Good mental health starts in early years

21 Apr 2022 Ryan Miller    Last updated: 21 Apr 2022

Photo by Robert on Unsplash
Photo by Robert on Unsplash

If interventions are better early rather than late, then perhaps it makes sense to make them as soon as possible.

 

The health service is crumbling. The plans to save it are made up of a handful of key strands.

Some of these are about, for want of a better term, business efficiency. Rationalisation of specialist services to allow expert clinicians to work together more effectively. Recurrent, multi-year budgets and the end of hand-to-mouth funding.

Some are more aspirational. People living healthy lives, for as long as possible. The home as the hub of all care. Independence, in general.

And the fact that prevention is better than a cure - and that the earlier any intervention takes place, the better.

Infant mental health is a great example of this. Mental health has momentum. Good mental health is more likely to lead to further good mental health. The same is true for poor mental health.

Northern Ireland has terrible mental health outcomes, for both adults and children. Trying to boost people’s mental health earlier in life could help address this, and chimes well with the direction the health service intends to take.

The Stronger from the Start Alliance is a collaboration between the Association for Infant Mental Health Northern Ireland (AIMH NI) and dozens of organisations from across the community & voluntary sector in Northern Ireland.

It recently published its manifesto ahead of the Assembly elections, calling for better services for the very youngest children.

Early years

What is infant mental health?

Toddlers are individuals, just like everyone else, but a two-year-old is socially and psychologically from an older child, teenager or adult.

The manifesto explains it thus: “Infant mental health describes the social and emotional wellbeing and development of children in the earliest years of life. It reflects whether children have the secure, responsive relationships that they need to thrive.”

It says that the relationships children build in their early years are fundamental to them developing and maintaining good mental health and that “sensitive, responsive” adults can help them learn to bring their emotions under control – and that parents’ responses shape how babies even experience their emotions.

The paper says that poverty “amplifies the negative effects of all types of stress” and that this can affect the care a child receives, and perhaps make it more inconsistent or harsh. This has long-term effects.

“Poverty, the associated parental stress and poor parent-child relationships have a negative impact on the child’s future cognitive abilities, behaviour and health.”

The manifesto’s central point is that by improving infant mental health, and making parent-infant relationships stronger, children will have better emotional and social development in their first five or so years - and the benefits of this can carry on, or even aggregate, throughout the rest of their lives.

Services

The Stronger from the Start Alliance says it was established in response to the draft Mental Health Strategy for Northern Ireland issued for consultation in 2021.

Campaigners felt it lacked actions, and measurable outcomes, directly related to mental health and so lobbied for change.

When the ten-year Mental Health Strategy was published in June last year, it had addressed that issue, to a point. The final strategy does discuss infant mental health, saying early years’ needs should be addressed by appropriate services and that in general children aged 0-3 have not been able to find help in Child and Adolescent Mental Health Services (CAMHS).

However, the strategy does not outline any detailed proposals or specific changes.

According to the Alliance: “We campaigned for, and welcome the explicit inclusion of infants within the Mental Health Strategy for Northern Ireland 2021-2031, particularly those actions specific to promoting and improving mental health. However, actions and resources beyond those committed to in the Strategy will be required if every infant and family in Northern Ireland are to enjoy the best start in life.”

Politics

Despite the fact this campaign is calling for significant reforms and improvements to services – something which can be at odds with politicians and policymakers – it is unlikely they will have to change too many minds. In fact, the previous (and possibly future) Health Minister probably agrees with them.

Robin Swann is no longer in post, as this is election season and so the Executive is dissolved, but he has been quite clear that child mental health services have not been up to scratch.

In a written answer to an Assembly question published last month, he said: “It is widely recognised that Child and Adolescent Mental Health Service (CAMHS) has faced significant pressures in recent years as a result of increased demand for services and resource constraints. These issues have been further exacerbated by the COVID-19 pandemic, which has continued to negatively impact young people’s health and wellbeing.

“My Department continues to work collaboratively with the Health and Social Care Board and the HSC Trusts to manage the pressures on CAMHS and to put in place measures to increase capacity and improve performance. This includes a formal review of waiting lists on a weekly basis, ongoing recruitment campaigns, providing initial assessments via telephone, zoom or face to face, and exploring greater involvement of the community and voluntary sector.”

He has even acknowledged the need to weave support for infant mental health into CAMHS, and said he plans to hike the CAMHS budget so it gets 10% of the overall mental health pot.

Asks

The Stronger from the Start Alliance’s manifesto has four main policy asks.

It wants health leaders to demonstrate a clear commitment to improving infant mental health, including the following actions:

  • Investment in infant mental health, including an increase to the Mental Health Strategy 2021-31 funding allocation of 34%, as campaigned for by the Mental Health Champion and mental health charities. This will ensure full delivery of the commitments made to infants and their families.
  • Ensure a multidisciplinary, cross-departmental approach to prioritise and improve infant mental health. This should include joined-up planning, commissioning, delivery and review processes, which are co-designed/co-produced in partnership with the voluntary & community sectors and with families.

More and better data should be retained and collated on infant mental health, and this data should be used to direct future policy. Specific actions should include:

  • Invest in research programmes to understand infant mental health needs, experiences and risk/protective factors.
  • Identify appropriate measures and implement data collection and sharing processes to inform and improve infant mental health service planning and delivery.

Service infrastructure should be put in place that can meet existing need. Actions should include:

  • Develop and resource a regional model for infant mental health, to ensure there is a range of universal, targeted and specialist support available with pathways of care that enable families to receive the right care at the right time to meet their needs.
  • Support services to be accessible and effective. This includes ensuring services are locally available, high-quality, culturally-appropriate, evidence and trauma-informed and relationship focused.

A skilled multi-disciplinary workforce should be created and maintained, with sufficient capacity to deliver services. Actions should include:

  • Develop and fund an infant & early childhood workforce strategy to ensure sufficient professionals with appropriate knowledge and skills across maternity, early childhood, family support and mental health services. This strategy should cover pathways, pre-qualification training and continuing professional development.
  • Enable effective collaboration with, and resourcing of, the community & voluntary sector as workforce partners in infant mental health

These requests are likely to be politically uncontroversial. However, for them to be put in place, Northern Ireland needs a government. That will be decided after election day.

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