What’s the idea?
Partners and other family members may have their own mental health needs, which can impact on the health and recovery of the mother and baby, as well as their own wellbeing. These needs may change over time and may increase later on, when the mother’s mental health has improved.
Be aware that signs of distress may manifest differently in men, and there are multiple barriers to seeking and accepting help. Services have a key role in identifying and validating partners’ and other family members’ distress, and supporting them to seek help.
Why implement it?
- Partners of women accessing specialist services themselves face increased vulnerability to depression and anxiety [ref. 15, 16 and 17].
- Partners and other family members want professionals to acknowledge how difficult things are for them, and to check how they are [ref. 18].
- Some grandparents feel that professionals need to do more to consider their unique role and needs [ref. 18]. There is little evidence on the mental health needs of other family members.
- There may be positive impacts on partners’ wellbeing where partner-inclusive interventions are offered i.e. those that include partners in order to improve outcomes for mothers [ref 19, 20 and 21]. There is little evidence about interventions which aim to improve partners’ wellbeing directly.
Actions to consider
If you become aware of a partner’s mental health needs, or are considering asking about their mental health, ensure that:
- you address risk
- you have the ability to record and share this information
- policies are in place regarding information governance and data protection. For example, where to record information and how to maintain confidentiality for each family member. This will also be relevant for pre-conception counselling
- any assessment forms part of a care pathway
- onward signposting considers a broad range of support.
Stigma and stereotypes in men’s mental health
Men may express distress in different ways to women. They may be:
- more likely to acknowledge fatigue, irritability, loss of pleasure or interest, and sleep disturbances rather than reporting sadness or worthlessness [ref. 22]
- more likely to withdraw socially and use avoidant/escapist activities e.g. sports, overworking, excessive time on internet/TV, gambling, alcohol use, reckless behaviour (e.g. infidelity, unsafe driving) [ref. 23]
- less likely to attribute distress to mental health [ref. 24].
In the context of fatherhood and perinatal mental health disorders, published evidence and our survey indicate that men may be reluctant to seek help because they:
- do not feel they are legitimate users of services during the perinatal period [ref. 24 and 25]
- focus on the needs of their partner and baby, rather than thinking about their own needs [ref. 17], feel they need to be ‘strong’ and that it is not acceptable to ask for, or accept, help for themselves [ref. 17 and 18]
- fear the consequences of disclosing their own distress, for example, the stigma of mental illness and worries that the baby may be removed [ref. 26 and 27].
Similar barriers may exist for same-sex partners. Emerging evidence with co-mothers points toward further barriers related to homophobia and discrimination within health systems [ref. 28].
“Stigma and not knowing that we can suffer as well. Social services is my biggest worry, and now knowing where to get the help.”
“The need to stay strong and support the mother while falling apart inside.”
Asking about mental health, validating distress and encouraging self-care
Actions to consider
- Make time to acknowledge the partner’s or other family member’s own wellbeing. This may be within a joint appointment or one-to-one (for example, when providing information about the mother’s care or answering questions about the service).
- ‘Mapping the family’ may include asking about the partner’s or other family member’s mental health. At a basic level, this may include:
- their mental health history
- any current diagnosis or treatment and whether they are already under the care of a mental health team
- their current mood/symptoms (that may indicate the need for further assessment or support).
There is currently not enough evidence to indicate that using a specific tool to identify the mental health needs of partners would be beneficial in specialist perinatal mental health services.
However, professionals can:
- talk about mental health with partners and other family members, listening for and reflecting the words they choose to describe their experience (e.g. stress, pressure). Be aware that the markers you are familiar with when looking for signs of distress in women may not be appropriate for men. It may be useful to ask about changes in behaviours as well as feelings
- help to reduce stigma by validating, normalising and making sense of distress at this time [see Practice Tips: box 6 below ] This may include giving information on self-care and the value of self-care. For example, information about how difficult this experience can be for family members, information about prevalence of health disorders in partners, how to recognise their own needs, ideas and tips on self-care
- engage them by framing these conversations as a way to ensure that the needs of the whole family can be supported. Acknowledge that they may be focused on the needs of the mother and not on their own mental health: they need to know why looking after themselves is so important in enabling them to look after the mother and baby.
Practice tips: box 6
Making sense of distress with partners
With thanks to Mark Williams (Fathers Reaching Out)
Examples of ways to help partners feel more comfortable talking about distress could be:
“This can be such a stressful time – you’re concerned both for your partner and your baby and there are lots of unknowns.”
“Some partners can end up feeling guilty or blaming themselves. For example, they have had thoughts like, ‘why is she depressed? Is it me? Doesn’t she want the baby?’”
“Around half of partners feel depressed, anxious or very stressed themselves when their partner is unwell. You could be struggling as well and we need to think about you, too.”
“Watching a difficult birth can be very upsetting. Often people can feel panicky or out of control.”
Signposting partners and fathers
Specialist perinatal mental health services in England only currently accept referrals for mothers (i.e. the gestational or birth parent). Therefore, where professionals become aware of a mental health need in a partner or other family member, they may need to signpost to other mental health services.
Other services may offer ‘in-house’ support for example, a 1:1 session, telephone support, psychological interventions for partners, individual therapy [ref. 29].
Signposting may include:
- primary care adult mental health services (e.g. talking therapies/IAPT) for mild-moderate symptoms
- secondary care adult mental health services (e.g. Community Mental Health Teams) for moderate-severe symptoms
- local and national voluntary and community organisations providing face-to-face, telephone or online support.
Fathers may be reluctant to access formal psychological support. It may also be practically difficult to do so if they are taking on additional duties in the household, working long hours, or caring for the mother. Therefore, other types of support may be preferred, such as connecting with other fathers, or using online sources of support [ref. 30].
The focus of voluntary and community organisations may include:
- family support (e.g. Home-Start)
- partners and fathers (e.g. DadsNet)
- men’s mental health (e.g. Andy’s Man Club)
- mental health and self-care (e.g. MIND)
- perinatal mental health (e.g. Birth Trauma Association, Action on Postpartum Psychosis, #PNDHour by PND&Me.
There are many innovative charity and peer support groups across England, designed to support men and fathers with their mental health, as well as others within the family. These take many different formats to encourage attendance, ranging from online forums to local sports groups.
Actions to consider
- Where it is identified that partners and other family members may benefit from additional support, find an appropriate time to discuss the possible options.
- Be familiar with the broad range of support available for partners and other family members and be able to provide information about them.
- Consider whether they need support with the referral. Many mental health services accept self-referrals, while others may need a referral from a GP or other health professional.
- Some local IAPT services offer perinatal priority to all parents and partners. When making referrals or encouraging self-referrals, ensure that it contains relevant information that may act as a ‘flag’ for other services. For example, documenting both being an expectant or new parent, and the partner of a mother who is accessing specialist services.
- Consider equity of access. For example, peer support that is targeted at fathers and grandfathers may not be accessible or available to co-mothers or grandmothers.
Qualitative data from interview studies [ref. 17, 18] and our survey indicates that partners want peer support. Peer support can help partners and other family members to:
- share their experiences with others who understand
- have their feelings normalised and validated
- gain reassurance that the current situation will pass
- overcome some of the isolation that may come from dealing with the stigma of a perinatal mental health disorder and the practical difficulties of maintaining a social life in a situation of role overload.
Peer support can vary in format, including a professionally facilitated group in an MBU, access to a 1:1 peer support worker, or enabling informal chats amongst partners. It may be provided directly by a specialist perinatal mental health service or by a third sector organisation. See the resources section for more information on setting up peer support.
Practice examples: Signposting to online peer support
Following her own experience of perinatal depression, Rosey Adams set up and hosts #PNDHour, a supportive Twitter discussion group running every Wednesday 8-9pm. Contributors and viewers include mothers, fathers, other family members and health professionals. Discussions include the impact of perinatal mental health difficulties on mothers and their families and suggestions for promoting recovery.
The BTA is a charity supporting families following a traumatic birth experience, providing online peer support predominantly through their private Facebook Group. There are currently 8,600 members. These are mainly mothers but some partners access the group to seek information, experiences and advice on supporting mothers as well as addressing their own mental health needs.
The BTA provides a forum that creates an important sense of feeling understood and validated, which can be a crucial first step in seeking help and overcoming these symptoms.
Dads Net was founded by Al Ferguson in 2013 to provide a place for fathers to access information and to come together to share their experiences. Individuals are invited to join private sub-groups based on what they share in the open forums.
These online groups allow dads to share their stories and experiences, opening up conversations and enabling peer support. The Dads Net admin team run and monitor the site and groups, managing safeguarding and support. Although the website is not specifically focused on perinatal mental health, several of its sub-groups have this focus.
Over 20,000 fathers use Dads Net and this is growing rapidly. The site has 60 local online communities. Some also meet up offline, allowing fathers to connect locally and there are now between 5-10 face-to-face meetings happening each month across the UK.
Practice example: Identifying and meeting the needs of dads
Dad Matters, Home-Start Oldham, Stockport & Tameside, Greater Manchester
Dad Matters started in 2017 as a collaborative partnership between Home-Start HOST, Tameside and Glossop Early Attachment Service (EAS) and Anna Freud Centre CORC. The aim was to improve access to support for Dads who may struggle with their emotional well-being in the perinatal period.
Consultation with local fathers highlighted that they:
- wanted to feel included in perinatal and parent infant mental health services
- often didn’t understand services or whether they were entitled to support
- wanted to be able to access information in short formats, as and when it suited them
- wanted to access one-to-one support when they needed it, tailored for dads
- wanted to communicate using social media.
Dad Matters is supervised by the Tameside and Glossop Early Attachment Service, and Kieran Anders is the project Manager. Dad Matters created ‘The Dad Chat’, a meeting for dads running alongside antenatal classes, providing key information on:
- the parent-infant relationship, and why this is important
- perinatal mental health (what it is, how men and women are affected and how to support themselves and their partner)
- further signposting.
The Dad Chat is primarily facilitated by volunteers who are dads and highlights the importance of a baby needing their dad to be well for their own developmental needs. Dads who attend the Dad Chat sessions report that they feel better able to look after themselves, able to talk about their own experiences and that their own struggles are validated. They also feel better able to support their partners.
The Dad Chat model has been replicated as drop-in sessions for partners of mothers admitted to the local MBU, facilitated by either the ‘Dads Champion’ or a Clinical Psychologist from the MBU. Dad Matters is being rolled out across Greater Manchester.