A small study in the UK has explored why health visitors in UK, who provide care to families after a baby is born, do not provide mental health support to fathers, even when there are known mental health risks. The small study highlights some universal issues around the culture of maternal and newborn health services.

Two focus groups of six health visitors were organised in the Central and North West London NHS Trust and the discussion analysed. The research was initiated and carried out by health visitor team leader, Amanda Whitlock.

The proposal under discussion was whether health visitors should screen fathers for postnatal depression when they have known mental health risks. (This is not equivalent to the service to mothers, who are universally screened for mental health, even if no risk factors are known.)

The researcher found that engagement with fathers was minimal among the health visitors in the two groups. In addition:

• There is no training for health visitors for working specifically with fathers or with men.
• There is a culture in health visiting that defines it as a “mother and child” service.
• There are no policies or strategy in place in the local health service.

One health visitor said “I don’t think we ever talk about dads.” Another said, “Until today it wouldn’t even have occurred to me to even consider anything to do with dads whatsoever.”

This situation takes place in the context of 15 years of discussion in UK about health visiting and fathers with many research papers, conference presentations, organisations promoting training of health visitors, media discussions and Government policies. Evidence about the high prevalence of poor mental health of fathers and its impact on mothers, babies, mother-baby relationships and future child development has been widely discussed.

The health visitors also talked about being too busy and about being afraid of men, particularly depressed men. Some also discussed the problem of the men being reticent because of their own beliefs, family expectations and the stigma of admitting poor mental health.

The researcher goes on to make a series of recommendations relating to training of health visitors, policies in health services, improving access to help including on-line, and active and visible health promotion that engages with men.

The study illustrates a situation where engagement with fathers is left to be discretionary – it is not measured or managed. So in this health trust there are some health visitors who have never even thought of engaging with fathers and there is a health visitor team leader carrying out a research project on the topic, and there is no difference between the two as far as management is concerned.

This pattern exists across the global maternal health field – some people believe in and actively promote family engagement, whilst the majority have little interest.

Our next article will review a service by World Vision across 23 countries that has taken the final step in community health support to families with babies, where family engagement is one of four core indicators in measuring and evaluating the service. The difference this makes is transformative.

The work in UK also illustrates that family inclusion is not a topic where the developed countries lead and developing countries follow. Ambivalence about family inclusion is a universal phenomenon in maternal health services globally.

Whitlock A (2016), Why do health visitors screen mothers and not fathers for depression in the postnatal period?, Journal of Health Visiting

Photo: myllissa. Creative Commons.