Data from 25 fathers were analysed. Thematic analyses identified 3 themes (see Fig. 1): “Support received to help support their partner” (Sub-themes: “Not enough support/information”, “Low quality support”); “Support fathers want that was not received” (Sub-themes: “Information on postnatal mental illness”, “Someone to talk to”, “Direct healthcare service support”) and “Father’s mental health” (Sub-themes: “Effect on own wellbeing”, “Fathers’ support services”).
Theme 1: support received to help support their partner
This theme examined what help was provided to fathers to enable them to better support their partner through poor postnatal mental health. This support also includes maternal and mental health services directed at the mother, and the mother and father’s experience of interaction with these services from the fathers’ perspective. This main theme contained two sub-themes, “Not enough support/information” and Low-quality support".
Sub-theme 1: not enough support/information
Twenty participants reported not receiving any support or information regarding postnatal mental illness and how they could support their partner pre- or post-birth. The two participants who received information considered it inadequate. The remaining participants believed they received enough support after the birth of their child, whilst another suggested that they did not need any support post-birth. The lack of support and information provided often left participants feeling confused and/or frustrated regarding how to help their partner, with some admitting it negatively affected their ability to support the mother.
“I didn’t know how to help her.” (P1).
Many participants, mainly those who did not receive any support, would have welcomed any type of support or information from healthcare professionals. Participants felt being asked if they required help or support would have been beneficial both pre and post birth.
“Any offer of help and support would be useful.” (P2).
Sub-theme 2: low quality support
Twelve of the participants who received support or information claimed the support provided by healthcare professionals was typically readable information (i.e. leaflets) and/or very brief verbal signposting to videos or other resources. For four participants this support was second-hand; information was narrated by partners to the participants. Only a very small amount of this information focused on postnatal mental illness.
“I read the information my wife was given.” (P3).
No participants reported receiving good quality support directed specifically towards them. Participants felt the lack of support suggested a reduced acknowledgement of the father’s role in the mother’s care.
"I received support but it was all so fast paced, it [information]
didn’t cover anything about the father and I felt lost." (P4).
Twelve participants recalled poor information and/or unprofessional services within the healthcare setting, which contributed further to their sense of inadequate support being provided.
“[The] crisis team were useless, trying to call them after giving us a wrong number” (P5).
Those whose partner and baby were admitted to a mother and baby unit blamed poor healthcare facilities for limiting the amount of time they could support their partner following the birth. This created a stressful environment and situation for both parents.
“[I] had to go home as facilities wasn’t there for me to stay” (P6).
In several cases, the perceived lack of support and information led both parents to seek help elsewhere.
“[We are] now saving in order to get private therapy” (P3).
Theme 2: support fathers want that was not received
This second theme covered what type of support fathers would like to have received before and after the birth. This theme contains three sub-themes, “Information on postnatal mental illness”, “Someone to talk to” and “Direct healthcare service support”.
Sub-theme 1: information on postnatal mental illness
Eighteen of the participants would like to have received more support and information both prior to and after the birth of their child. They felt that they would have benefited from knowing warning signs for poorer postnatal mental health and ways to help their partner cope.
“[To be] made aware of symptoms, and it would have been good to know what to do when you suspected it [mental health problems].” (P7).
These eighteen participants suggested information on their partner’s specific mental health condition would have supported them in understanding the condition, the symptoms and how to best help their partner. They felt this information would be best presented in the form of easy to access leaflets or other written materials available on the internet because these types of resources can be easily accessed at any time point. Two participants expressed concern about forgetting information they were verbally told about their partners condition by health care professionals, especially if the information was narrated during a stressful time (i.e., a partner having a psychotic episode).
“A basic understanding of depression and how to help [when] dealing with psychosis episodes … Leaflets on what to look out for, as you can’t always remember what you are told in the immediate aftermath” (P6)
Sub-theme 2: someone to talk to
Seven participants stated they would have benefitted from having someone to talk to about their situation. They felt it would have helped them to understand what was happening to their partner, what the options might be regarding their partner’s treatment plan, and how they could support their partner. These participants would have liked their partner’s treatment and recovery plan explained by a healthcare professional.
“A specialist to sit with me and explain the situation and care plan.” (P4).
Participants viewed having someone to talk to as a useful form of emotional support. Many felt they were given little to no emotional support, such as having someone to talk to, to cope with their own mental health issues.
Sub-theme 3: direct healthcare service support
Twelve participants said they would have appreciated more engagement and communication from maternal healthcare providers, in addition to increased access to mental healthcare professionals for their partner. They believed that better guidance on their partners diagnosis and treatment could be obtained from a range of healthcare professionals.
“Some Mental Health support, as well as social worker support and referral to a therapist” (P8).
Two participants suggested that mothers should be able to access services (i.e. counselling or talking therapy) where they could speak to a healthcare professional on their own without any family members or other healthcare professionals being present. These fathers felt that their partners might have been more likely to speak openly about their experiences when seen alone.
“we could have both seen the same therapist but individually and then together.” (P9).
When discussing their own support needs, all twelve participants stated that they would have benefitted from training in coping strategies to help them both support their partner and care for their own mental health:
“Having coping strategies and understanding how to keep calm!” (P5).
Theme 3: fathers’ mental health
The final theme explores the participants’ mental health in light of their partner’s symptoms including any support they personally received from healthcare professionals and outside organisations. This theme has two sub-themes, “Effect on own wellbeing” and “Fathers’ support services”.
Sub-theme 1: effect on own wellbeing
Twenty-three fathers believed that some aspect of their overall wellbeing had been directly affected by their partner’s mental health during the perinatal period. This often led to feelings of low mood, anxiety and general stress and affected physical areas of their life such as their ability to sleep, concentrate and even care for their child.
"I was scared. I could not sleep. My memory lapsed and I cried too often.
Made me feel like I couldn’t be as supporting to my son" (P10).
Four participants stated that these heightened physical changes and emotional responses had a negative impact on their relationship with their partner resulting in arguments, spending time apart and a decline in the support they offered each other:
“Things became very difficult and pushed us apart.” (P7).
Nevertheless, two participants confirmed that although the postnatal period was a stressful time, they were able to cope with the emotional demands, suggesting that they were either more resilient to the emotional effects of their partner’s poor mental health, or less willing to admit vulnerability. Several of the participants felt they needed to be seen to remain emotionally and mentally strong to support their partner and baby, despite coping with their own mental health.
"It was challenging supporting my partner and baby and managing with
my own mental health, but I coped" (P11).
Sub-theme 2: fathers’ support services
All twenty-five participants reported they rarely received support for their own mental health, and any support received was minimal. This lack of support from healthcare professionals led to fathers experiencing feelings of isolation and confusion around their own mental health issues.
“My wellbeing was of little interest to midwifes, health visitors … [I] had not given birth so had no cause for sympathy. A leaflet for my wife and a page for the fathers to read which wasn’t enough” (P10).
Participants agreed there was not enough information (and reassurance) on father-child bonding activities, something which they worried about, leaving new fathers feeling they were forgotten or treated with little sympathy.
“There was no information … .. how to understand that it could take a while for your child to bond as it does with the mothers” (P10).
Consequently, nine participants felt there was an extreme imbalance between the level of support fathers receive from healthcare professionals compared to mothers.
“Mothers have support from midwives and health visitors, but dads get nothing” (P12).
Although these nine participants acknowledged that the focus should primarily be on the woman, as she carries the baby and gives birth to their child, they still felt fathers should be offered more information and support than that currently made available by healthcare professionals.
“I understand the focus was and should be on my partner, but a bit of concern … would have been most welcomed.” (P11).
Any “better-quality” support participants received for their mental health problems was typically provided by organisations outside of the major healthcare services. Participants felt high quality services directed towards fathers’ mental health within current healthcare providers was currently inadequate but were able to access support from external organisations and groups.
“I’m now getting [the] support that I need as I did meet with a fathers group where Mark was present, and what a great help he was” (P13).