at these seminars. Some questions were asked only once but they are deemed important enough to be published here. Since laws, policies and guidelines evolve with time and changing social conditions, the answers provided here are necessarily time-bound. Wherever and whenever possible, we will strive to keep these answers accurate and updated. However, we cannot assume liability for the veracity of information provided.