Despite increasing attention on children and young people's mental health, there is an ongoing ‘baby blind spot’ in mental health services and also in wider public policies that is leading to gaps in their treatment and care.
‘Professionals across different services can have very different levels of understanding about early child development and mental health,’ explains Sally Hogg, senior policy fellow at the University of Cambridge's Centre for Research on Play in Education, Development and Learning (PEDAL). ‘Gaps in understanding make it less likely that babies’ and young children's needs are identified, and that they get appropriate, timely support. The language used around mental health also differs across services, which can make it harder to work together to understand and respond to a young child's needs.
‘Delivering mental health services for babies and young children is very different to working witholder children. It requires an understanding of early child development; the ability to work appropriately with pre-verbal children; and the ability to work with parents, children and their relationships simultaneously. Because there is a lack of this specialist expertise, it is less likely that babies and young children will get mental health services that meet their needs.’
PEDAL and UNICEF UK have developed a toolkit to support local areas in developing a deeper, shared understanding of mental health in infancy and early childhood. It includes a multi-agency checklist (see box) to help practitioners consider the skills and capacities of their workforce or the services available to them locally.
They found that the baby blind spot in mental health services and systems exists for a number of reasons, including those mentioned above, plus:
There are gaps in professional training, even for those working in mental health services. Both pre-qualification and post-qualification training programmes are more likely to focus on the needs of school-aged children and to overlook the specific needs of babies and young children. For example, a 2021 survey of NHS mental health professionals found that 48 per cent had not worked with birth to twos in their training.
When commissioners and service providers are under pressure, the more obvious and well-understood needs of older children and young people can be prioritised above the needs of babies and young children.
UNICEF UK's research last year showed that 59 per cent of parents of birth to fours say they struggled with their mental health while being a parent, and a recent Maternal Mental Health Alliance report shows there are still regional inequalities in access to support.
UNDERLYING FACTORS
‘Traditional conceptions of mental health generally do not work well for this age group,’ says Joanna Moody, senior policy advisor – child mental health and wellbeing at UNICEF UK. ‘Before we can understand babies’ and young children's mental health, we need to challenge stereotypical views about what mental health and “mental health” support looks like.
‘For example, mental health is often mistaken to mean diagnosable disorders rather than a positive state of health. Mental health services also typically work with individuals based on a problem or diagnosis. Responding to babies’ and young children's mental health needs a different approach. These children require services and support that can act on the basis of an accumulation of risk factors, significant adversity, or signs of significant stress and distress, rather than clinical diagnoses.’
When working with younger children, professionals also need to recognise that mental health needs present themselves differently. ‘Babies and very young children are non-verbal or lack the language and understanding to describe their thoughts and feelings using words. Therefore, professionals need to understand child development, and to be attuned to babies’ cues, and to what young children's behaviours communicate about their mental health needs,’ says Hogg.
‘All babies and young children struggle to manage their emotions and exhibit behaviours that challenge at times. Some young children may show emotional or behavioural problems that are more extreme, persistent across different contexts, cause more significant distress and/or stop children being able to play, interact and learn. These significant and persistent issues should prompt professionals to be curious about what is happening for a child and to investigate further to understand their development, their relationships, and their experiences.’
Hogg warns that the same external behaviours might indicate different underlying factors in different babies or young children. ‘While some problems may be the result of a child's biology or a developmental condition, others might be an adaptive response to situational factors such as problems in early relationships, or significant stress in the family home,’ she says. Regular contact with children and a ‘holistic’ understanding of the child are important if problems are to be effectively addressed, she adds.
MULTI-AGENCY WORKING
The toolkit highlights that some professionals might not understand the vital role of relationships in early childhood mental health. This could mean that problems in children's behaviour and development are not seen through a relational lens, and opportunities to strengthen and repair early parent-child relationships are missed. For example, in the case of a child in an early years setting who regularly struggles with managing their emotions and is aggressive towards other children, the setting can put strategies in place to help the child to manage and communicate their emotions and regulate their behaviour. But unless professionals across services work together to understand a child's home environment and relationships with their parents or primary caregivers, they may miss other vital elements which will help to understand and manage the child's behaviour, and to protect and promote their mental health.
‘Multi-agency working can help services to identify children whose mental health is at risk and to offer appropriate support,’ says Moody. ‘Understanding cumulative risk can often only happen if a number of different services, with different insights into a family's life, work together and share information.’
Workforce self-assessment checklist
Use a simple RAG (Red-Amber-Green) rating, to summarise your workforce's capabilities (edited version):
- Understand child development from pregnancy to age five.
- Understand how to meet the needs of children with SEND.
- Have the knowledge and ability to implement evidence-based strategies or practices to promote babies’ and young children's mental health.
- Have the knowledge, skills and opportunities to ‘tune in’ to young children's cues.
- Understand the importance of parent-child relationships.
- Have the knowledge and skills to observe the quality of parent-child relationships and identify concerns.
- Have the ability to practise in a relationships-informed and trauma-informed way.
- Understand and signpost other services available to local parents.
- Reflect with colleagues on why a child is displaying emotional problems, and how to respond.
- Have reflective supervision.
- Learn together with other professionals in the local area.
FURTHER INFORMATION
- Understanding and Supporting Mental Health in Infancy and Early Childhood toolkit: https://bit.ly/3XdjWSf
- Early Moments Matter report: https://bit.ly/460FS7b
- Maternal Mental Health Alliance report: https://bit.ly/4603Xej
- Early Moments Matter campaign: https://bit.ly/3X5cWXu
