Mental health checks for dads: how the NHS announcement played out

5 December 2018

Adrienne Burgess writes:

NHS ENGLAND announced via a press release (2 December 2018) that when an expectant/new mother’s mental health has been identified as poor, a mental health assessment and relevant referrals are to be offered to her partner.  The policy was informed by an understanding of the inter-connectedness of mothers’ and fathers’ mental health at this time, as reported in the Fatherhood Institute’s recent research review Who’s the Bloke in the Room? which showed that:

  • The expectant/new mother’s most important support person is her partner
  • At the time of the birth, 95% of biological parents in the UK are married, living together or planning to raise their child together (and 95% jointly register the birth)
  • Expectant mothers overwhelmingly want their partner to be included in antenatal education and care – and to a great extent judge the care they receive positively if they perceive their partner as having been encouraged and included
  • Partners’ mental health is closely intertwined
  • When the father is supportive his partner is less likely to become ill; and, if ill, more likely to recover quickly
  • The man’s own poor mental health is a risk factor for the woman (and the child);  and
  • In some cases couple-relationship problems underpin her vulnerability.

The NHS press release was careful to point out that resources for the assessment/support of fathers would not be snatched from mothers, but would be part of a much wider expansion of perinatal mental health services that, as part of NHS Long Term Plan, will be accompanied by additional funding.

HOWEVER, what is interesting is the way the media picked up the story.  Almost certainly because the press release had dared to mention potential benefits to fathers (who will no longer have to ‘suffer alone’ if their partner’s mental health is poor), the ‘it’s a gift for dads’ narrative was repeated widely (as for example here, by The Independent),  This narrative completely overwhelmed the story.

The problem is that anything presented as a benefit to dads can all too easily be perceived as taking resources/focus away from mothers – a zero sum game. And since the ‘additional resources’ offer was not widely repeated in the media, concern was expressed about this:  for example, a number of organisations contacted the Fatherhood Institute, trying to be positive about the ‘gift to fathers’ but wondering whether this would mean reduced services/resources for mothers.

It is vital that when this policy is introduced, the narrative focuses on the benefits to maternal mental health, not on the benefits to fathers.  This is a principle the Fatherhood Institute adopts in all its work, and particularly in midwifery:  the term ‘midwife’ means ‘with woman’ and, quite rightly, in this context the mother is the service’s primary concern.  Expectant and new fathers concur with this view.  In fact, fathers’ sense of entitlement to support at this time is so low, that when asked how maternity services have supported them, many do not even understand the question.

How has the Fatherhood Institute responded?

First, we tried to take the media narrative back from ‘it’s a gift to dads’ to ‘it’s a gift for mothers/the whole family’ by publishing and circulating an important comment piece in The Guardian (N.B. as published, it is not exactly as had been written – The Guardian ‘subs’ introduced some errors!)

Secondly, we are responding to the ‘resources’ question by pointing out (as here) that new resources for the policy will be made available.

Thirdly, we are hypothesising potential cost-savings – as follows:

1 Assessment is not the same as referral.

2 Assessment alongside the mother when her mental health is poor is not likely to increase professionals’ workloads to an unacceptable extent.

3 Assessing the father’s own mental health/capacity to support his partner (alongside her assessment) is effective triage, allowing for more appropriate referrals and thus, potentially, saving money.  Such triage will enable identification of the ‘problem’ as:

(i) the ‘mother’s problem’ – an individual problem resulting from  her own mental health/life history vulnerabilities? AND/OR
(ii) a couple-relationship problem AND/OR
(iii) a vulnerability in the father himself, which is negatively affecting the mother.

4 Assessing/informing the father/woman’s partner also has the potential to engage him more effectively in her support. This, too, we hypothesise may save money: a woman better supported by her partner may not need such lengthy intervention.

5 If attempts to refer fathers to support services reveal that appropriate services do not exist locally or nationally this may help in the design of the planned expansion of perinatal mental health services to meet families’ needs. This too may represent money-savings in the longer term.

6 Action research should be carried out when fathers/women’s partners are included in provision so that the real – not the fantasised – issues can be identified;  services mapped;  and outcomes explored.  The action research should be randomised, with a control group, so that researchers can also monitor what happens when fathers/women’s partners  are NOT included.

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