Dr Andy Mayers is a perinatal mental health expert, campaigner and educator. In this piece he explains why although it’s great that NHS England announced they will screen fathers for their mental health in late 2018, it’s perhaps premature to get too excited.
The journey before the NHS announcement
I’ve been working on aspects related to perinatal mental health since 2003. For many years, my work focused mostly on mothers. It was relatively recently that I realised that fathers were struggling too. That’s when I met inspirational campaigners like Mark Williams. It was clear that fathers needed support for mental health during the perinatal period. They need support for themselves and they need guidance about how to help their partner should she develop mental health problems at this time.
I’ve been conducting research at Bournemouth University, with the help of my psychology students, focusing on three aspects of fathers’ mental health:
- Our data has shown that dads were not getting enough information and support, or encouragement to even seek help.
- As with all mental health it is difficult to overcome barriers because of stigma.
- Another crucial finding in all of these studies was that fathers were not being recognised by health professionals as being worthy of any attention.
Dads as well as mums
Along with fellow campaigners, such as Mark Williams, we’ve been speaking at conferences, public meetings, and parliamentary events, as well as making media appearances, all in an effort to raise the profile of fathers’ mental health. This is not about taking attention away from the mothers. Nothing could be further from the truth. Quite apart from the fact that my campaigning has focused on mums for far longer than it has dads, this latest focus is about mums and dads. If we support the fathers, we help the mums; if we support the mums, we help the dads. If we support them both, we are helping their children and the entire family. It really is that simple.
How NHS England came to make their decision to support fathers
So, on the back of multiple campaigns and countless research studies, NHS England approached several of us in the summer of 2018 to supply them with evidence to support why we believe change was needed to protect fathers’ mental health. Data from three of my studies was included (along with evidence from several other sources across the UK). It is worth noting that, until then, no fathers were routinely screened for their mental health.
In November 2018, NHS England announced that, where mothers have been referred to perinatal mental health services, the father would now also be assessed for his mental health. To follow that up, in January 2019, fathers’ mental health was included in proposals for the perinatal mental health element of the NHS Long-Term Plan. Success! Or is it?
New provision for fathers: cause for optimism but room for caution
Of course, we were pleased when we heard these announcements. It was more than we have had before. But this optimism must be met with caution. Quite apart from anything else, governments and national bodies have often made promises; seeing them through to reality is another matter. But there are also some crucial caveats in what has been proposed. I was delighted to be included in steering groups for NHS England following these announcements, where I have expressed my reservations. So, what are those concerns?
Let’s focus on that statement again: “where mothers have been referred to perinatal mental health services, the father would now also be screened for his mental health”. It’s great that fathers are being screened in this way. Evidence indicates that fathers are most at risk for poorer mental health if their partner has developed problems herself. So, we can tick that box. But there are a few problems with that provision:
- Fathers can develop mental health problems independently of their partner. These men will be missed if we just screen fathers whose partner has symptoms.
- Despite improvements in (maternal) perinatal mental health provision, not all areas of the UK have adequate services into which mothers can be referred if they become unwell. This lack of support for mothers could mean that even more fathers are missed.
- Not all mothers who are potentially referred to these services meet the criteria for specialist support. They may be sent back into primary care. There is plenty of concern about what support she might now get, and how her symptoms could escalate. As well as that, the father is once again potentially overlooked.
- There is no mention of those fathers who have witnessed birth trauma. Without support, those men are at increased risk of mental health problems such as posttraumatic stress disorder (as I found in my research).
- The proposals are just for England. What about the fathers in the rest of the UK?
There are other factors related to fathers’ mental health, and men in general, that are not accounted for here. Such is the social and media stigma towards men and mental health, it’s a real challenge to get men to come forward to seek help. We need to break the barriers that suggest that men should not talk about emotions, but be the rock and ‘man up’. Also, even when we identify those fathers who may need support, we still do not fully understand what the interventions should look like. What works for women may not work for men. I am working on that with men’s groups and perinatal mental health professionals.
Then, there are the health professionals themselves. I mentioned earlier that data from my research indicates that fathers often feel that they are not given any real consideration by midwives, health visitors, birthing staff, GPs and obstetricians. Fathers feel that they could be given more information and support by these professionals, about protecting their own mental health and helping their partner if she is not well. I will be working with key bodies, including the Institute of Health Visiting and Royal College of Midwives, to address this.
There is indeed plenty to celebrate that fathers’ mental health is now been taken seriously. Recent proposed changes to NHS policy are encouraging. But, if they believe they have done enough to keep campaigners like me quiet, they need to think again!