International Fathers' Mental Health Day 2018

IFMHD 2018: June 18th

Over the past few years, there has been an increase in awareness about maternal mental illnesses, including postnatal depression, postpartum psychosis, maternal obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD) following birth trauma. Global campaigns have led to greater public, media, and political awareness. There is now somewhat better understanding about the need for more specialist services, especially more recently in the UK. Although this is encouraging, very little is said about fathers. But men can get perinatal mental illnesses too. The relative lack of awareness and understanding for fathers is evident in diagnostic methods, support services and recognition from perinatal health professionals.

Officially, only mothers can be diagnosed with postnatal depression. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), “peripartum depression” relates to clinical depression in women, where onset is during pregnancy or within the four weeks after giving birth. In practice, those working in perinatal mental health often extend that period to the first year postnatally. Nonetheless, no diagnosis is available for fathers.

The features of postnatal depression in mothers varies little from what we might expect in traditional (adult) depression: low mood and/or lack of motivation for at least two weeks, along with symptoms that might include poor sleep, agitation, weight changes, guilt, feelings of worthlessness, and thoughts of death and dying. So, it could be argued that there is little rationale for having a separate diagnosis. However, for me, there are considerable differences and implications. The most obvious one is there is also a child involved, for whom the consequences of perinatal mental illness can be dramatic. But the impact for this can be every bit as relevant for fathers as it can mothers.

Evidence suggests that the long-term consequences of postnatal depression on the child can be damaging, including developmental problems, poor social interaction, partner-relationship problems and greater use of health services (including mental health services). That evidence drew on observations with mothers, but there is research that also shows that when fathers show symptoms of perinatal mental illness, their children can show problems with behaviour and conduct.

Around 7-20% of new mothers experience postnatal depression. It is often thought that postnatal depression is caused by hormonal changes. Although this is partly true, it is far more likely that life factors are responsible, such as poverty, being younger, poor education, and lack of social support. Another potential cause is the sudden overwhelming responsibility of having a baby to care for, and the life changes that it entails. In that respect, there is little difference for fathers, as these are the same risk factors they can experience for poor perinatal mental health.

All of the above factors can equally apply to fathers. But there is no formal diagnosis of postnatal depression for fathers. Yet evidence from several countries, including Brazil, the US and the UK, suggests that around 4-5% of fathers experience significant depressive symptoms after their child is born. Some other studies claim that prevalence may be as high as 10%. However, perhaps even more crucially, men are much less likely to seek help for mental health problems, perhaps through fear of judgement and stigma.

Societal norms in many nations suggest men should suppress emotion. This is probably even more a factor for fathers, who may perceive their role as being practical and providing for the family. Fathers – especially first-time fathers – might experience many sudden changes, including significant reduction in family income and altered relationships with their wife or partner. These are major risk factors for depression in fathers.

Of course, all of this is just focusing on postnatal depression. There are many other perinatal mental illnesses that are every bit as relevant to fathers as they are mothers. It’s also not just about the fathers’ own mental health (important as that is); they also need information and resources to support their wife/partner should she experience mental health problems at this time. All too often, fathers see their partner develop emotional problems and other significant difficulties and have no idea what to do.

It is my pleasure and honour to work with my good friend Mark Williams on raising awareness about fathers’ mental health. Mark is the UK co-founder of International Fathers’ Mental Health Day. I am grateful to Mark for sharing his remarkable story here.

Mark says “I was one of those people who was totally uneducated about depression until it came knocking at my door in 2004, when my wonderful wife (Michelle) went through an emergency C-section. As a result, she suffered postnatal depression and needed specialist perinatal mental health services. In those days, services were not in place back. Her illness, and the lack of support, impacted greatly on me and my family. It had a huge impact on my own mental health too. I witnessed Michelle’s birth trauma and I thought she and my baby were going to die. This led me to have my first ever panic attack (at the age of thirty). In the following twelve months my personality totally changed. I was now feeling angry which led to a total breakdown. It was only years later that I realised that I had experienced postnatal depression too.

“I was totally out of character. I wanted to avoid family members and drink more to cope. I didn't experience the ‘overwhelming feeling of love for my baby’ that I thought society expected of me. I was even starting fights. One time, at a nightclub, I picked a fight with a doorman. I wanted someone to hit me to take way the pain I was feeling inside. I was also overeating. I felt isolated from society looking after Michelle. I was having money worries after giving up work for six months and couldn't tell my best mates due to the stigma. I didn't think men could have postnatal depression back then and felt I had to ‘man-up’ as all I wanted was my wife to be happy. Even when Michelle did recover (after getting support) I couldn't tell her how I was feeling, as I didn't want it to impact on her mental health, but I didn't know where to turn for help.

Eventually, I did get the help I needed. I had been at my lowest ebb but have come though it. Now I help others get help. I have written a book, which will be published in July. I hope this will help other parents, and help generations to come, so they don’t suffer as I did.

What I would do today if I was struggling is to inform the health visitor or go to my GP.  I would look to access community mental health services. I would take someone with me who understands postnatal depression, perhaps from a charity or support group. I would replace the negative coping skills (such as drinking or looking for fights) with positive ones (actually reaching out for help). I would phone the Samaritans or contact CALM.”

Mark has often retold his story on blogs and international media. Much of what he describes here is about postnatal depression, but he also mentions birth trauma – and the impact that this had on him and his wife. For far too long, the impact of birth trauma (for both parents) has not been given the attention it needs. Birth trauma can occur for any unexpected birth outcome, such as unplanned caesarean through to events that could lead to potential loss of life. Mothers’ experience of trauma increases the risk of developing PTSD. And yet, few get sufficient support to reduce that risk when there has been birth trauma.

The same can be said for fathers who witness that birth trauma. Fathers could potentially be watching their wife and child die in front of them. At the very least, they are witnessing a sudden, and sometimes dramatic, change in the birth. Working with one of my students, we have recently undertaken qualitative research with fathers who have witnessed birth trauma. Our initial findings show that fathers get little information about what is happening, or what the consequences are likely to be. Fathers also told us that there was no follow-up to see whether they needed to support for their own mental health. In many cases, fathers said that they were effectively ignored by health professionals and seen as ‘inconsequential’. This really must change.

So where does all of this leave us? While there have been some great advances in raising awareness, and get better support for, perinatal mental health we still have a long way to go. I will continue to campaign for better services, educate health professionals, undertake research, and work with support services – for mothers and fathers. But I am particularly concerned that fathers continue to be overlooked. Not only do we do to address the gap in awareness and support, we need to look at different ways to engage fathers and encourage them to seek help.  There are limited resources for support across the UK, but I have a listed a few of those on my web page for fathers.