NCCMH Draft

http://www.rcpsych.ac.uk/default.aspx

I';ve only given it a cursory look, but tend to agree. It gives fair notice of at least many studies we find credible and does not offhandedly dismiss them as the APA does.

Missing Points That Should Be Mentioned

• There is no evidence when, if ever, allowing a pregnancy to continue poses significantly greater mental health risks than abortion. Therefore, there is no evidence to when abortion may be legal under British law. A conclusion of equal risk does not satisfy the requirements of British law which allow for abortion only when the risks of allowing the pregnancy to continue are greater than the risks associated with abortion.

• There is no call for funding of a proper longitudinal study.

• Very similar, but subtly different, there is no evidence when, if ever, abortion is beneficial.

• The section on risk factors is very incomplete. "Abortion decisions and the duty to screen: clinical, ethical, and legal implications of predictive risk factors of post-abortion maladjustment" identifies many more which have been shown to be statistically significant.

• Since prior psychological problems are a predictor of elevated rates of psychiatric treatment following abortion, seeking an abortion is a marker for elevated needs for psychiatric care. Women with a prior history of psychiatric care should be advised that abortion will not reduce this need and may be associated with a need for additional mental health care and that they should not delay seeking it. They may also be scheduled for routine psychological followup care.

• Regarding the prior psychological problems question, that does not dismiss the importance of these studies, it underscores the need for screening. These comments regarding the Munk-Olsen study apply in general to all studies which find elevated rates of psychological treatment preceding abortion:

• Unfortunately, the authors did not segregate their results to determine if the particular women who sought counseling prior to their abortion subsequently fared better or worse than those who did not. Did pre-abortion mental health screening/counseling (1) reduce subsequent risk of mental health treatment, or (2) was it a risk factor predicting that the same women would require higher rates of subsequent mental health treatment?

• If (1) is true, then pre-abortion mental health treatments may be an important preventative measure which should be encouraged. If (2) is true, women with a history of seeking mental health care prior to an abortion might be advised to continue seeking mental health treatment.

Check

• Do they address the finding that multiple abortions are associated with more problems?
• It also appears that they gave inadequate attention to substance use issues.