The emotional well-being of the under-fives age group is being overlooked by many child mental health specialists, although research evidence supports early intervention, according to a report by the charity Young Minds.
Its policy document, Mental Heath in Infancy, warns, 'Failure to identify the need for support may result in poor educational achievement, anti-social behaviours such as criminality and substance abuse, and adult mental health problems. All this is very costly for the individual and for society at large.'
A key barrier to progress is a 'general lack of awareness that many mental health problems may have their origins in early childhood, or even babyhood, and are linked to the emerging relationship and bonding between the child and the mother or primary carer.'
Gabrielle Crockatt, consultant child psychotherapist and co-ordinator of the Parkside Clinic in north Kensington, London, says, 'I think babies can be totally overlooked. Babies are very affected by family environment, particularly their mother's mental state, and it can be that the mother is too upset or preoccupied to notice that the baby is being affected.'
'The real problems will only show up later,' says consultant child psychotherapist Robin Balbernie. 'You can how see a baby who has been poorly treated is an aggressive toddler, and aggressive toddlers progress to become aggressive teenagers.'
But he adds, 'There is no such thing as a bad parent. Every mum or dad wants to do the best they can, but if you have been abused yourself, or were brought up in care, that is where you learned your parenting.
Parenting classes should be for toddlers. You learn your parenting in the first two years of life.'
While babies do not exhibit classic symptoms of mental illness and disorder, they demonstrate that they feel anxious, tense, distressed or fearful through poor sleep patterns, difficulties with feeding, restlessness and gastric disturbance, according to the Young Minds report.
Multi-agency services
'Children have problems because of difficulties with attachment,' says Dinah Morley, acting director of Young Minds. 'We know that if a child attaches poorly and their brain doesn't wire up optimally, it provides the root to poor mental health. If the child doesn't respond properly or learns a set of responses that are antisocial it may switch off, become dissociative or depressed.'
She says an insecure attachment by itself is not necessarily a disorder but makes a child more vulnerable to life's events, such as bereavement.
The report calls for the establishment of multi-agency, multi-disciplinary infant mental health teams of professionals from the local Child and Adolescent Mental Health Services (CAMHS), healthcare services - particularly health visitors, public health nurses and GPs - plus practitioners from social services, and early years services, including Sure Start.
The drive to keep waiting lists down means referrals for babies and toddlers, who may show few overt symptoms, can easily be rejected.
Children's psychiatrists and other CAMHS specialists often have little training in working with infants, while adults' psychiatrists tend to focus on parents in isolation from their families.
But early years consultant Jennie Lindon questions whether we need new teams. 'Instead of setting up infant mental health teams in every area, maybe we need to look at bringing together what is already there,' she says. 'Why do we need a whole new kind of development? Haven't we have had enough new initiatives?
'We need to acknowledge and understand what the different professional groups are doing now. We need to value and acknowledge the work of others and if something works in one area, we should share it with others.'
Money matters
Although funding for CAMHS has risen with additional allocations from local authorities, and it increases year on year from the Department of Health, the Young Minds report points to a significant gap between needs and resources.
'Specialist teams would be great,' says Gabrielle Crockatt. 'But where does the money come from?' She believes that some funding for infant mental health work should come from the budgets for adult services, since the parents' emotional well-being is so pivotal to the baby, and money spent on interventions early in life could lead to reduced demand for services in later years.
The report also argues that the situation is not helped by the 'ongoing separation at Government level of the services which need to combine' to make an effective infant mental health service.
In particular, practitioners think that overworked health visitors need more support. 'Health visitors are the most important people in specialist multi-disciplinary teams, as they are in position to pick up and refer,'
says Robin Balbernie.
The Parkside Clinic has written to the local health visitor manager about the number of vacancies. 'We said that the health visitors are in the front line and what they do has such an enormous impact on mothers and their babies,' says Gabrielle Crockatt. 'Some of our health visitors have 600 mothers on their casebooks. They can't deal with that size of workload properly.'
Identifying need
The Sure Start collaborative model of linking different services, which has done so much to transform family support and intervention in some of the most deprived parts of the country, is tackling infant mental health, but only where the need is recognised.
'Sure Start responds to local need, which is its great strength and a fault,' says Robin Balbernie. 'Unless somebody locally is prepared to push hard, services like this won't appear. Sure Start is led by local demand.
If local demand doesn't know what its needs are, then services like this do not get supported. You can go to a meeting and say "what do you want with all this money?" and they will say "disco equipment".'
Gabrielle Crockatt recalls that the two Sure Start areas near the Parkside Clinic did not initially want to involve the clinic. 'It was said that the mothers did not need these services,' she says. 'But of course, those who need these services do not go to meetings. They are, by definition, at home, crying.'
Further information
* Young Minds policy document: Mental Health in Infancy available on www.
youngminds.org.uk.
* An Infant Mental Health Service: The Importance of Early Years and Evidence-Based Practice by Robin Balbernie, available at the Association for Infant Mental Health website: www.aimh.org.uk.
CASE STUDY: LIKE MOTHER, LIKE DAUGHTER
A teenage mother in Cheltenham told her health visitor she had been having thoughts about hurting her four-week old daughter - hitting her, throwing her on the ground or against a wall.
The health visitor referred her as an emergency and Robin Balbernie made a home visit straight away.
'She had some support from her boyfriend and from her parents who lived nearby, but she been unable to touch her baby for the first two weeks after her birth. The baby's crying was making her very angry. She had not done anything to the baby.
'She was a quite well-educated young woman from a middle-class background.
She talked about how angry and trapped she felt.
'I got her mother over to talk about this girl's own baby history and it turned out that her mother had not touched her for the first two weeks of her life. She had had postnatal depression.
'The daughter had never heard this before. It immediately made sense as to why she couldn't touch her baby. She had not been able to understand why she couldn't, so she had interpreted her feelings in terms of aggression.
She had been a very aggressive teenager. She saw everything in terms of conflict and had used that to explain why she could not touch her baby: "I can't touch my baby because I hate my baby and it might be because I want to hurt my baby."
'She was desperate not to hurt the child, but she had these fantasies. Once we found a reason, it seemed to work. Things began to change.
'I saw her for less than a year. She got rid of her boyfriend and got on better with her family.
'I followed up a couple of years later when her daughter was three and a half. She had moved and was very proud of her new home and was getting on really well. You could see that she and her daughter had a lovely relationship.
'If I had been told this in a lecture I would not have believed it. I find it hard to believe that the experience down to the exact two-week period can have been so similar, but something that happens very early on in life can stay in the brain.'
