How Are You Dad?

1. How Are You Dad? Understanding Paternal Mental Health

2. Setting The Context

3. The Family around the Child • Child and Family Services across Scotland takes its approach using the national Practice Model (Getting it Right for Every Child- GIRFEC) • This makes it clear that our practice must be focused primarily on the health and well being needs of a child, supporting the family around the child. • This ecological model doesn’t place any more importance on the gender of a parent.  • Where one parent is not fully engaged, then positive outcomes for a child can be limited

4. Dads and Father Figures… Where Dads aren’t around, we can refer to family friends, uncles, brothers, etc… …What can a ‘father figure’ add to the family context… A dad is no single thing.

5. The Evidence • In 2006, Scotland’s Chief Medical Officer set out the evidence of the connection between early years and a range of physical and mental healthoutcomes. Particular emphasis was placed on the importance of pregnancy and parenting in defining health outcomes. The early parent-infant relationship was highlighted as key to child development, laying the foundations for positive physical and mental health development (The Scottish Government, 2007). • The Early Years Framework acknowledges that it is during our very earliest years and even pre-birth that a large part of the pattern for our future adult life is set. It identifies the risks of poorer outcomes for children and families are strongly correlated to underlying factors, mainly poverty and lack of parental skills and knowledge as well as education (The Scottish Government, 2008). • The evidence base around parenting suggests a gender bias towards females (DFES 2007, Scottish Government 2008a,). Evidence for the positive involvement of fathers in children’s healthy learning and development is indisputable. In the words of Children in Scotland (2010) “It is well established that fathers (whether resident or non-resident, biological or de facto, good or bad) are profoundly important to the development, well-being and life chances of their children.”

6. The National Context Growing Up in Scotland: Father-Child Relationships and Socio-Emotional Wellbeing (Scottish Government 2017)

7. Contemporary Supporting Evidence the Avon Longitudinal Study of Children and Parents (Alspac); the Millennium Cohort Study (MCS], and Growing Up in Scotland (GUS) Who’s The Bloke In The Room (2018) How Was It For You Dad? (2018 survey – 600 participants)

8. Growing up in scotland • Supportive father-child relationships are equally important for boys and girls • Father and mother-child relationships matter equally for children’s wellbeing • Factors Associated with poor father-child relationships by age 10: A male child; low family socio-economic status; father as small employer or self employed; unsupportive relationship between child’s parents; living in a remote location; adverse family events; weak home organisation; low levels of positive parenting.

9. Children of highly involved fathers:

10. Pre-conception /during pregnancy • Fathers’ pre-pregnancy body mass index (BMI) is associated with their children’s bone mineral content and density (Macdonald-Wallis, 2010) • Fathers’ as well as mothers’ frequent binge drinking just before conception is correlated with lower Key Stage 2 test scores in their children (Alati et al., 2013) • Both parents’ smoking during the pregnancy is associated with ADHD symptoms in their children (Langley et al., 2012) • While 15% of the variability in fetal growth is explained by the mother's characteristics, 7% is explained by the father's (Hennessy & Alberman, 1998)

11. …During Pregnancy.. • One of the two most significant predictors of a pregnant woman’s emotional wellbeing is her partner’s emotional wellbeing (Thorpe et al., 1992) • Partner-support during the pregnancy predicts the quality of THE MOTHER’S parenting after the birth (Thomson, 2014) • Belfast Babies & Neighbours Theme Tune…

12. How Fathers Support Mums…Mental Health • Perceived support by baby’s dad in a sample of young highly disadvantaged mothers was strongly associated with lower rates of depression. • A mothers mental health is strongly associated with the quality of her relationship with her partner. • Decreased involvement by young fathers increases young mothers’ parenting stress • In child protection; a male carer can act as a protective presence, or have important information and insights into the children’s safety

13. How Father Friendly Is Our Practice? • What are the challenges with engaging dads? Think: Systems; Process; Policy; Attitudes; Our Offer…

14. Suicide • Men are <10 times more often likely to commit suicide than women • Suicide is the biggest killer in men under 50 in the UK • 4 out of 5 suicides in the UK is male • Over 500,000 men every year commit suicide, globally (Movember) • Men reporting of suicidal behaviour was significantly higher than their partners when screened with the Edinburgh Postnatal Depression Scale (EPDS) (Fisher et al 2012)

15. Post Natal Depression • 55,000 women in Scotland give birth each year… • 20% suffer from perinatal anxiety and depression • 10-15 % of men suffer from perinatal depression • 35-40% of men suffer from perinatal anxiety and stress

16. Risk Factors – Red Flags • First time fathers • Mental Health Disorders • History of Anxiety • History of Trauma (ACEs) • ADHD/ Autism • Children with disabilities / need end of life care

17. Sleep Deprivation & Mental Health

18. Anxiety & Stress • 35-40% of men suffer from perinatal anxiety and stress • 73% of new dads are concerned about their partners mental health • Increased pressures of fatherhood, new financial responsibilities, changes in relationships and lifestyle, sleep deprivation and increased work at home can induce anxiety and stress….

19. Teen and Underage Parenthood • High rates of teen parenthood in Scotland; gaps in knowledge/provision, with policy focus on young mothers • Challenges for Young fathers include: • Very real deprivations • 16+ destinations/trajectories • Housing insecurity • Constructed as a ‘risk’ • Rapid shift from childhood to adulthood • Low levels of welfare support • Professional Support: • ‘hard to reach’ or ‘easy to ignore’….because we don’t know much about them • Fathers tend to perceive that support services are targeted towards mums, and perceive ‘parent’ on advertising literature as meaning ‘mother’ • …Professionals can turn this around by building a virtuous circle of support

20. Man Up… or Man Down? • 61% of Britain’s young men feel pressured to “man up” as a result of damaging gender stereotypes • 67% of 18-24 year olds felt compelled to display “hyper-masculine” behaviour in tough situations and… • 55% said crying in front of others would make them feel like less of a man.

21. the perfect emotional storm Sense of loss and resentment, coupled with insecurity and anger

22. What we might see in Men

23. Impact of dads Mental health on children • Depressive symptoms in fathers during childhood were associated with adolescent depression aged 13-14. This association was independent of, and as strong as, maternal depressive symptoms. (MCS & GUI, two large population-based cohorts) • A depressed father may talk to his child using more negative and critical utterances…process of secure attachment can be disrupted (Sethna et al, 2012)  • Children who have fathers who don’t warmly interact with their children have higher rates of behavioural problems • Having an absent father can contribute to a child’s difficulties with peer relationships including bullying (Sethna et al, 2012) 

24. Impact on the infant • Infant behaviour which is difficult may be indicative of the parent’s behaviour as the child is reacting to parent’s depression. • Studies found that depressed fathers' speech was more critical and negative compared with non-depressed fathers. • Expression in speech of fathers who experience depression was different. • When both parents are suffering from postnatal depression, studies have shown there is less emotional attachment with the infant, higher parenting stress, increased risk of behavioral and cognitive problems in children, and greater marital dissatisfaction (Goodman 2008, Isles et al 2010, Parfitt, et al 2013).

25. Present Dad, Absent Father Dads Still Face Experiment https://www.youtube.com/watch?v=6czxW4R9w2g

26. Where’s Dad? The Myth of the Absent Father

27. Where are dads at the time of birth? What percentage of biological parents in the UK are in a couple relationship at the time of birth? 95% What percentage of biological parents jointly register the birth of their baby? 95% What percentage of births are jointly registered to two women? 1:1000

28. What contact do dads have with Maternity Services? How many first time Scottish dads: Attend at least one routine antenatal appointment? 92% Attend at least one scan? 99% Are present at birth? 97%

29. What do Mums Tell Us? • They want partners to attend ante natal appointments (Young, 2008) • A dads support is more highly rated than midwifery support (Spilby et al 1999) • Mums require less pain killers during labour (Chan; Paterson 2002)

30. …Despite All The Evidence…

31. What do Maternity Services staff ask dads? Your relationship as a couple? 25% Your smoking? 51% Your alcohol intake? 44% We asked Scottish dads about their antenatal appointments – did staff ever talk to you about: Your physical health? 25% Your mental health? 16%

32. Dads interaction during antenatal appointments? Speak to you directly? 71% Address you by name? 50% Did staff at least sometimes: Encourage you to ask questions or raise concerns? 70% Speak about the father’s role? 39%

33. Changing AttitudesChanging the message… “I realised that while we never intentionally excluded dads, we didn’t actively include dads either”…

34. Positive male role models How Can We Provide Positive Role Models?

35. Changing The Message ……..TO INCLUDE FATHERS? ….think • SYSTEMS; • ENVIRONMENT; • ATITUDE • POLICIES; • ACTIVITY;

36. Small Changes = Culture Change

37. What Do Mums Need? • ???

38. What do mums need? An Invite A Warm Welcome Positive Environment Smile Time Go at Her Pace Listen Use Her Name EMPATHY Patience Humour Respect…from the beginning Transparency Small Talk Approach Her Reassurance Information Be Human Avoid Jargon Eye Contact Don’t Rush Follow Up Be Reliable How Are You? Be Consistent Body Language.. Validation Thank Her Respect Honesty Avoid Interruption What I Can Do What I Can’t Do Do with, not to Manage Expectations Transparency

39. What do dads need ???

40. What is Working? Good Practice Across Scotland • Overnight Stays Across Several Health Boards • “Dad2Be” NHS Lothian • Understanding Dad Training Uptake • Kirkcaldy Health Visitors: asking, “How Are You Dad?”, and lunch-break phone calls

41. Ask: How Are You Dad? • EPNDS – Can be used with Dads • We can find out how Dad is doing by asking the right questions: • Are you avoiding situations? Working to much? • What was the birth experience like for you? • Are You Sleeping well? Have eating habits changed? • Explore parental mental health; by proxy if father is not present Kirkcaldy Health Visiting Team: • Lunchtime/break time phone appointments

42. Invite, enrol and engage with expectant dad Expectant fathers/women’s partners should be formally enrolled in maternity services and an official invitation to meet the maternity team issued, subject to the wishes of the pregnant woman. Glenrothes Home Start: The INVITATION saw many more dads using the service

43. Deliver woman-focused, family-centred services Maternity services should be formulated as ‘woman-focused and family-centred’. Ninewells: at Ninewells Hospital in Dundee dads and partners are encouraged to stay overnight

44. Ninewells: what used to happen You need a good nights sleep!” Its not visiting time No men allowed overnight She will be fine! Don't worry we will call you of anything happens!” It’s time to go home now!”

45. Ninewells: challenges MEN SMELL MEN SNORE HEALTH & SAFETY PRIVACY WE DONT DO THAT HERE!!! INFECTION CONTROL SECURITY FACILITIES

46. Ninewells: Overnight Agreement…

47. Ninewells: impact I wanted to be involved in caring for my baby I didn't want to leave them a few hours after the birth I was able to spend our first night as a family on the ward it was great I chose to have my baby in Ninewells because I knew my partner could stay I was scared of being on my own with the baby having my partner there with us made such a difference It was amazing having my husband stay overnight

48. ‘Father-proof’ maternity staff training ‘Understanding Dad’: West of Scotland Mother and Baby Unit: • A facility for mums suffering with acute maternal mental health problems • Staff training in Understanding dad has seen a shift in attitude and approach toward dads and partners…”Come back – you’re important!!”

49. Good Family Learning Practice Example: Promoting Roles of Father Figures (PROFF) “Dads as partners in their children’s learning”

50. Family Learning…What Works: • Family Learning that is specifically aimed at engaging male carers • Helps families to overcome barriers to participation, learning and achievement • Promotes inclusion and equality • Families are able to access learning activities that meet their needs (and use their strengths). • Male carers are supported to actively and meaningfully engage in their children’s learning and life at school. • Strong Partnership Approach Promoting Roles of Father Figures: St. John Ogilvie High/Calderside Academy