“My story will resonate with many but it was my pride that stood in my way and it will stand in his way too”.

"I knew something was up. I had absolutely no idea that I was experiencing this!"

What is Postnatal Depression (PND)?

Postnatal depression is a type of depression that many parents experience after having a baby.

It's a common problem and can affect more than 1 in every 10 women within a year of giving birth. It also affects us dads! We might not expect it but it typically hits hardest 6-12 months after baby arrives.

Now your wife/partner might experience "Baby Blues" which is common and considered normal but it shouldn't last more than 2 weeks after she gives birth. With PND you need to be aware of the signs and the impact it can have on you, her and the family unit.

Postnatal depression can start at any point in the first year after baby arrives. In men it is less likely to be diagnosed because the symptoms can align themselves to a diagnosis of depression. Many women do not realise they have it because it can develop slowly. It's fair to say that men are less inclined to seek support which can result in the diagnosis going undiagnosed or ignored completely. A lack of early support and resources can also hinder early identification for both mum and dad.

The guidance from the NHS is "Speak to a GP, midwife or health visitor if you think you may be depressed'. The great news is that both midwives and health visitors have access to training to help them recognise PND. They also have techniques that can help. The challenge facing many fathers is that there is a lack of contact with care professionals during and after paternity and that's if you're lucky enough to have access to paternity leave.

Think back to you and your partners experience of post birth care:

• How often did you partner get access to a midwife or health visitor?

• When did the visit(s), if face to face take place?

• What role did you play during the visit, and did you take a backseat?

• Did the healthcare professional talk to you about how you were feeling?

• If you were feeling low would you have reached out during that meeting?

• What support was available in your local area to you and your partner?

• Did you know that PND existed and could affect men?

Your experience in the early days can shape the way you feel as a father and often overlooked we feel taking a back seat is the right thing to do, especially in the early days and during crucial mum and healthcare professional meetings.

What do I do if I think I've got PND?

The guidance given suggests that we need to 'Speak'…….. Let's face it this is an immediate obstacle for many men. Seriously you expect us to show vulnerability after just witnessing the physical and mental strength of the female body and mind? Hmmm…… I don't think so! It might also be considered an incredibly selfish act to interfere or direct attention away from mummy and baby.

In most cases we've either never heard of PND or if we have, we put any symptoms we're experiencing down to adjusting to the pressures of parenting. I know I initially downplayed the anxiety I felt and even when questioned by my wife I rolled out the standard male response 'I'm just tired or I'm fine'.

Our experience in the immediate aftermath of Max's birth was to bring him home to a home locked down by the government. At our first and only health visitor appointment the scales were placed halfway between the house and the health visitors car, Max was placed on them and my wife had to step back and wait instruction. No questions were asked of me and even if they had been I wasn't ready to share beyond the four walls of our house that I had in fact had a total meltdown. I'm sure my wife was nervous and apprehensive and I know how alone she felt. I'd admitted my struggle and she could see I was trying to get back on track but did she have anyone to turn to for advice or support? The simple answer is no.

Regardless of the guidance there are blockers that prevent fathers tackling their health after baby arrives. I've said it before, biting down on the gumshield and moving forward is the strategy we deploy. In reality, this tactic leads to burn out and is best avoided if you can summon the strength to reach out. But if you're not clear on what to look for and not willing to do the research for fear of looking stupid, how can you put into words the pain you might be experiencing?

For many their default position is "It'll pass. I have to push on because my family need me". I for one took this very approach. The difference….. I had admitted the struggle and confessed to the thoughts that I had allowed to cloud my decision making. Whist the thoughts were still there I had begun the work needed to get back on track. I buck the trend but at the time only within the four walls of our house. I didn't tell anyone else.

Now reflecting back, I wonder what the health visitors reaction would have been had I asked her about the symptoms I was experiencing, about PND and how it might be affecting me? I think the big 'Red flag' box would have been ticked and we'd have been under more regular supervision and I can only imagine the shame I'd have brought to myself and my wife had we been referred to child services because I wasn't up to the task at hand.

As part of my research for this blog I spoke to my GP, I'll never forget the look of horror on his face when I brought up PND in fathers. I'm not sure if it was because I'd asked a question about my mental health or whether it was because I knew about PND and that caught him off guard. Once I assured him that I was researching the issue and not suffering from PND he let me go on my way but I got the distinct impression this wasn't something he'd seen regularly.

So what do the stats tell us?

• 80% of men will become fathers, and

• 3-10% of new fathers develop depression during pregnancy and post birth.

• The average age of a father in the UK is nearly 34 years old (33.7 years old to be exact), and

• The highest killer of men between 20-49 is suicide.

The numbers of dads actively talking about PND are relatively low but I put that down to a lack of understanding and a willingness on the part of fathers to participate in the studies. I also put it down to a lack of fathers talking to their health care professionals.

In England and Wales in 2020 there were 613K live births and in the US there were 3.6M. So in the UK we'd expect between 18,000 and 63,000 and in the US between 108,000 and 360,000 reported cases of PND. Now our healthcare system is free so I suspect the case numbers in the US are much lower than those we'd expect to see here. One of the biggest challenges facing fathers is a lack of research and funding for care. On the NHS Mental Health Dashboard (Q3 2021/22) just over 40,000 women accessed specialist community perinatal mental health services (Including MMHS) in a rolling 12 month period at a cost £124M*.

*The number of women in contact with specialist community perinatal health services includes women who had a least one attended contact (F2F or video). All other consultation mediums were excluded (Telephone, SMS or email). Women are only counted once nationally in the reporting period, even if receiving multiple episodes of care. https://www.england.nhs.uk/publication/nhs-mental-health-dashboard

The great news is that there are longer term plans to support up to 66,000 women with moderate to severe or complex perinatal mental health needs and these mums will have access to specialist community care, from preconception to 24 months after birth with increased availability of evidence based psychological therapies. Whilst this is essential care and frankly the funding feels a little light I can't help but think…… What about dad?

For the same period there is no data on fathers accessing support. Now with 3-10% of fathers experiencing PND we're not even registering as a number and there doesn't appear to be any reference to a budget line that can be tracked and reported on. Therein lies the problem, in simple budgeting terms a budget is set for the service needed. If the service isn't used then the budget isn't set aside. The bigger problem and I think this is a wider issue for both mum and dad is that many aren't aware of the symptoms of PND and due to a lack of education many aren't getting the support they need until it's too late. There isn't just a risk to mum. The risk to dad exists too and ultimately there is a risk to the children both physically and later mentally if more isn't done in this space.

As parents it's our duty to raise awareness of the issues we face but it's absolutely critical to the success of these facilities that they have the funding and resources available to deliver the services needed to protect both parents and baby. There are some fantastic resources available on PND and the three books below can help you start to understand if you have or if you experienced PND.

• Daddy Blues - Postnatal Depression and Fatherhood - Mark Williams

• Sad Dad - An exploration in Postnatal depression in fathers - Olivia Spencer

• Fathers and Perinatal Mental Health - Jane Hanley and Mark Williams

And there are great online resources available via Instagram and plenty of resources on PND. However, if you think you're ok and I'm directing this at you dad, will you seek out a book on PND or will you put it down to the early pressures of fatherhood? I bet you won't be holding on the phone for your local GP to get an appointment to talk about the prolonged period of low mood you're experiencing.

I didn't even know it was a thing! Nobody ever mentioned it and it wasn't covered on the NCT course we attended and honestly speaking the first time I'd heard the expression Daddy Blues I was well on my way to feeling mentally and physically healthy again. Lockdown pushed me to invest in my mental and physical health but I'd be lying if it hasn't been a tough journey. It has required sacrifice, focus, energy and the support of my incredible wife. The picture of the mother of my children staring blankly back at me through streams of tears on that that fateful night will forever be etched in my memory. To this day, it remains the biggest motivating factor behind my recovery. However if you don't have the support where do you turn?

What am I looking out for?

Now this next section isn't aimed just at you dad. It's aimed at you too mum! Why? Whilst the symptoms of PND and depression generally are widely searchable and I too will cover them in a later blog, you both need to understand what you or he might be experiencing.

As his partner you'll see him change and yes his behaviour might throw up some tell-tale signs, but you have to understand that he's internally battling something and it's something he may not have experienced before.

My story will resonate with many but it was my pride that stood in my way and it will stand in his way too. The man you are or the man you know and love has changed.

• He will feel conflicted and constantly question the thoughts and feelings he is experiencing.

• He will feel guilt. He just witnessed the raw power of the female body and mind and here he is struggling to stay afloat.

• He will feel frustrated and in a lot of cases he won't know what's wrong or where to turn.

• He will feel ashamed and embarrassed and he might be struggling to articulate what he's feeling.

• He will push you away because he's trying to protect you.

• It's not his fault! But he will feel hurt, undervalued, overwhelmed and lost.

• He will question his worth and retreat further into the shadows.

• He will battle on because that is what he's been taught to do and it's what you've come to expect.

• He will not show weakness for fear that you might judge him, use it against him or even leave him.

He may have been your rock and you may have fallen in love with a strong, powerful and courageous man but today he might just feel like a shadow of his former self.

The challenge you face as his partner or wife is one that requires a lot of effort and exhausted at times you might not feel up to the challenge but stay in there. Your support, love and ability to listen will help him see that there is more to life than the way he is feeling. The stark reality is he has to come to the realisation that he needs help. You can encourage but he must admit that he's struggling.

Remember, he's already accepted that's he is in a battle and wrestling with guilt, shame and embarrassment is more than some can handle. It will feel like you're treading on eggshells and his stubbornness will wear thin but he will need you by his side if he is to win this battle. I know what it is like to be backed into a corner and with someone you trust it can feel like you're failing. He will know you have his best interests at heart but push too hard and he'll be lost forever. Please be patient accept that it takes a lot for him to admit to you that he's lost his way. His pride will force him to push on, and yes he might make it through this first battle but depression doesn't just go away and that's something he has to recognise.

From the moment a breakthrough occurs he is accountable for making the changes necessary to stay on track. It's at this point your role changes, he has shown you his faults and his vulnerabilities. The day he confronts his demons with you by his side you are entrusted to keep his secret safe. There are now two people with knowledge powerful enough to destroy a man, and no matter your future together this evidence must never be used against him because his biggest fear is failing you and his second biggest fear is you using that failure against him to drive a wedge between him and his kids.

The battle with PND is real. The resources are improving but the services are underfunded and many will suffer because their pride will stop them seeing support. Your role as a father is to protect your children at all costs but at the cost of your mental health and wellbeing; that's not a strategy that's going to play out to a successful end. As his wife/partner you play the most important role. He must never feel like you've lost confidence in him, and collectively you both need to work together to get him the help he needs. His inaction is costing you both and it will damage your family but it has wider ramifications. Our failure to seek out the support will result in another father losing his way and with nowhere to turn he might be lost forever. If you need help it's time to act and it doesn't matter how low you feel today because when you look into the eyes of your children you'll see only love staring back, no judgment just unconditional love and a love that can motivate you to turn a corner and feel stronger.

Today is the first step and tomorrow is just another step and the day after that another step. To the wives and partners, have his back and to the dad reading this they need you and will love you no matter what but the first step is on you.