A stay on a psychiatric ward wasn’t part of the plan! Hang on: A stay on a psychiatric ward wasn’t part of the plan! Dr Anna Wroblewska Consultant Clinical Psychologist Lothian Perinatal Mental Health Service MMHS18

Maternal Mental Illness 4 stages in recovery. Recognising the problem. Seeking and accepting help. Achieving recovery. Maintaining recovery. Family involvement aids all of these stages. Proximity of the baby is central in achieving and maintaining recovery.

Research and recognition is gathering momentum. Fathers? Research and recognition is gathering momentum. Transition to fatherhood involves helplessness, uncertainty and separation. Fathers have different experiences and therefore different needs. Because mothers seek support first and foremost from there partner his wellbeing is integral to the whole family unit and so should be explored.

Fathers? What do we know so far? Fathers make a positive contribution towards recovery especially if he is seen as and described as ‘supportive’. Studies identify 42-50% of fathers meet the diagnostic criteria for psychiatric disorder at the same time. Research is beginning in the MBU setting. (Marrs, Reid)

Keeping the family together and bonding (Marrs et al 2014) Aims: Impact of admission on role and relationships in the family. Qualitative semi structured interviews. 8 participants. Grounded theory.

Managing the self and other relationships Bonding with the baby Keeping the family together Feeling overwhelmed Experiencing and managing uncertainty Feeling contained

Bonding with the baby Bonding with the baby Father needing to bond Feeling left out Making time for siblings to bond A fleeting figure Importance of mother being with the baby

Keeping the family together Trying to be normal Adjusting to the couple relationship Relying on support from family and friends Relationships under pressure

Feeling contained Feeling contained Relief of admission holding care Appreciating expertise Welcoming but not quite home Mixed emotions on discharge

Feeling overwhelmed Feeling overwhelmed Experiencing anxiety and stress Feeling watched Travel and work pressures Life turned upside down

Experiencing and managing uncertainty Taking each day as it comes Understanding illness Communicating with staff Understanding treatment

Clinical implications Fathers experience uncertainty and anxiety. To enable fathers to optimally support their partner it is essential fathers develop an understanding of the illness, treatment and what he can do to facilitate recovery. Recognition of what hinders communication with fathers. Attachment style. Personality. Confidence in talking to professionals. Increase communication between professionals and fathers. Inclusion in meetings, one to one’s, hard copy information.

Experiences of Fathers at the Mother and Baby Unit (Reid et al 2016) Aims: His experience and its impact upon relationships. His view of MBU services. His experience of the involvement of Child and family services. One to one semi structured interviews. 17 fathers. Thematic analysis.

Theme 1: The Double whammy Coming to terms with mother’s illness Coming to terms with fatherhood

Theme 2: Understanding the admission and Illness Partners change Information Future expectations of family life and recovery

Theme 3: Support for fathers Partner and baby Family and friends MBU Children and family services.

Theme 4: Personal Stressors and coping Work/life balance Own health and self care Other children

Conclusions Overlaps in the themes identified by both studies. The experience of the father. Simultaneous challenges of illness, baby, giving and receiving support, work and roles. Overall the care of the MBU is viewed as positive. Knowledge, understanding and communication could be improved How do you best tailor support for the father and from whom?

Information for fathers. Regular information sharing and updates. Implications Information for fathers. Regular information sharing and updates. Suitable interventions. Psychosocial support for fathers. What would be best in an MBU setting? What would be best in a community team setting? How can we best engage fathers? What are the barriers and facilitators?

Thank you!