Health visitors are at the front line of perinatal mental health, able to support, signpost and refer patients on when they need help most. But, it is not just mothers who may need mental health support during the perinatal period. There is an opportunity at this time for health professionals to support the mental health of fathers as well.
However, fathers of newborn children will rarely interact with perinatal mental health services, despite growing evidence of the severe mental health problems that can present during fatherhood, according to research published by the BMC.
Kieran Anders of the mental health charity Dads Matters UK, points out that on a self referral form for adult mental health services, the question that triggers priority access to services, is ‘Are you pregnant?’ This is an example of how there is ‘absolutely a gap’ in service provision for fathers, he suggests.
There are concerns that fathers – and non-traditional parents, including same sex and transgender couples – are sometimes falling through the cracks of the mental health support systems, despite the mental health of parents having a significant impact on children’s development, according to the Institute of Health Visiting (iHV).
The Institute of Health Visiting (iHV) has found that fathers may often feel uninformed and ‘invisible’ during this period due to a lack of father-specific services and a pervasive misconceptions about father’s mental health, according to a spokesperson.
Fathers can also be harder for health services to maintain contact with. Often newborns are only linked to mothers in health visitor notes, the iHV told Nursing in Practice, and by the time health visitors are making later visits fathers may have returned to work, meaning they may not have a chance to check up on them at all.
Dr Ruth Naughton-Doe, who researches perinatal loneliness at York University, says, for example, that fathers are particularly at risk of suffering from a form of loneliness when a new child joins the family. ‘Existential loneliness’, as opposed to the more familiar ‘social loneliness’, comes from a lack of meaning or purpose life, she describes.
‘I think it [fatherhood] can be really alienating for men, because they’re expected to go to work full time and they’re also expected to be a dad; it can cause a lot of conflict,’ says Dr Naughton-Doe.
This kind of mental health issue, she says, can even be exacerbated by kind of services that are supposed to be in place to support the mental health of parents.
‘If a dad goes to a playgroup for parents, everyone there is a mum and they’re all moaning about how their husbands never get up to help, then that is a very exclusionary environment for a dad. Any transition period increases the risk of loneliness but a lack of proper support structure can exacerbate that.’
There is good reason to be concerned about the mental health of fathers. Not only is it estimated that perinatal mental illness for men and women costs the economy over £8 billion a year, but also that mental illness in fathers has been linked to slowed infant development in key areas such as walking and talking.
Dr Andrew Mayers, a psychologist at Bournemouth University, told Nursing in Practice that despite some misconceptions, postnatal depression in men is often overlooked due to a belief that the condition is hormonal. However, Dr Mayers says that ‘it’s nothing to do with that at all. It’s all about the life experience, about the psychological, and environmental factors’.
While postpartum depression in women is often associated with a drop in reproductive hormones, research suggests that social and environmental factors play a very large role in causing the onset of depression.
For men in heterosexual couples, factors such as the mental health of the mother, additional stress, and anxiety over responsibilities significantly contribute to the onset of perinatal mental illness. Recent research suggests that 5 to 10 percent of fathers experience perinatal depression and 5–15% experience perinatal anxiety.
Some fathers may even suffer as a result of being present at the birth. While more fathers being there in the birthing room with their partner than in the past is a positive, Dr Mayers says that this can also sometimes cause problems if a medical emergency occurs.
‘Now around 98% of dads are in the birthing room. That’s not an issue in itself, but sometimes it goes wrong, horribly wrong, and they’re witnessing this and that’s no different to witnessing and any other trauma, as he is potentially watching his partner or infant get into serious trouble.
‘What makes it worse is, more often than not the father is rushed out of the room and left completely clueless about what’s happening, about what’s likely to be in a prognosis, and what he can do to help. It’s no wonder that the these fathers are more likely to develop post traumatic stress disorder.’
But providing mental health support for fathers is not likely to be as simple as extending the kind of services that are already in place for mothers, Mr Anders of Dad Matters UK went on to tell Nursing in Practice.
Mr Anders started Dad Matters UK in 2020 on behalf of Home-Start, a local community network supporting young families, when they found that fathers simply weren’t engaging with their mother-focused support programmes.
Communicating with fathers at all was a challenge. ‘People thought if we get a man in, they can do the same work that we’re already doing with mums. But what we found in the first year or so was that they [fathers] didn’t associate with the brand. They needed to hear the word ‘dad’ in whatever they were engaging with.’
In fact, he says, language alone can play a large role in how fathers engage with mental health services, saying that men often wouldn’t engage with mental health services open to ‘parents,’ as the assumption was that these were only intended for mothers.
‘We will often challenge [health] professionals on using terms like ‘mum and partner’. Because we are actually talking about dads or co-parents; they are parents not partners.’
When and where you engage with people makes a big difference to the outcomes you see, says Mr Anderson, ‘We don’t approach dads in football grounds, we approach them in antenatal clinics, because they are there to be a dad and its with issues about being a dad that we can support them.’
Inviting dads to mental health support sessions meant only the fathers who were already seeking services got help. However, by getting information to dads when they engaged with universal services Mr Anderson says they are able to reach thousands of fathers across the country and signpost what services are available.
The novel aspect of Mr Anderson work with Dad Matters UK is that, rather than setting up support groups for dads or trying to attract dads to existing support systems, Dad Matters UK uses existing perinatal services to engage with dads from the earliest moments of their parenthood.
‘We don’t advertise something for dad’s to come to,’ said Mr Anders, ‘because while some dads will come, they are self selecting and they would probably be okay without that particular intervention as they are already looking for support.
‘Even if we had 30 dads attending a ‘play and stay’ session two hours a month, that 24 hours would only see 30 dads. Instead we go to an antenatal clinic, there we can see 30 dads in one hour. So in Greater Manchester we can see between 6-10,000 dads a year in a universal space. All we’re doing is having a five minute conversation with them about what is attachment and why do babies need it; helping dads to have a relationship with them earlier because we know that improves the relationship later on. And then we give the details for the health visiting pathway and the mental health services so if dads feel they need help they can just go directly to wherever it is that will help.’
Both Dads Matters UK and Dr Mayers are both working with the iHV to educate health visitors about the importance of dad’s mental health and teach them to overcome the barriers to effective mental health support. This April, the iHV is also teaming up with Mr Anderson to offer a ‘fathers and perinatal mental health champions training programme’ for those who want to develop the skills to lead on mental health in this area.
Since health visitors operate as a universal service that engages with fathers as part of the perinatal service, they are uniquely placed to reach dads when they need information and support.
A spokesperson for the iHV says that health visitors ‘play a clinically effective and cost-effective role in perinatal mental health care because they see all families’.
‘Health visitors are skilled in assessing family mental health, identifying opportunities to promote mental wellbeing, recognising when there is a need for additional support, offering evidence-based interventions and timely referral onto specialist PMH services when needed. They can signpost to, and deliver, psychoeducation and interventions to promote positive parenting by fathers.’
The Dads Matters UK website has guides and information on perinatal mental health and how to support fathers who are suffering from mental illness.