Time of transition

Dr. Andrew Howlett is helping men overcome barriers to treating mental illness

By Suzanne Rent

Dr. Andrew Howlett was finishing his psychiatry residency in Toronto when he started hearing stories about the problematic relationships between fathers and their children. “And that was contributing to the kids and their behavioural issues,” he says. 

After researching, Howlett also discovered fathers found it hard to address or get treatment for their own mental-health issues. Rigid work schedules, medical offices that are unwelcoming to dads, as well as healthcare professionals who solely dealt with moms are just a few of the barriers Howlett noticed. 

He started to look for ways to engage men in the discussion, looking at treatments for mothers suffering from post-partum depression and realizing fathers were at a crucial transition stage as well.

Howlett, who is from Lower Sackville, developed the Fathers Mental Health Research Network in Toronto. He says when a man is about to become a father he’s more connected with the health-care system than ever before. 

“They may not want the treatment themselves, but if they think it will have a positive effect on their child’s development and health, then they may be more inclined,” he says.  

Our Children recently spoke with Dr. Howlett about his work, what prevents fathers from seeking help, and what families can do together.

Are there any gender stereotypes that prevent men from seeking help?

“Strong and silent” is the term I use … [An unwillingness] to be emotional or vulnerable, to talk about our feelings. I would say one of the other kinds of big stereotypes is that we see men cope with stress by behavioural issues such as drinking alcohol or being aggressive. But one of the things I say men do is when they are feeling stressed or depressed is isolate themselves and they socially withdraw. And I see that as a significant tactic that is often overlooked. There is a considerable withdrawal from the family, disengaging as a partner and parent, but also social isolation from friends and certainly an absence of looking for help.

How can mothers and families support fathers struggling with mental illness? 

I think one is being aware this transition is as tough a time for dads as it is for moms. I think dads often want to ensure the baby is looked after, the mom is looked after, but they too also have their own needs, emotional needs, they often neglect. But they inevitably come out in ways of feeling anger or resentment, that kind of thing. I think it’s great if partners and family members can come and check in, even with dads and see how they are doing. It’s really important from the beginning to encourage dads to feel comfortable and confident in their roles as parents. I think that happens by involving dads, enquiring how they’d like to do things, giving them alone time with the child. Trying to encourage them to talk about their experience with other new dads, ideally friends within their social network. That can be challenging at times if dad is around a lot of bachelor friends. Moms get a lot of support on what’s expected from them, socially and from family. Many of them have these mommy groups. Many of the blogs and books are written as if the mom is the primary reader. And if that is the case; moms are more likely to go to the books and read the blogs. It’s more difficult to find material that will be of interest and a take up for dads. 

Besides pregnancy, are there other family transitions that might be triggers for mental health issues for dads?

A pregnancy loss is a risk factor for a dad to develop post-partum depression in a subsequent pregnancy. I don’t know much on the literature around dealing with a child with a medical illness or an intellectual disability, but certainly when there is stress on the child’s health, I know there is difficulty for the moms and dads, to some degree. Things like separation and divorce certainly can be triggers.

Why did you want to start your program?

I saw a real, unique opportunity to provide service to men and particularly fathers to create something that will invite and engage men. I also wanted to take the opportunity to provide education around the importance of a father’s role in a child’s life. I think it’s under appreciated overall, the unique and positive impact dads can play on their kids’ lives. There is certainly more opportunity to begin to explore that and begin to engage dads in that.

Are the treatments different for men than they are for women?

The treatment can be pretty standard. What’s unique about it is this is an opportunity to provide access to services. I think it’s important to appreciate the relationship the dad is in and how that is affecting their depression. IPT, interpersonal psychotherapy, is therapy designed for depression and now it’s the gold standard in post-partum depression for women. I think that can be equally adopted for depression in dads. Its focus is on role transition such as becoming a father, or interpersonal conflict such as difficulties with the relationships. That is something that will become more tailored over time seeing IPT as a therapy for dads.

How can parents together be aware of these issues before the baby comes along?

I do think that preparation is key. I think there are some ways to become more informed. One is attending any pre-natal or parenting classes together. I would talk openly about the transition of becoming parents and how that will affect their current lifestyle and how they will manage that first year. I would reflect on the fact that the parents together have a whole new relationship. It’s sort of a co-parenting relationship to their child. Ideally, a disruption in the relationship won’t disrupt the co-parenting relationship, but it’s important to be mindful and separate the two. Often the partnership feels like it gets lost as the focus becomes co-parenting and that can be disruptive for both most men and women.

Where can people find more information?

The Canadian Father Involvement Initiative, that’s a national fatherhood association that’s kind of designed to make organizations and community associations more father friendly. That is one place that is helping to educate and bring forward information about the role of dads. Birthing centres all have programs tailored to moms, but would welcome dads’ participation without question. I think people can reach out to their family doctor and sort of identify themselves as someone who is going to become a dad and look at ways to optimize both their [physical] health and their mental health. I would invite dads to participate in all their child’s care, including immunizations and some checkups and become informed that way. 

Do you think practitioners are becoming more aware of a father’s mental health?

Slowly. There are times when I’ve made presentations and people say, “Wow, the entire time we are thinking about mom and not looking at how this is affecting dad.” So I think there is still a lot of capacity building to be done. I think dads could identify themselves and have a family doctor appointment. But it would be great for family doctors to screen dads. There are forms where mom could fill out the depression screen on behalf of her husband as well.

What is the most surprising thing you’ve learned?

One, that being isolated as a new dad, feeling unsupported by your partner, and not having anyone to go to is a common theme. I also recognized when there is a new family, if you asked about their upbringing you appreciate the family narrative repeats itself from one generation to the next. Also, that most surprisingly the fathers I’ve worked with have followed through with the program and have attended the follow-up appointments and have been really engaged in the psychotherapy and the treatment plan. I’ve been very impressed by the response to the service and feel generally quite more hopeful with each family I work with.   

Learn more about Dr. Howlett and his work at the Fathers Mental Health Network: fathersmentalhealth.com. 

For more information on the Canadian Father Involvement Initiative, visit dadcentral.ca.  

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