International Fathers' Mental Health Day 2020

IFMHD 2020: June 22nd

As we mark another International Fathers Mental Health Day, it’s a good time to reflect again on what we have achieved since June 2019 but also reinforce what still needs to be done.

What I do

As a Principal Academic at Bournemouth University, my work focuses on mental health and especially how that relates to the perinatal period. In addition to teaching, I undertake research that explores a wide range of important factors in perinatal mental health. Beyond that, I am involved with many (national) mental health campaigns where I aim to influence key policy makers to improve services and provide more support. I am also a father of 4 (now adult) children and have 7 grandchildren. I have been working in perinatal mental health for 17 years. Until relatively recently, that work mostly focused on mothers. Around 6 years ago, I also started work with fathers – not because we need to support dads instead of mums, but as well as. Poor perinatal mental health impacts the entire family; mums, dads and the children.

Why it still matters

It is worth starting by restating why I feel fathers’ mental health matters. For me, there are three key areas that we need to focus on: what information and support do fathers need to help their wife/partner should experience poor mental health in the perinatal period; what support do we need to give to fathers to deal with their own mental health in the perinatal period; and what information and support do we need to give to a father should his wife/partner experience what might be a traumatic birth.

Last year, I said that I was in the process of submitting research papers on all of those topics. I am delighted to say that two of those are now published in BMC Pregnancy and Childbirth. The impact of birth trauma on mental health (including the risk for post-traumatic stress disorder) can be devastating. Research with mothers who have had a traumatic birth is still in its infancy. However, until now, nothing has been done with fathers (who have witnessed that trauma). At Bournemouth University, we undertook research to explore this vitally important area of work. We wanted to examine fathers' experiences, especially around the information and support given to them at this time. Some initial  data were presented at an event in the UK Parliament and at a birth trauma conference. The full data from that research is now published.

We also need to give fathers resources to help them support their wife/partner should she develop mental health problems in the perinatal period. We often hear that men have limited knowledge about that they can do and where they can access information. While we are beginning to see some appropriate mental health support directed at mothers during the perinatal period, including signposting and information, their partners are all too frequently disregarded. In some further research at Bournemouth University, we sought to explore fathers' perceptions about what information and support they received (and needed) to enable them to help their partner. The outcomes from that research are have now been published.

I am currently working on submitting a final paper, focusing on fathers' experiencing their own perinatal mental health problems. One theme that was consistent across all of the work we have undertaken so far is that fathers are saying that some health professionals do not regard them as part of the birthing experience, or give them due consideration when it come to perinatal mental health. To that end, we have just finished collecting data from UK health visitors, where we asked what support they are able to give fathers. I hope to report those findings soon.

We also know that enduring poor mental health can mean that the relationship between the father and his baby can be deeply affected. A strong bond is needed between an infant and both parents to ensure a healthy development for that child. We need to provide more support for fathers’ mental health and to enhance the relationship with their infant. I will be working on some projects around that soon too.

Successes and work-in-progress since 2019

Last year, I reported the exciting news that NHS England had announced how they would now screen some fathers for their mental health. This decision was largely based on data that myself (and others, such as Mark Williams, The Fatherhood Institute, and many more) had provided on what was needed. I said last year that was welcome but also cautioned about how much more was needed. Since then, some developments did begin to emerge. However, much of that progress was suddenly postponed when the awful impact of Covid-19 started emerging in early 2020. NHS resources in the UK have needed to focus on fighting this pandemic. When the time is right, I will be re-igniting the pressure to get support for fathers back on track.

A very pleasing development in the last year or so is the media attention that is being directed at fathers' mental health. I have had the honour of contributing to many of these stories across national radio and television in the UK, and some well-known international newspapers. In July 2019, BBC Stories released this great video, featuring 'Dan' and his experience of being a father. Later that month, Channel 5 News devoted an entire programme to men's mental health, including a section specifically on fathers. In September, the Washington Post ran this great story about fathers mental health.

As result of our work with fathers' mental health, I was approached by BBC Radio 4 as they were producing a documentary about fathers. I helped them develop the programme focusing in fathers experiences in the delivery room, using dads' voices. The programme was officially aired on BBC Radio 4 on Christmas Eve, but it is still available on BBC Sounds, Mark Williams and I featured on BBC Radio talking about why this programme was important. I was on BBC Radio 5 Live with Adrian Chiles and Mark was BBC Radio 2 with Jeremy Vine. In January 2020, I was interviewed on Sky News, talking about fathers' mental health. In March, BBC Radio 4 produced this great full-length documentary on fathers (The Science of Dad), to which I contributed a short section.

Covid-19

Given the shocking events in recent months, when reflecting on International Fathers' Mental Health Day 2020, it would be remiss not to consider how Covid-19 has affected families across the perinatal period, including fathers. At the outbreak of the pandemic, so little was known about the threat posed to the developing foetus (and addition to fears about bringing a child into a very different world). This only added to the deep anxiety experienced by parents-to-be during pregnancy. We are learning more, but the evidence is still patchy. In the UK, there are now some great resources available to help inform families and signpost to support (see Make Birth Better, Maternal Mental Health Alliance, and Best Beginnings - as three excellent examples).

Another concern throughout Covid-19 has been how fathers are included in pregnancy and the birth. One thing my research (and that done by many others in recent years) has shown repeatedly is that, when health professionals include fathers at every step of the perinatal period, the entire family benefits: the mother, the fathers, and the infant. Some of that evidence has driven positive changes in clinical practice. Despite that, across many part of the UK, as the pandemic developed we have seen fathers excluded from antenatal appointments and (in some cases) the birth itself. Of course, the safety of everyone is paramount (including health professionals). However, if the expectant parents have been exclusively self-isolating and are symptom-free, that risk is very low. This must be weighed alongside the growing evidence for including the father. I have been made aware of cases where a severe complication has emerged during an antenatal visit. As the father was excluded, he was unable to contribute to immediate decisions that needed to be made nor was able to help the mother process what she was being told. As lockdown measures are reduced, these exclusions may be removed too. I hope so. The father needs to be there.

How can we identify fathers who may need help?

I thought it would be useful to repeat what I said last year about identifying fathers in need and getting them help. One of the arguments we are often faced with, especially from health professionals and NHS commissioners, is that it is hard to identify at-risk fathers who are no longer under the attention of health services. This most likely because they have returned to work (and those symptoms of poor mental health can be delayed for several months after a baby has been born). My response is that we need to do more to reach fathers in the workplace. We could take services there and we can educate employers to be more vigilant to symptoms that might be developing. I have the honour of working alongside Peppy Health who are encouraging employers to invest in perinatal support services (for mothers and fathers) that Peppy can commission. It’s models like this that we need to develop to reach more families.

What we can look out for in dads if we’re concerned?

While we campaign for better services, we still need to be vigilant towards fathers to make sure that they are OK. Here’s a few tips about what we can do to look out for dads.

• Has his mood changed lately?

• Has he become more withdrawn?

• Does he seem more irritable than usual?

• Do you know if he is sleep well?

• Is he drinking more alcohol than he used to?

• Does ever talk about harming himself or even suicide?

• If you know the birth was traumatic, have you noticed any of the following in that father?

o He seems jumpy or on edge

o He mentions poor sleep and/or nightmares

o He is distant or shows no emotion

o Has he said that he no longer has feelings for his wife or child

o He speaks about flashbacks that relate to that traumatic event, and appears to be distressed by that

o He suddenly stops talking about that event

If you are concerned about any of these, talk to him. Encourage him to talk more – or suggest that he talks to someone. If you re close enough, suggest that you go with him to ask for help. If you are concerned that he may be thinking about suicide, never be afraid to ask that question. All too often, if we feel someone is so troubled that they might be at risk, we don’t want to ask the question in case we put that thought in their head. That’s not the case. The thought is likely to be there. We just need to get that in the open, so we can talk about reasons for living and for seeking help.

Always remember that (in the UK and Ireland) the Samaritans are available 24 hours a day, every day of the year, of 116 123. That’s a free number that will not even appear on the caller’s phone bill.

What we can do to make a difference?

I have some resources on my website, including a list of the few support groups that we currently have. You can also find my social media accounts there – so you could use those to add weight to our campaigns. We can make a difference. If it was not for the attention we have got through radio, TV, newspapers, online media and social media, we would not have got as far as we have. But we can do more with your help.