New and expectant fathers will be offered mental health assessments if their partner is suffering from depression or anxiety, NHS England recently announced.
The NHS described the plan as “radical” and a “landmark move”. While it is vital that fathers whose partners are suffering get support, the plan still falls far short of what new fathers need. I would know. I was diagnosed with postnatal depression after my son was born and under the proposed plans, my symptoms would still be missed by the NHS.
Postnatal depression is a non-psychotic depressive disorder that can occur after the birth of a child. Between 6-13 per cent of new mothers will suffer from postnatal depression, with symptoms including persistent sadness or low mood, feelings of hopelessness and worthlessness, loss of interest in activities that were previously enjoyed, and thoughts of suicide.
Postnatal depression in new mothers results in poorer mother-child attachment, shorter breastfeeding duration and poor child development. The cost to society is huge. In the UK, every case of maternal depression costs, on average, £74,000, with the bulk of this relating to the negative effects on the child.
Some people, including scientists, used to think that postnatal depression was mainly a result of hormonal changes post-birth, or experiences that are specific to women, including delivery complications or unsuccessful breastfeeding. But there is now wider recognition that postnatal depression can also affect new fathers. In fact, recent studies have suggested that between 8 and 11 per cent of new fathers suffer from postnatal depression.
And as with maternal postnatal depression, the condition can seriously impair father-child attachment and the nature of a father’s interactions with their child, and it can also increase behavioural and emotional difficulties in the child. Fathers with depression are also about 20 times more likely to consider suicide compared with non-depressed fathers.
Many factors are known to contribute to postnatal depression in new fathers. The most common is maternal postnatal depression. Fathers whose partners have postnatal depression are about two-and-a-half times more likely to have symptoms of depression six weeks after the birth of a child. This is why NHS England’s plan to screen fathers whose partner is suffering from mental health conditions is important and will mean many more men will receive the care they need.
But this focus still ignores new fathers, like me, whose partners do not have a pre-existing mental health condition, such as anxiety or depression. Instead, a more holistic account of the mental health of new fathers would consider their previous history of mental illness and the psychological and social context of fatherhood. For example, men often report large discrepancies between the expectations and realities of childbirth in the postnatal period. And men who experience greater difficulties with childcare.
New fathers are also more likely than new mothers to return to work sooner and, in many parts of society, men are still expected to be the breadwinners. Yet new fathers are also expected to play an active role in childcare, and difficulties managing an early return to work with childcare responsibilities can contribute to symptoms of depression.
New fathers can also have difficulty developing an emotional bond with their child compared with mothers, which may increase feelings of helplessness.
But when new fathers get depressed, they are still less likely than new mothers to have their symptoms caught and are more likely to go untreated. In part, this may be because men are reluctant to disclose symptoms of mental ill health, especially if such disclosures are seen as inconsistent with ideals of masculinity. But it may also be because healthcare practitioners do not recognise depression in new fathers or provide opportunities for new fathers to raise concerns about their mental health.
In the UK, for example, the tradition of health visiting is heavily focused on mothers and children, and some health visitors are reluctant to address postnatal depression in men. As a result, fathers end up feeling overlooked following the birth of a child and their experiences rendered invisible.
The invisibility of depressive symptoms in new fathers is important because it often forces men to manage their symptoms on their own, leaving them frustrated when they are unable to do so. New fathers may also end up questioning the legitimacy of their depressive experiences and avoid or delay seeking help, as a result.
While the plans by NHS England are an important first step, there is a risk that many new fathers will continue to be let down through under-diagnosis or a lack of attention to the mental healthcare needs of new fathers. Instead, what is needed is routine screening of new fathers for depression and other mental health conditions, so that all new parents are treated equally. This, in turn, requires that healthcare practitioners who are most likely to meet new fathers have the appropriate education, training and time to engage with fathers too.