Why is infant mental health so important?
Gavin Moorghen, professional officer, British Association of Social Workers: Infant mental health is an essential aspect of human growth and development and there should be recognition that mental health needs are present from conception and through to adulthood. Children are born needing love, attention and consistency, and without those components even the youngest of children may suffer poor emotional wellbeing.
Julia Brown, co-founder, the FASD Trust: The brain grows during the first two years of life at a tremendous rate – at the age of two, 80% of the brain has developed – and so those early years are critical. It is a unique, special time when so many emotional responses are learnt and, if it goes wrong, we spend the next 20 years trying to correct.
Matt Forde, head of service for Scotland, NSPCC: The more severe the adversity faced in infancy and childhood, the more serious are the risks across childhood and into adulthood. Informed by this understanding, infant mental health seeks to improve parent-child relationships and enable nurturing care. Often this can mean working with parents to deal with the unresolved consequences of their own experiences of trauma, abuse and neglect, and to develop the capacity to be attuned to their child’s needs.
Is enough attention paid to young children’s mental health: are there enough services and funding?
Jane Barlow, president of the Association for Infant Mental Health (UK): I think the withdrawal of funding from key services over the past five years has significantly affected the ability of key practitioners such as midwives and health visitors to provide the preventive services that are so important to promoting infant mental health. Many local authorities are also closing down children’s centres as a result of funding problems, which was a key place for families with babies and young children to receive services. The long-term consequences of these funding cuts will begin to emerge over the next five to 10 years.
Alice Cook, independent family assessment practitioner and PhD student at Royal Holloway University: In my experience, there are pockets of brilliant services which therefore results in a postcode lottery for those families who need to access them. There is an issue when it comes to implementing the large knowledge base we now have in relation to what are effective interventions.
Maria Kane, representative from the Cavendish Square Group of NHS trusts and chief executive of Barnet, Enfield and Haringey NHS mental health trusts: There has not been nearly enough focus on infant mental health to date. Interestingly, now that the financial challenges of the NHS are so evident, more focus is being put on perinatal services because of the enormous opportunities to save costs in the long term if we intervene as early as possible in a child’s development. Sufficient funding for identifying and treating maternal depression and anxiety in the perinatal period will have enormous return on investment for the NHS and social services.
Are children’s emotional and attachment needs forgotten when care decisions are made?
Susannah Bowyer, research and development manager, Research in Practice: I don’t think they are forgotten, but they can and do certainly get lost in competing priorities, changes in policy and case law. We explored practice in the family courts in a number of “deep dive” projects for the Department for Education in 2015. In the course of these, we observed a wide range of practice, including:
- Thoughtful and focused practice at pre-proceedings stage, supported by good use of family group conferencing as a means to link in with wider family support.
- Decisions for placement that were causing a good deal of anxiety, and were accompanied by changing use of court orders which suggested that no one involved was confident that the placement was a safe and permanent home for the child concerned.
- The lack of therapeutic support, both post-adoption and for other carers such as special guardians. Support is required sometimes years down the line from a family court decision, as issues may emerge much later in a child’s life.
Sheena Webb, consultant clinical psychologist and service manager for the London Family Drug and Alcohol Court: Court reports will often pay heed to the benefits of children growing up with birth parents, and will often acknowledge a good quality of relationship between parent and child. Nonetheless, when this is presented alongside issues of risk, the concern over risk usually prevails – in some cases rightly so. However, often the risk analysis, particularly for infants of mothers who have had previous children removed, is based upon mainly historical risk factors. It becomes impossible for the parent to demonstrate enough change to mitigate the history, no matter how good a bond they are forming with their baby.
More and more I think local authorities are trying to offer parents a chance to access the help they need and to demonstrate change, but we need to increase the confidence with which we can measure that change and demonstrate its sustainability to the courts. Risk assessment needs to be multidimensional and dynamic, and needs to seriously consider the emotional and attachment impact [on the child] of losing their biological mother or father.
Clea Barry, practice supervisor (public law), Cafcass: Social workers and guardians have a lot of expertise around promoting attachment for children in care and managing risk. Once matters get to court, it becomes harder to talk about promoting change because of the competing need to avoid delay. The answers are, first, that more work should be done earlier on to prevent the need for proceedings; and, second, in ensuring that court assessments are tightly focused and combine a therapeutic approach towards parents with a focus on assessing and managing risk.
What can be done to support mothers with mental health difficulties in the perinatal period?
Jane Barlow: The key issue is to encourage women to access whatever services are available, because there is still stigma attached to issue of mental health problems such as depression and many women worry that if they disclose such concerns they will be at risk of having their baby removed.
Julia Brown: We were involved in some work around understanding why midwives did not want to ask women about their alcohol consumption in pregnancy. The main answer we uncovered was that midwives did not know to whom and where to refer pregnant women with an alcohol issue for further help and support. There was a reluctance to “open a can of worms” with no “worm catchers” around. Therefore, if we have clear pathways, midwives (and others) then feel empowered and confident to ask questions because they know they can offer appropriate help and support in return.
Karen Broadhurst, professor of social work, Lancaster University: When we think about the collateral consequences of child removal, this not only relates to the huge emotional trauma of removal of, typically, infants, but also the very real practical hurdles that follow such things as loss of housing, welfare entitlements and immediate “exclusion” from everyday informal networks. In addition, there can be very real restrictions on kin relationships, where contact is restricted because infants are placed in extended families. So, we need to grasp the enormity of child removal for birth parents.
This debate is about infant mental health, but as children grow up in substitute care, the wellbeing of their parents is a key consideration for them – particularly where infants remain in kin care. This isn’t an argument against kin placements, nor safeguarding infants from harm through removal, but it is an argument in favour of continued help for birth parents for all concerned, as this is in everyone’s interest.
David Shemmings, co-director of the Centre for Child Protection at the University of Kent: What we need to be observant and vigilant about are the signs of “toxic” trauma in childhood. We need to be able to identify it quickly and as accurately as possible and then, if they are its primary cause, to help family members prevent or stop its occurrence. One way to do that is to change their relationship with their child, so that they become more nurturing, as well as provide sensitive discipline.
There is growing evidence that epistemic trust is pivotal in promoting lasting change. This means that the person needs to feel, believe and know that someone understands them.
We need to make sure that policies and practices avoid blaming parents, because there is strong evidence that the quality of relationships between professionals and families is a key variable involved in promoting lasting change.
The longer we leave things, the more difficult it is to change things because the wiring becomes more “hardened”.
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