Dean Rogut was holding it together.
He had become a father for the first time, but it had not gone to plan. At 12 weeks pregnant, his wife was put on bed rest. At 24 weeks, their son, Max, was born.
As the weeks went by, things were hard. There were times when they thought they might lose Max. Throughout that period, in and out of the NICU watching their tiny baby, Rogut took “the very male supporting role”. He supported his wife. He was the point of contact if anyone needed to know what was going on. But it felt as though he was in a sensory deprivation tank.He became detached from everything and anything. “I was very much in survival mode – but trying to keep everyone else sort of above water.”
Staff would check in and ask, “How’s mum doing today?” No one asked about how Rogut was doing unless his forthright wife told them to. His friends would get in touch, but there wasn’t much they could do. About halfway through the 121 days Max spent in hospital, his wife was diagnosed with postnatal depression, which helped her access support.
“But yeah, there was nothing really for me.”
Max was born in March. He came home around July. The new family got into a routine. Rogut was problem solving, helping his wife. He had friends around him. It would have looked to the outside world that he was doing OK. That he was being a good dad.
“I didn’t realise how bad I was until about November, December when I hit the wall.” He became clinically depressed, suicidal. He checked into a hospital.
Ababy is a beautiful thing. But for decades, after years of advocacy, researchers and health systems have recognised that the arrival of a baby can also be a challenging, traumatic, disorienting thing for new mothers.Up to one in five mothersexperience perinatal anxiety or depression. As a result, women are screened for their mental health at metronomic points throughout the orchestrated health path from confirmation of pregnancy through to their infant’s routine immunisations. Maternal mental health remains a serious problem, but one for which a system exists.
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There is no such system for fathers. And an increasing body of research shows about one in 10 fathers experience serious mental health issues in the period before and after their child is born. It is also showing that the impacts of this are not just devastating for the fathers, but for their partners and their children.
“We don’t have a community where we wrap our arms around fathers in the same way that we do around mothers in the early stages,” says Deakin University Associate Professor Jacqui Macdonald, convener of the Australian Fatherhood Research Consortium. “Instead the language is around fathers being a support for the mother. There’s not a discussion about who the support is for fathers.”
It means that fathers, like Rogut – but not limited to those who have had traumatic experiences – canslip through the cracks.
When you think about the challenges facing a first-time father, says Associate Professor Richard Fletcher, who leads the Fathers and Families Research Program at the University of Newcastle, “the context for him having the baby is one that’s like being in a desert and not even being aware of how thirsty you are, but there’s no water anywhere”.
“The dads are isolated from pretty well everything.”
It is not a phenomenon limited to Australia. Dr Sharin Baldwin conducted a systematic review on perinatal mental health in the UK in 2018. “What stands out most is how often men feel invisible or excluded in the perinatal period,” she says. Meanwhile, they were dealing with challenges associated with changes in identity and their relationship, financial pressures and work-life balance.Not much has changed since then, she says.
“Many men suffer in silence during one of the most significant transitions in their lives.”
“Families don’t work as individuals, they work as systems. So if one part of that system is really struggling, the rest of the system isn’t going to be working as well,” Macdonald says. “If we can care for the father, then the father does provide a better source of care. The father becomes a partner of the healthcare system in supporting the mother and child, but that’s not possible if we haven’t cared for the father as well.”
The figure of 10% of new fathers experiencing mental health difficulties, such as anxiety and depression, is an estimation. One reason, says Macdonald, is “we don’t really have proper screening anywhere for new fathers”. The second is that male depression often looks quite different from perinatal depression in women.
“What we do find is very high correlations between feelings of anger. It doesn’t necessarily mean that they’re aggressive, it just means that there’s an internalised sense of anger,” she says. It may be adaptive, “a sense [in fathers] that there’s an energy there to manage; to fight against this feeling of depression and sadness – but it needs support.”
Arecent systematic review of paternal copingidentified in fathers a cohort of what Macdonald calls “dual copers” – men who look as if they are doing really well but have underlying unaddressed unease. “These dual copers in men often are also engaging in avoidant behaviours. Things that are distracting, things that will reduce the emotional intensity of the feelings that they’re having, and that may include things like alcohol use.”
The review echoes findings from Baldwin in the UK: “For fathers, distress may show up as anger, irritability, or conflict, and through avoidant behaviours like working excessively, smoking, gambling or increased focus on activities like sports or sex.”
When Macdonald and a team tracked a Covid cohort of dual copers, the study found higher rates of depression over time than among other fathers.
“But everyone looks at them and thinks ‘Oh, you seem to be doing alright … We won’t dig any deeper,’” she says. “And my fear is that’s where we start to see risk for suicide.”
The way society expects fathers to engage in domestic life has undergone a fundamental shift within the last 30 years.
“Couples before birth say what they want is a more egalitarian arrangement,” says Fletcher. “The community’s changed quite a bit but the system around dads hasn’t changed. That makes it hard for them to be clear about ‘Well, what’s my role, exactly?’”
The message to fathers about the role they are expected to play, from antenatal care to the way Australia structures parental leave, Fletcher says is: “Well, we think it’s pretty small.”
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While couples entering into pregnancies often expect egalitarian parenting, the fundamental cultural preparation for being a parent is often different for men and women. “There’s been this lifetime of socialisation towards motherhood for women, and less so of that for men,” says Macdonald.
“The social environment is one where men are not expected to be caring for babies or interested in babies,” says Fletcher. This can make the transition to parenthood difficult for men. It is well established that men frequently take longer to bond with their babies than women. But the work of addressing that, says Fletcher, cannot be left up to individual men, operating in a vacuum.
“People think we’ve really got to get those dads to change their attitudes and be more egalitarian. That’s the task. Whereas I would say we’ve got to change the system surrounding conception, pregnancy and birth so that it’s assumed he’s part of it.”
Caring and earning dynamics established early in family life can be difficult to untangle, and cancause long-term conflict when the reality of the division of caring does not cohere with the vision parents had when entering parenthood. Both parties can feel disappointed, says Fletcher – though women often more so, left literally holding the baby if their partner retreats into work, or hobbies, or alcohol as a way of coping with their own distress.
The chasm between parents’ expectation and experience, between fathers’ needs and support, leaves families fumbling. They’re asking, says Macdonald:“Why does the system not respond to what we do as a family and what we need?”
“My hope is that we’re seeing a potential tipping point … where we see the family as a system; where we see both parents as providers, not just fathers, which means both parents are also protectors, both parents are carers, emotional caregivers.”
But that needs intervention.
“The simple thing” that governments could do, says Fletcher, is screen new fathers for anxiety and depression. “I think that’s a basic fundamental thing.”
TheNHS in the UK introduced screening for fathersby health visitors when their partners had already been identified as having perinatal mental health problems. Baldwin says it is a positive step, but is only part of the solution.
“What we really need is a broader cultural and systemic shift that normalises support for fathers.”
Often when one asks new fathers how they are doing, they are reluctant to identify that they are struggling. Their response, says Fletcher, is: “‘No, look after her.’”
It is a mistake to attribute this to the father’s sense of the need to preserve a stoic masculinity, he argues. “The evidence says that they’re not so much thinking about that they want to be tough and super masculine, but they care for their partner.” They can see that their partner’s needs are most acute. “They’re not thinking, ‘Oh, what about me?’”
This means the need for services which are specifically targeted towards fathers. A recent trial of an app which asked fathers to track their moods and offered cognitive behavioural therapy interventions, developed by Dr Sam Teague at James Cook University, found an improvement in fathers with anxiety, stress and even those with severe depression. Fathers also reported improved relationships with their partners.
Likewise Fletcher, with a team, developed a father-specific mobile-based information support service called SMS4dads which has more than 18,000 fathers signed up. Afeasibility study for the servicein 2019 found that fathers using the app improved their relationship with their baby and partner, and reduced their sense of isolation.
Fletcher and Macdonald say the field of advocates and researchers invested in fatherhood is growing, but efforts to support fathers and their families are still often quite piecemeal.
Macdonald advocates using the universal GP system, and encouraging men in the early stages of fatherhood to attend routine mental and physical health checks – “just full-on dad checks across that period of time”.
“A number of practitioners have told us they don’t feel as confident working with fathers, but once there’s training to do this, they feel very confident,” she says. One program working to skill up health practitioners, including GPs,Men in Mind, has recently been given funding to expand.
Both Macdonald and Fletcher also say restructuring the parental leave system to allow fathers to be primary caregiver for a period is fundamental to the health of fathers and the families they are part of.
Dean Rogut’s son is now a teenager. With the passage of time, Rogut has become able to share his experience. For a few years, around the time of his son’s birthday, tensions would be high in his home, the relationship would struggle. Now, he is a community champion forperinatal mental health service Panda, and even as he trawls through the darkest of his memories, he comes across as confident, open. Things have changed for fathers in the last decade, he says. “We know this happens and there’s more of a spotlight on it,” he says.
What might have been different if he had been viewed as someone who needed help, too?
“I don’t think I would have ended up in hospital, to be honest,” he says. He may have received support before he reached his crisis point. “It’s all those kinds of things that we look back on and think, ‘If only’.”
In Australia, the crisis support serviceLifelineis 13 11 14. ForPanda, call1300 726 306.In the UK and Ireland,Samaritanscan be contacted on freephone 116 123, or emailjo@samaritans.orgorjo@samaritans.ie. In the US, you can call or text theNational Suicide Prevention Lifelineon 988, chat on988lifeline.org, ortext HOMEto 741741 to connect with a crisis counsellor. Other international helplines can be found atbefrienders.org