What is male postnatal depression and what part can pharmacists play in tackling it?


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By Saša Jankovic
Freelance journalist

28 Feb 2019

Men’s mental health is often overlooked by maternity services. However, it is a vital part of healthy parenting that should not be ignored, says Saša Jankovic

An estimated 10% of fathers experience mental health difficulties during the period around the birth of their child, according to NHS England. But while post-natal depression (PND) and mental health issues have become more recognised and supported in mothers, they remain under-discussed and little acknowledged in men.

Dr Sandra Wheatley, a social psychologist specialising in parenting and relationships, says we still know ‘very little’ about the prevalence of perinatal mental health problems in men. ‘What little money there is for this kind of research is spent on women’, she says, ‘although in most professionals’ minds if a woman has PND then the additional pressure this puts on the family means men are also going to be vulnerable.

‘We do see PND in just the male partner, but again there is sparse data about this for a variety of reasons. Men are less likely to recognise it as depression, or admit it, and therefore don’t see a professional to treat it, so it’s hard to get figures.’

 

NHS support

 

Thankfully, an initiative in the new NHS Long-Term Plan (LTP) may help, with a commitment to offer mental health checks and treatment to new and expectant fathers whose partners are themselves suffering from anxiety, depression or more severe disorders such as psychosis, and signpost them to professional support if needed.

However, while those with an interest in this issue welcome the move, there are concerns that it doesn’t go far enough. Jeremy Davies, head of communications at The Fatherhood Institute, says: ‘The LTP announcement is a significant shift because generally speaking the NHS doesn’t really recognise fathers other than that they pitch up with mothers. So it is a positive move, but it’s only picking up men who are attached to women who have mental health issues, and we still don’t know how it will be done.’

Dr Wheatley agrees: ‘In the marathon of depression it is just a pigeon step, although it is a damn sight more than we’ve had before,’ she says. But she warns that ‘while it is a good start, it has to be handled carefully. For example, if couples are offered counselling, it should be separately – there may be things they don’t want to talk about in front of each other.

‘And who is training the [healthcare professionals] who will be identifying these at-risk fathers, and then who will they be sent to? Is there the capacity to meet these needs?’

Mr Davies believes that for healthcare services to truly make a difference, they ‘need to see men’s fatherhood’. He says: ‘If they see a guy at all, at best it’s as somebody in a supporting role to the mother, rather than as a father in his own right. Services need to make sure his relationship with the child is functioning and able to develop, as well as him playing a supportive role to the mother.’

 

Pharmacy interventions

 

These gaps create an important role for community pharmacy. You will know if your female customers have had a baby, so how can spot signs of mental health issues in their male partners – and what can you do to help?

Dr Wheatley says the markers are obvious and can be the same in new dads as in new mums. ‘With women, we look for under- or over-care for themselves. If they are absolutely pristine it can be a sign they are trying ultra hard to hide issues – and it’s the same in men,’ she says. ‘Or are they continually dishevelled or buying things to help them sleep?

‘Maybe he is coming [into the pharmacy] repeatedly for her – for example, if he is buying formula milk every other day, you might wonder why he’s not getting two at a time. While it could be that he can’t afford it, it may also be that he is seeking an interaction with you.’

Indeed, Mr Davies says men are crying out for meaningful interactions with family services. He says: ‘Our How Was It For You survey of new dads last year asked about their experiences of maternity and health visiting services, and we found that smiling at him, asking his name, and things like that were not being done by a massive proportion [of healthcare professionals]. In a very female context, it’s as if men are being treated as unwelcome visitors.’

Dr Wheatley says starting a conversation around the baby can be a good way in. ‘Ask him how the baby is getting on, and then ask how he is sleeping,’ she advises. ‘It may be a common question for new parents but it’s one that can open up a chat about how he is and enable you to signpost to services that can help.’

And Mr Davies stresses that ‘the casual conversation at the counter must not undermine fathers with comments like “what are you doing here buying this stuff for a baby?”. There is good evidence that fathers take their role as protectors of their children very seriously, so if you want to engage with men, talk about their parenthood because that’s the thing that matters to them.’

As Dr Wheatley says: ‘The time you lose to depression you never get back, but talking to a friendly face can make fathers realise there is sunshine somewhere, and encourage them to seek the help they need.’

 

The Fatherhood Institute offers training for healthcare staff about unconscious bias, and why fathers are important


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