Dr Andrew Mayers
PhD, MBPsS, FRSA
My work frequently attracts the attention of local and national media. Please click here to see an overview of radio, TV, and other media appearances.
November 20th 2017
Men can get post-natal depression too
This blog was written for The Conversation
Over the past few years, there has been an increase in media reports about postnatal depression and other maternal mental illnesses, and campaigns have led to greater understanding about the need for more specialist services. Although this is encouraging, very little is said about fathers. But men can get postnatal depression, too.
Currently, only mothers can be diagnosed with postnatal depression. The psychiatrists’ “bible”, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), includes a diagnosis of “peripartum depression”. Peripartum depression is a form of clinical depression that is present at any time during pregnancy, or within the four weeks after giving birth, although experts working in perinatal mental health tend to be more flexible, extending that period to the first year after giving birth.
In many ways, postnatal depression varies little from traditional depression. It, too, includes a period of at least two weeks where the person experiences low mood or a lack of motivation, or both. Other symptoms include poor sleep, agitation, weight changes, guilt, feelings of worthlessness, and thoughts of death and dying. But the biggest difference is that a depression at this time involves a significant additional person: the child.
Evidence suggests that the long-term consequences of postnatal depression on the child can be damaging, including developmental problems, poor social interaction, partner-relationship problems and greater use of health services (including mental health services).
Around 7-20% of new mothers experience postnatal depression. A common view is that it is caused by hormonal changes. Although this is partly true, it is far more likely that life factors are responsible, such as poverty, being younger, lack of support and birth trauma. Another potential cause is the sudden overwhelming responsibility of having a baby to care for, and the life changes that it entails.
Depressed mothers also feel intensely guilty about the way they feel about their baby, and fear shame and stigma from society. As a result, at least 50% of mothers will not report a mental health problem. Other mothers will not tell their health provider out of fear of having their child taken away by social services.
All of the above factors can equally apply to fathers. But there is no formal diagnosis of postnatal depression for fathers. Yet evidence from several countries, including Brazil, the US and the UK, suggests that around 4-5% of fathers experience significant depressive symptoms after their child is born. Some other studies claim that prevalence may be as high as 10%.
The cause of these feelings in fathers is similar to what we see with mothers, but there are extra complications. Men are much less likely to seek help for mental health problems, generally.
Societal norms in many nations suggest men should suppress emotion. This is probably even more a factor for fathers, who may perceive their role as being practical and providing for the family. Fathers – especially first-time fathers – might experience many sudden changes, including significant reduction in family income and altered relationships with their wife or partner. These are major risk factors for depression in fathers.
The importance for supporting fathers at this time is as vital as it is for mother. Evidence suggests that a father’s depression can have a damaging effect on their child’s development. Despite this, it has been shown that fathers are also less likely than mothers to seek help, and that health professionals are less likely to consider that fathers need support, compared with mothers. More evidence is needed to build a case that fathers need support as much as mothers.
It has been argued that, until recently, health professionals have been poorly equipped to recognise and treat mental illnesses associated with the birth of a child. Recent campaigns in the UK have led to changes in policy, funding and health guidelines. However, the recent revision of the National Institute for Health and Care Excellence (NICE) guideline on perinatal mental health does not address fathers’ needs. Despite a campaign to address this having support from several professionals and academics, a NICE spokesperson told the BBC that guidelines are unlikely to be changed as there is no evidence that men experience postnatal depression. However, if we discount hormonal factors in new mothers, the remaining risk factors for postnatal depression also apply to fathers. And we need support that recognises that.
October 1st 2017
Why we still need mental health campaigns
This blog was written for Mind Republic http://mindrepublic.mozello.co.uk/
On September 21st, the BMJ interviewed Sir Simon Wessely, President of the Royal Society of Medicine (formerly President of the Royal College of Psychiatrists). The central message of that interview suggested that we should stop raising awareness about mental health. The argument was that we do not have the resources to cater for those seeking help. Raising more awareness would, the article argues, only serve to put more pressure to an already over-stretched system.
In this blog, I will argue that we need more investment in those services; not fewer awareness campaigns. At the same time, we need to ensure that those campaigns are realistic, safe and appropriate.
I would like to start by stating my utter respect for Sir Simon. He has often spoken out for the need for better support for people with mental health problems. That is perhaps why I was so surprised when I read the BMJ article. A few of us took to Twitter to (I hope politely) challenge the arguments put forward. In his defence, Sir Simon stated that a short interview can only capture a small part of what he was trying to say. Nonetheless, what was said could potentially do a great deal of damage to people with a range of mental health difficulties. Perhaps there’s an argument there for writing one’s own press releases; I often do.
In one quote, Sir Simon said “We don’t need people to be more aware. We can’t deal with the ones who already are aware.” For me, mental health awareness campaigns are not about making people aware that they may have certain conditions. Most people, unless they lack insight or have a complex personality disorder, are aware that there are unwell; they just lack the confidence to seek help, or they fear stigma and judgement. Instead, campaigns should be about a whole raft of other factors – including persuading governments and commissioners that we need to invest in services, reducing social stigma, helping people not to feel guilty, and making it OK not to be OK.
I have been part of several campaigns that have influenced the Government. Through the Maternal Mental Health Alliance (Everyone’s Business) campaign and the 1001 Critical Days initiative, we have seen commitment to investment that would not have occurred without the awareness campaigns. The Time to Change campaigns have raised awareness across all areas of society reducing stigma and getting people talk positively about mental health. All of these campaigns have probably saved lives.
I agree that, by successfully raising awareness about mental health, we have been the victims of our own success. More people are coming forward to potentially seek help. That is indeed putting greater strain on services. However, that should not be a reason to stop. It’s the investment that’s wrong. Reducing awareness and failing to tackle stigma will not make that problem go away. All it will do is make people less likely to seek support, which would put their lives at even greater risk. Not raising awareness will not reduce depression, bipolar disorders, or psychoses. Any more than diabetes will go away if we stop raising awareness about that. The conditions will still be there; they just will not be diagnosed and properly treated. Reducing awareness might place less burden on services, but it would be wrong and indefensible.
Furthermore, those coming forward to seek support need not be a burden on NHS services. We need to radically rethink how we deal with mental health. With the right investment, the charity and voluntary centre can play a big part too. During the interview Sir Simon said “We should stop the awareness now. In fact, if anything we might be getting too aware. One wonders what’s happening when you have 78% of students telling their union they have mental health problems—you have to think, ‘Well, this seems unlikely.’”. Of course, it’s unlikely that three-quarters of students have a diagnosable condition. But, there’s a lot more to mental health support than primary and secondary care. At my own university, we have a whole range of support services, where students are, essentially, triaged. It’s a question of signposting to the right support. Many may need no more than simply directing towards activities that might tackle low mood and anxiety. Others may need counselling support. A few may need something more intensive. We frequently run awareness events, and wouldn’t stop those for fear of overwhelming demand. Without awareness, they might not seek help at all (and the problem could escalate). We have responsibility to support our students and adapt to what we can offer or signpost to.
In any case, mental health awareness is not just about making people aware about mental illness. Far from it. Campaigns can also teach people about how to lead better mentally health lives. We can show the importance of exercise, diet, sleep, and work-life balance, for example. We can also use campaigns to educate those with life-long conditions about tool kits that can help them stay well and reduce relapse. There are many excellent programmes across the UK doing just that. These very same people can be trained to be peer supporters, using lived experience to help others. We need to use public awareness campaigns to illustrate the benefit of peer support – to those who give the support as well as those being supported. Investment in those services, typically provided by charities, can help with prevention of relapse, or escalation of mild mental ill health into something more serious. It could save a great deal of money in future spending and, more importantly it can save lives.
Sir Simon was cautious about promises made by the Government about mental health investment, especially on the recruitment of mental health staff. I share his concerns. But that should not stop the awareness campaigns. Instead, we must use these campaigns to show that the Government still does not ‘get it’. I said as much in a blog I wrote in August. We need a revolution in the way we see mental health. Our awareness campaigns should focus on how we can foster a mentally healthy population (through positive lifestyles). Mental health education in schools can teach young people about emotional wellbeing, and how to seek help if they become unwell (as well as look out for friends and family). Early intervention could prevent a lifetime of mental illness – and that intervention, if early enough, need not be expensive either.
I also agree with Sir Simon about the need for integrated physical and mental health services. Much of what he says in the latter part of the article (which many readers could not see without a subscription to BMJ) was applaudable. Sadly, the message about mental awareness campaigns, which pervaded the opening paragraphs, might have done more damage than Sir Simon might have imagined. Sure, many of these campaigns are not perfect. In fact, we have a duty to make sure that campaigns are realistic, safe, and appropriate. A campaign that is not underpinned by networks that can, at the very least, signpost to support is dangerous. But having fewer mental health campaigns is also dangerous. We run the risk of undoing all the work that has been done over the last few years.
I will continue to campaign and raise awareness, but I will also continue to lobby Parliament for more investment (partly through my political work) and to be a critical voice in mental health services (I am a Public Governor for Dorset Healthcare University NHS Foundation Trust). I will also continue to advocate the role that charities can play in providing services (I hold trustee and ambassadorial roles to several local and national mental health charities, including Dorset Mind). We can all play a role in putting mental health at the heart of everyday living. It is a public health priority.
August 1st 2017
Jeremy Hunt announces ‘major’ recruitment in mental health: A new dawn or just the same old day?
Yesterday, Jeremy Hunt (Health Secretary) announced plans to recruit almost 10,000 staff to mental health posts over the next 4 years. The money would be drawn from the £1.3bn 'committed' to improve mental services (with the aim to bring services in parity with physical health). As a mental health campaigner, I was initially encouraged by the headlines that greeted me when I awoke on Monday morning. But does it all add up?
I have been campaigning for better mental health support for several years, especially for young people and for mothers (and fathers) experiencing mental health problems in the perinatal period. I am an academic psychologist at Bournemouth University, specialising in mental health. Through my external commitments and professional practice, I belong to a number of campaign groups (such as the Maternal Mental Health Alliance and I contribute to the All Party Parliamentary Group for perinatal and infant mental health group, 1001 Critical Days. I was driven to join these groups because of the chronic underfunding in mental health for decades (or probably ‘forever’, as Paul Farmer, CEO Mind Charity, put it yesterday). Through my work with local and national mental charities (such as Dorset Mind), I have seen the impact of cuts to services, reduction in public health and local authority funding, and the effect of austerity on communities. I was also compelled to tackle public stigma towards mental health, which ostracises sections of our society and discourages seeking help.
Let’s not forget that 1 in 4 of us will experience some mental health difficulty at some stage of our life. If you have not encountered problems, you no doubt know someone who has. Some conditions, such as depression, are a major burden to health services, and yet mental health only receives a fraction of the overall health budget. So, surely, I should welcome the promised investment and the commitment to recruiting the workforce to sustain that? Well, it’s a little more complex than that. Partly as a result of our campaigning, we have seen some encouraging funding pledges, especially in perinatal mental health. But there needs to be more. The promised £1.3bn investment in mental health needs to be put into context. Some might say that this funding only partially replaces what has been lost over the last decades. Where pledges have been made (even recently), the actual funds have failed to reach front line services. But let's say we give Mr Hunt the benefit of the doubt this time. He claims, to properly invest in mental health, we need a strong workforce to implement that. Hence the call to recruit thousands of new workers. That's OK, in theory, but what is the reality?
Part of the recruitment drive is to employ a further 2000 nurses by 2021. Surely that has to be a good thing? Well, it depends. To ensure that these nurses are in post, fully-trained, by that time, they would need to start their undergraduate courses by September this year. And yet, we are seeing a reduction in the numbers of applicants for nursing posts following the introduction of fees. There is little incentive for people to enter nursing, with the prospect of high debts to pay for the fees, and then years of chronically low pay. Why not waive the fees? Why should future nurses be paying to get the training needed to benefit society? Then there's nurses pay itself. While the pay rise cap remains, where is the reward for hard work (especially in the highly demanding and stressful role of mental health nursing). When questioned on this yesterday, Mr Hunt sidestepped the issue, focusing instead on praising how hard nurses work without addressing the problem with low pay. Hunt says that he is confident that they will recruit the nurses. But how convenient it would be, should the recruitment fail, to use that as an excuse not to spend the £1.3bn pledged. We might hear "well, we made the commitment, but no one took us up on it, so we will spend the money elsewhere".
It's not just about the pay either, or just nurses. All mental health staff have incredibly stressful jobs. Many of those staff enter the profession because they have their own lived experience and want to give something back. That experience is very powerful; I have seen that in the contact that I have with staff and service users. However, very little (until recently) has been done to protect those staff from the impact of working in those challenging conditions. Investment is needed in ensuring that all staff have access to proper clinical supervision. It's also not just about staff working directly in mental health services. All health professionals (GPs, acute hospital staff, practice nurses, community teams, etc.) need mental health training, so that (at the very least) they can properly signpost and/or refer to specialist services.
Of course, most of what I have said to this point applies to 'patients' with chronic or acute mental illness. There are considerably more people with sub-threshold mental health problems who do not qualify for treatment. But many still need support. That's where the third sector comes, especially through local mental charities. In many cases, someone with (say) relatively minor mood or anxiety problems might simply need structured, effective, peer support. Local charities can provide that expert support, especially through peers with lived experience. However, as Patron and Trustee for Dorset Mind, I can attest that our biggest challenge is finding the funds to runs the services. Very little comes from local authority, public health budgets, or local commissioning. A great deal comes from grant funding. Simply by providing these local services, we can prevent so many people escalating into more acute mental illness, and becoming a great burden on NHS budgets. Surely, one answer is to use LA and/or local clinical commissioning to ensure that all areas have access to expert services, away from the NHS.
So, was I happy with Mr Hunt's announcement yesterday? I welcome any funding, and certain applaud a drive to increasing staffing. However, this was not properly thought through. There is a much bigger picture that is being missed, quite probably because those making the decisions simply do not have the understanding about mental health that is needed to truly make the changes that are needed.
June 19th 2017
A blog for International Fathers’ Mental Health Day: Why paternal mental health is so important
When my good friend Mark Williams asked me to write this blog for International Fathers’ Mental Health Day (IFMHD), I had no hesitation in agreeing. This is something very close to my heart, professionally and personally. Here’s why. Professionally, I am an academic psychologist (based at Bournemouth University), specialising in mental health (and particularly perinatal mental health). I campaign for better mental health provision for mothers, fathers, and the entire family. Personally, I am Dad to four (now adults), Granddad to five.
Of course maternal mental health is important. I work with many groups across the UK to help make that a little better for mums. I help train midwives and health visitors on mental health. I am advising the NCT on their new perinatal mental health peer support service. I worked on the Best Beginnings maternal mental health project. I am part the 1001 Critical Days initiative. I am a member of the grassroots Perinatal Mental Health Partnership (which is part of the Maternal Mental Health Alliance). I work some of the most inspiring maternal mental champions across the UK. But, fathers’ mental health is important too.
I have worked with Mark Williams to try and establish a charity and support network for fathers. That work is ongoing. For me, fathers need support in two ways: to understand more about how they can help their wife or partner, should she develop mental health problems; and to protect their own mental health. To mark IFMHD 2017, Mark Williams and I recorded this podcast. In that I mention some of the work that I have been doing.
For some men, when their wife or partner develops a mental health problem (whether that be during pregnancy or after the baby is born), they lack the knowledge, resources, and confidence to know what they can do to help. Often, they feel the need to ‘fix’ it. Because the person they love is ‘sad’ they try to make it better by (perhaps) organising a holiday, or treating her to new clothes. That’s all very well, but it’s not understanding what’s really going on. Emotional support is vital. In some cases, when the mother develops a serious psychosis, or exhibits extreme obsessions and compulsions, fathers might become very scared of what is happening. Dads need to learn what to do and where to get support, but there are still too few resources to guide them. We need to change that. There are good resources, such as those provided by Action on Postpartum Psychosis, Bluebell, and the NCT. There is a need for more resources that are safe and reliable.
Also, health professionals and other support services (including charities and peer support groups) need to cater more for fathers (and dads-to-be). Some antenatal classes include dads, and some of those are now including emotional wellbeing and mental health (for both partners). However, that needs to be standardised (and benchmarked) and extended to all locations. Following campaigns (such as Maternal Mental Health Alliance, 1001 Critical Days, and others), the UK Government have been allocating funds to improve maternal mental health. We now need to exert more pressure to have more funding for fathers too.
Then there’s the work we need to do to support fathers’ own mental health. It’s hard enough to get men talking about emotions, let alone fathers. There is so much stigma about ‘manning up’ and being the ‘rock’. At the end of the day, it is perceived, it’s the man’s job to provide the security. But, chaps are vulnerable too. All sorts of factors can cause the father (and dad-to-be) distress. There’s the uncertainty of fatherhood, the sudden change in responsibility, financial concerns, and relationship changes to name just a few, and that’s quite apart from the sheer emotional turmoil. We need to make it OK not to be OK, and to be able to talk about it. We need to provide outlets to allow men to talk freely and without judgement. We need professional and support services to be better trained in how to support fathers (and recognise the signs that dad might need support).
A key area that I have been working on recently focuses on birth trauma. That trauma might relate to significant threats to life (for the mother and baby), major blood loss, birth complications, and unexpected outcomes (including unplanned caesareans). We already know that mothers need more support following birth trauma, and some great work is being done on that by the likes of Unfold Your Wings, the Birth Trauma Association, and the Birth Trauma Trust. However, not nearly enough is being done for fathers who witness that trauma. When there is a birth complication, understandably, the mother and child are the main priority in what might be a medical emergency. All the same, much more could be done for fathers. They are left to cope alone, with no information and (perhaps more crucially) no follow-up. We know that the way in which trauma is processed, and the level of support given, are major factors in whether a person develops post-traumatic stress disorder (PTSD). And yet, little is done to recognise that for fathers who have witnessed (often) very distressing scenes.
I know of one case, where a mother (in the final stages of labour) experienced significant blood loss following a placental tear. The father (who was present) only knew there was an emergency when the delivery team hit the alarm (to get more help). He was given no information. Not even a brief explanation of what was happening. He was simply given his new son and told to ‘get on with it’. When his mother-in-law (alerted to the emergency) entered the room, he was seen to be visibly shocked and deeply distressed. The emergency was dealt with, and the mother and baby were fine. However, the father was never followed up to check the impact of witnessing that trauma.
We need to ensure that information and support is more readily available. However, before we can demand that, we need to know what fathers need. There is too little research to date. To address that, I have started some work in this area. Under my supervision, one of my undergraduate (final year) psychology students (Emily Daniels) undertook a research project. We recruited fathers who had witnessed birth trauma. We asked them about that experience, what information they were given, and what support they received. The formal results will be published soon, but we do know that fathers were saying about how little information and support they got. We will use that evidence to inform agencies to help change this lack of support. The work has already received some media attention, through newspapers (e.g. The Times) and BBC Radio and TV. Bournemouth University made this short video about the work. We will be extending the work in the near future.
In the next academic term (Autumn 2017), I will be starting two new projects on fathers’ mental health: one that explores what resources dads need to support the wife/partner’s mental health; and one that examines what help fathers need to support their own mental health.
You can read more about my work at www.andrewmayers.info or follow me on Twitter (@DrAndyMayers). I will be updating my website about progress on the research and campaigns.