With our increasing diversifying and inevitable mechanising of the human reproductive process, it is good to learn that our NHS is at last taking on board fathers as real people who are an integral part of the family process, and of the children’s child care network. In today’s announcement by Simon Stevens (CEO, NHS England), when a mother is presenting with mental health problems in relation to a birth or post-natal period it is intended that the father or other partner should also be offered an assessment of their mental health needs . The push to improve the services for the mental health of mothers and babies in the first year of life has been one shining light of positive development by the NHS in a background of grim deprivation. Dr Liz MacDonald has led the training of perinatal psychiatrists from a broad and holistic base – including using this writer – and that is itself a positive move in the thinking behind mental health practice generally. Despite huge social and cultural changes in how father are now perceived and act, there still remains a cardboard cut out image of the 1950s father going to work and ‘popping home’ in some social policy planning as well as in some sections of the public mind. And in fact there remain remnants of these traditional fathers, who play no active part in their children’s developmental lives in some sections of our ‘British’ society, still craving its lost traditions. Child development and psychological thinking have often not done much better.
Until recently attachment theory – a theory to make sense of how children achieve their key emotional connections – was almost entirely focused on mother-child relationships. Gill Gorell Barnes – who I must confess happens to be my wife – has tried hard to redress this balance in her recent book: ‘Staying Attached; Fathers and children in troubled times’. One of her key messages is to throw light on the intensity of emotion which many fathers experience in relation to their children, even children they may have for one or other reason been out of touch with for many years. And because we do not really have a narrative for men being emotional – ‘that’s women’s business’ – many of these men are confused by , and do not know how to make sense of, the intense emotions they may feel. In fact because cultural stereotypes often still define men as not showing or even having strong emotions, for many of these fathers this may be the most intense emotional relationship they have ever experienced. So Gill has addressed how these fathers may be brought in from the cold. But they are not the only ones. Dr MacDonald has recognised that when mental ill health strikes a mother, it is not necessarily just in the first year of life of her first child. The problem may continue and need ongoing help or it may happen in relation to later births. The NHS has now acknowledged that it may affect the father, so now we need to take on board the other parts of the family whose emotional lives also matter.
It may be new for fathers to begin to understand what has happened to their partners – and why – as well as the unacknowledged impacts on themselves. However the same is happening to their children and that largely remains unacknowledged and not responded to.
One young person said “ When my mum was having an episode we spoke the least about it then – when we needed to” – another described “ When the doctors came and took her hospital, we never knew what was going on…and no one seemed to want to talk to us” – whilst another “ and we had relatives who thought that we were either causing the mental illness or that we could get it from her”, and one added” I couldn’t sleep at night, so I was often late for or falling asleep in school, I couldn’t eat and was losing weight…but then when I found someone who could talk to me, help me understand it and be available to help me manage the situation at home all that fell away….its really so simple”.
The truth is that it is simple: talking about and helping children manage adversities going on in the family is not high tech, but it can make a huge difference, and can even be the deciding factor in the future mental health of that child. We need to get our child and adult mental health services as well as our social care and education services to take that on board – to make space to help children face and understand what is happening when parents have a mental illness, and to learn how to protect themselves. Schools like Stoke Damerel Community College in Plymouth who have heeded that need have also found that it has paid off many fold; absenteeism is reduced, the children focus and study better, and they have even reported an overall improvement in school atmosphere and discipline.
This is also what Our Time – a charity dedicated to helping children and young people affected by parental mental illness – has been doing, but we need and want to be joined by other charities as well as by the full range of public services.