Abstract
Despite growing recognition of fathers’ influence on infant development, they remain inconsistently integrated into infant mental health (IMH) systems. This paper draws on national impact data from the Home-Start powered Dad Matters service, local evaluation findings from Home-Start HOST in Stockport, and practice-based delivery insights to examine why fathers continue to be engaged late, indirectly, or not at all. It argues that this gap is not primarily caused by fathers’ lack of motivation, but by service design, professional practice, administrative systems, and language that too often position fathers as secondary caregivers rather than parents in their own right.
Nationally, Dad Matters has engaged more than 50,000 fathers, with the 2025–26 data showing 17,249 dads engaged through in-person Dad Matters universal engagement to date, excluding one-to-one referrals. Current outcomes remain strong, with 84% of fathers reporting improved wellbeing and 81% reporting improved parent-infant knowledge. Local evaluation in Stockport highlights both the scale of need, including fathers reporting mental health difficulties, stress, and anxiety, and the value of targeted, relational, father-inclusive support. The paper strengthens the case for father inclusion by connecting service engagement to early relational health, parent-infant attachment, co-parenting, family resilience, and long-term child development.
Pregnancy is presented as a critical but underused window for engaging fathers, when identity formation, reflection, and openness to change are heightened. The paper concludes that integrating fathers into IMH care requires a paradigm shift: from aspirational inclusion to embedded, equity-informed, system-wide father-inclusive practice beginning in the preconception and antenatal periods.
Introduction: The Missing Parent in Infant Mental Health
Infant mental health is fundamentally concerned with early relationships. In practice, however, these relationships have often been conceptualised and operationalised primarily through the mother–infant dyad. While fathers are increasingly acknowledged in policy and research, their integration into services remains inconsistent, indirect, and frequently peripheral.
In many systems, fathers are visible but not centred. They may attend appointments, occasionally appear in records, and be present in family narratives, yet they are rarely engaged directly as parents with their own needs, experiences, strengths, and influence on the developing infant. This creates a disconnect between what is known about the importance of fathers and how perinatal and early years services are designed and delivered.
This paper draws on practice-based evidence from Dad Matters, a Home-Start UK programme focused on improving outcomes for babies by strengthening father–infant relationships in the first 1,001 days. It uses national and local data to explore the gap between evidence and practice, with a focus on father voice, fatherhood identity, relational health, methodological transparency, and equity.
Why Fathers Matter in the Perinatal Period
The evidence base for paternal influence in the perinatal period is well established. Around one in ten fathers experience postnatal depression, with many more experiencing heightened stress and anxiety. Paternal mental health is closely linked to maternal wellbeing, relationship quality, co-parenting, and infant outcomes. When fathers are supported, they report increased parenting confidence, stronger attachment to their babies, and improved relationship stability.
For infants, paternal involvement is associated with improved cognitive development, emotional regulation, social confidence, and reduced behavioural difficulties later in life. These outcomes are not achieved simply by fathers being present in services; they depend on the quality of early relationships and the extent to which fathers are helped to see themselves as active, emotionally available parents.
The Engagement Gap: A Systemic Issue
A central finding across both national and local Dad Matters data is that fathers are typically engaged too late. Dad Matters has demonstrated that it is possible to reach fathers at scale, with more than 50,000 fathers engaged in community settings and nearly 3,000 receiving one-to-one support. However, this engagement often occurs despite existing systems rather than because of them.
Late Engagement
Most fathers’ first meaningful contact with services occurs during pregnancy, often at antenatal appointments or scans. Even then, engagement is inconsistent and frequently indirect. The earliest opportunities to build trust, ask fathers about their wellbeing, and affirm their role as parents are therefore often missed.
Indirect Practice
Fathers are often engaged through mothers rather than as individuals. Language such as “partner” can unintentionally reinforce a secondary role, positioning fathers as supporters of the mother rather than as parents with a direct relationship to the infant. Moving from “partner” to “father,” “co-parent,” or “non-birthing parent,” where appropriate, is not simply a matter of terminology; it changes what professionals notice, ask, record, and prioritise.
Structural and Cultural Barriers
Service design, workforce confidence, appointment structures, data systems, and cultural expectations all contribute to fathers being overlooked. In Stockport, local evaluation highlighted that some fathers felt included, while others wanted better mental health support and more equal recognition from professionals. These barriers are systemic rather than individual: fathers may be absent from referral forms, invited only through mothers, or addressed as accompanying adults rather than as parents.
Fathers’ Voices and Lived Experience
A stronger father-inclusive approach requires more than describing fathers as a group; it requires listening to fathers’ own accounts of becoming parents, encountering services, and trying to be involved. Practice learning from Dad Matters suggests that many fathers want to be active and emotionally present, but do not always know whether services are intended for them. Some report feeling peripheral in appointments, unsure how to raise their own mental health needs, or reluctant to ask for help when professional attention appears focused elsewhere.
Father voice also illustrates the relational value of the model. One father described the importance of sustained contact in simple terms: “Someone is reaching out, building a relationship. We speak weekly and feel close… these thoughts are OK.” This kind of testimony helps demonstrate how father-inclusive support can normalise difficult feelings, build trust, and create a safer route into help-seeking.
Pregnancy as a Critical Window for Fatherhood Identity
Pregnancy is often the first period in which men begin to move psychologically from being an expectant adult to seeing themselves as a father. This identity transition can involve excitement, uncertainty, protectiveness, anxiety, and a growing awareness of responsibility. For some men, particularly those who did not experience positive fathering themselves, this period may also raise questions about what kind of father they want to become.
From an infant mental health perspective, this transition matters because paternal identity influences caregiving, sensitivity, help-seeking, and attachment. When services address fathers directly during pregnancy, they can support men to imagine themselves in relation to the baby, reflect on their own wellbeing, and develop confidence in early caregiving. Even brief relational interactions—being named, asked about, and included—can signal that fathers are part of the infant’s relational world from the beginning.
From Service Engagement to Early Relational Health
Engaging fathers is not the ultimate aim; it is the route through which services can strengthen early relational health. Father-inclusive practice matters because it can improve the quality of parent-infant relationships, support emotional regulation, strengthen co-parenting, and increase family resilience. When fathers feel recognised and supported, they are more likely to engage in sensitive interaction, seek help earlier, and participate confidently in caregiving routines.
Dad Matters outcomes should therefore be understood not only as evidence of successful service reach, but as indicators of relational change. Improvements in fathers’ mental health and knowledge of bonding and attachment are meaningful because they affect the emotional conditions in which babies develop. This connects programme outcomes directly to core IMH concepts: attachment, regulation, relational safety, and the infant’s experience of being held in a responsive caregiving network.
The Dad Matters Model: A Practice-Based Response
Dad Matters provides a practical example of how fathers can be integrated into IMH systems through intentional design and delivery. The model combines universal outreach, one-to-one peer support, and professional engagement. Universal outreach creates visible, low-pressure opportunities for fathers to connect and learn. One-to-one peer support offers relational, tailored support for fathers who need more sustained help. Professional engagement builds confidence across the wider system so that father inclusion is not dependent on individual champions alone.
National Impact 2017–2026
- More than 50,000 fathers engaged since 2017
- Nearly 3,000 new referrals for one-to-one peer support since 2017
- 17,249 dads engaged through in-person Dad Matters contacts in 2025–26 to date, excluding one-to-one referrals
- 2025–26 reach includes 12,442 dads in universal settings, 2,134 through targeted activities, 1,515 through perinatal and infant mental health routes, 1,096 through NICU/neonatal settings, and 62 through rainbow or bereavement clinic engagements
- 889 new one-to-one referrals in 2025–26, with 171 declined and 124 closed due to no engagement
- Demographic monitoring indicates that in 2025–26, 14% of engaged fathers were from ethnic minority backgrounds, 19% had SEND, and 26% were under 20 years old
- 84% of fathers reported improved wellbeing
- 81% reported improved parent-infant knowledge
- The 2025–26 figures are interim programme monitoring data to date and exclude one-to-one referrals unless stated.
Local Delivery: Stockport Case Study
The Stockport evaluation provides insight into implementation within a Family Hubs context. The project aimed to reach 600–800 fathers in universal settings and support 50–60 through one-to-one work, and it surpassed those targets. It also focused on multi-agency training, peer support pathways, and targeted engagement in areas of disadvantage. Local data highlighted need and impact, including fathers reporting mental health difficulties, stress, anxiety, and limited prior help-seeking.
Evidence, Methods, and Limitations
The data presented in this paper are drawn from programme monitoring, local evaluation, and practice-based learning. Much of the reported impact relies on fathers’ self-reported outcomes following engagement with Dad Matters. These data are valuable because they reflect fathers’ own perceptions of change, particularly in relation to wellbeing, confidence, and understanding of bonding and attachment. However, they should be interpreted with appropriate caution.
Limitations include variation in local data collection processes, challenges collecting sensitive information without undermining trust, and the absence of independent assessment for some outcomes. The paper therefore presents Dad Matters as practice-based evidence of promising impact rather than as a controlled evaluation. Further research could strengthen the evidence base by examining longer-term outcomes for fathers, infants, co-parents, and service systems.
Future Developments in Evaluation
A future priority is to strengthen the evidence base through a planned full system evaluation in partnership with ECORYS. This evaluation will move beyond service reach and self-reported experience alone to examine impact across fathers, infants, families, and wider service systems. It will use validated tools to measure changes in paternal wellbeing, including the Patient Health Questionnaire (PHQ) and Generalised Anxiety Disorder (GAD) measures, alongside assessment of the parent-infant relationship before and after birth.
The evaluation will also assess parenting confidence, goal-based outcomes, and value for money. This will help Dad Matters demonstrate not only whether fathers report positive change, but how father-inclusive practice contributes to relational health, early intervention, system integration, and the efficient use of resources. Building this evaluation framework into future delivery will provide a stronger foundation for scaling father-inclusive IMH practice and embedding it within mainstream perinatal and early years systems.
Fathers Experiencing Adversity and an Equity Lens
Father exclusion is an equity issue as well as a service design issue. Fathers experiencing poverty, trauma, racism, migration, insecure housing, poor mental health, or social isolation may face additional barriers to being recognised and supported. Some may also have had negative prior experiences of services, making trust-building particularly important.
An equity-informed approach requires services to ask which fathers are missing, whose needs are least visible, and which administrative or cultural assumptions make father engagement harder. This includes examining referral forms, appointment times, digital access, workforce confidence, recording systems, and the language used in service pathways. Father inclusion should therefore be understood not as an optional enhancement but as part of fair, relational, whole-family practice.
Implications for Infant Mental Health Systems
The findings from Dad Matters point to five implications for IMH systems.
- First, language should recognise fathers and co-parents as parents in their own right.
- Second, engagement should begin as early as possible, ideally during the preconception and antenatal periods, and include an element of learning and resources.
- Third, services should be designed with fathers in mind, including accessible entry points, flexible delivery, community-based support, and direct attention to parent-infant relationships.
- Fourth, professionals need training, confidence, and reflective support to engage fathers effectively.
- Fifth, father-specific pathways should be embedded within mainstream systems rather than developed as peripheral or short-term additions.
Conclusion: Towards a Paradigm Shift
The integration of fathers into infant mental health care is not a new idea, but it remains unrealised in many systems. The evidence and practice learning presented in this paper suggest that the issue is not fathers’ lack of interest or engagement, but the way services are designed and delivered. When fathers are engaged early, directly, relationally, and equitably, outcomes can improve across the family system.
This requires a shift from viewing father inclusion as an optional or additional element to recognising it as a core component of effective IMH practice. If infant mental health is truly about early relationships, then fathers must be present in the system from the start—not as partners on the margins, but as parents who shape the relational world of the infant.
The paper offers a practice-based model for translating father-inclusive principles into IMH service design, workforce development, and evaluation.
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Authors
Kieran Anders,
Home-Start UK,
United Kingdom
