PIP: The issue of choosing contraceptives for mentally ill patients is important. Over 400,000 female mental patients of childbearing age are treated each year in the US. With less longterm institutionalization, they are increasingly exposed to pregnancy risk. The reproductive rate of mentally ill women has risen markedly since the 1950s. Some evidence exists that pregnancy, childbirth, and child care can contribute to recurrences of psychotic or depressive episodes. Mental patients are interested in family planning, but they may be socially disorganized and thus unable to effectively use community resources. Consequently, they are at especially high risk for unwanted pretnancy. Many mental patients have impaired ability to communicate their needs, making specialized contraceptive services for them imperative in the settings where the patients are usually seen. Before prescribing an oral contraceptive, diaphragm, or IUD, clinicians should obtain informed consent from those patients. For a woman to give adequate informed consent, she must have sufficient knowledge to make a decision, and clinicians must not use coercion in the decision making process. Due to the fact that judgment and reasoning may be impaired in the mentally ill patient, ensuring that she fully understands the risks and benefits of contraceptives may be difficult. Only specially trained professionals should provide contraceptives for the mentally ill. OCs may not be appropriate for patients who are taking antidepressants or who have history of depression. The literature contains contradictory reports about whether or not OCs worsen existing depression or cause depression. 9 of 12 major studies of the association between OC use and depression report depression in 16-56% of women using OCs. 3 studies found no such association. Although vitamin B6 may be a helpful adjunct to OCs for depressed women, pyridoxine may not be entirely benign. Women with mental illness may find mechanical methods of contraception difficult or impossible to use. IUDs also pose problems. 3 factors should be considered when contraceptive services are provided for mentally ill women: those services should be administered by specially trained individuals who can obtain informed consent and can consider specific needs and problems of psychiatrically impaired persons; OCs should be used very cautiously for women with a history of depression; and before prescribing other contraceptive methods, the clinician should consider the ability of the patient to use the method consistently and correctly.