Mental health: Service cuts hit mothers and babies

Almost one in ten five- to 16-year-olds has a mental health disorder, according to Government statistics, while some experts believe this number could be higher. However, the services designed to treat such conditions are shrinking due to Government austerity measures.

Research published last month by charity Young Minds suggests more than half of councils in England have cut or frozen their Child and Adolescent Mental Health Services (CAMHS) budget since 2010. Some reductions have been more dramatic, with Birmingham City Council's budget falling by 94 per cent from just above £2.3m in 2010/11 to £125,000 in 2014/15.

The findings follow a warning from the Royal College of General Practitioners in January that the recession is prompting more cases of depression, stress and anxiety among 15- to 34-year-olds.

Mental health campaigners warn the cuts have forced CAMHS to prioritise acute cases, rather than investing in preventative early intervention services that could save money and reduce suffering in the future. Research has also revealed a rise in the number of children being treated in adult psychiatric wards. And cases have emerged of children being placed in care hundreds of miles from their homes.

England's chief medical officer professor Dame Sally Davies raised these concerns in a meeting with MPs in March this year. The Commons Health Committee is currently conducting an inquiry into children's and adolescent mental health and CAMHS. Professor Davies told the group, 'Fifty per cent of mental illness in adults starts before the age of 15, and 75 per cent before the age of 18. So if we screen for it in children and get them treated early, we will save morbidity and money.'

Charity Mental Health Foundation's head of children and young people Barbara McIntosh agrees services should treat children as early as possible. 'In most places CAMHS no longer offer a service to the under-fives - it tends to be children with problems later on,' says McIntosh.

'It's so short-sighted not to invest in prevention, for example in Sure Start centres with well-trained childminders or well-supported foster carers.'

Young children's mental health is directly connected to their mother's mental well-being. Research published by NSPCC suggests more than 10 per cent of women experience mental health issues during pregnancy and the first year after childbirth.

'Stress, we know, can impact seriously from pregnancy onwards,' explains McIntosh. 'If you're stressed in pregnancy you have a lot of cortisol in your system, which is toxic to the foetal brain. After birth, babies pick up a mother's stress, which can inhibit normal physical growth of the brain. Children who are very stressed are smaller and their brain development is held back. That's really hard to catch up on later in life.'

McIntosh says reduced mental health support for young children should also be measured in terms of cuts to other services accessed by mothers and families. In particular, she regrets reduced universal children's centre services across the country.

In 2013, 4Children's census of children's centres revealed overall budgets had fallen by more than a third since 2010. It predicted 60 would close within a year. Action for Children surveyed children's centres in the same year. It found 52 per cent of managers said children needed more support as a result of parental mental illness than in 2012.

The NSPCC's development manager for children under one Sally Hogg says children's centres are among the first-tier services available to support maternal mental health. Midwives and health visitors are also of key importance. She says that for midwives to encourage mothers to disclose mental health concerns, they need time for high-quality visits and to build relationships.

'Because of a shortage of resources, those sorts of things are being threatened,' she warns. In 2013, NSPCC research found that 40 per cent of women see a different midwife at every appointment, while 41 per cent said a health visitor or midwife never spoke to them about depression.

COALITION CAMPAIGNS

NSPCC is one of a coalition of more than 50 organisations that make up the Maternal Mental Health Alliance. One of its aims is to increase the number of specialist mental health midwives. Last year, it convinced the Department of Health (DoH) to commit funding to ensure specialist midwives would be available in every birthing unit by 2017. Currently, only about half of England's mothers can access specialised maternal mental health staff.

The DoH also puts funding towards free perinatal mental health training for health visitors, but Ms Hogg warns that the situation will only improve if resources are available to fund posts after training.

The alliance is also campaigning for the creation of more mother and baby mental health units in hospitals. These are specialist psychiatric wards where women with severe mental disorders are admitted with their babies.

'Evidence shows that if a mother is struggling, just addressing the mother's mental health doesn't necessarily have an impact on the baby,' says Ms Hogg. 'It's far better for babies to go to mother and baby units than be separated.'

There are 17 such units in the UK, but Ms Hogg says the spread is patchy, with big areas in North West and South West England lacking provision. The only such unit in Wales closed in 2013 to save money. As a result, Ms Hogg says, mothers are being placed in beds miles from their homes, parting them from their other children and fathers.

The Children and Young People's Mental Health Coalition is another group of organisations that has joined forces to improve youngsters' care. One of its five key priorities is to ensure there is 'universal information for all parents and targeted support for vulnerable parents to promote babies' emotional development'.

Coalition co-ordinator policy and campaigns Paula Lavis says the group wants local authorities to develop strategies on infant mental health. 'Different people commission all the different levels of service,' she says. 'You're unlikely to have a strategy that looks at the total package for children.'

Research conducted by the group last year confirms this. Recent health reforms mean local authorities and clinical commissioning groups are required to undertake a joint strategic needs assessment (JSNA) of local health needs; the coalition reviewed 145 JSNAs available to the public from a total of 151. 'We found a third of JSNAs did not include an estimated or actual level of need for children and young people's mental health services in their area,' says Ms Lavis.

Anita Soni, an educational psychologist and professional tutor at the University of Birmingham, suggests changing the Early Years Foundation Stage (EYFS) could increase support for younger children's mental health. 'Mental health is not explicitly referred to in the EYFS,' she says. 'It's implicitly referred to through Personal, Social and Emotional Development, but that causes confusion for practitioners.'

Dr Soni points out that the Government takes a different approach to children over five. Last month, the Department for Education published guidelines for schools about mental health and behaviour. 'People think mental health is something special you have to do in a magical way,' she says. 'But in reality it's the normal stuff about getting to know your children.'

CASE STUDY: FUN WITH MUM

Fun With Mum is a support group for mothers developed by Suffolk County Council senior social work practitioner Bridget Macdonald and educational psychologist Penny Rackett

'In 2010, we noticed an over-representation of mothers with postnatal depression being referred to the council family support services,' explains Bridget Macdonald. At the time I was training to use an approach called Video Interaction Guidance (VIG). With help from Penny Rackett, we developed a group to offer psycho-therapeutic support for women combined with the VIG approach.

'We held the first session in a children's centre in 2010. Groups of up to six mothers met us with their children, aged from birth to two. We considered women suitable if they had an Edinburgh Postnatal Depression Scale (EPDS) score of 10 or above (a questionnaire used by health professionals to determine if a woman has postnatal depression).

'The sessions lasted for an hour and a half and were held weekly over eight weeks. Each week we did a different activity, and filmed the mother and their baby doing these in the group. Activities included reading, singing and hand and feet painting.

'After this, we went through short video clips with each parent. Trained VIG practitioners micro-analysed the film looking for moments of positivity between the mother and child.

'An example is where the baby has taken the lead - or provided the cue - and the mother has recognised and responded to it. Cues aren't just verbal; they include body language. We ask the mothers what they can see, how they felt about the activity, and how they feel now. We ask them how they can use that meaning to do something more positive.

'We have held five courses so far for about 30 mothers. Following each, mothers have overwhelmingly reduced their EPDS scores. They have been far less depressed and many have made new friends. We give them a DVD of the clips to take home.

'We're now helping to roll out the sessions to other children's centres. But the approach is not necessarily cheap, as it requires staff to be trained in VIG and it takes up a lot of staff time.'

MORE INFORMATION

• - Children and Young People's Mental Health Coalition report, www.cypmhc.org.uk/resources/overlooked_and_forgotten_full_report
• - DfE guidance to schools on mental health and behaviour, www.gov.uk/government/publications/mental-health-and-behaviour-in-schools-2
• - MindEd - a new portal of elearning sessions and resources for those supporting children's and young people's mental health, www.minded.org.uk
• - Maternal mental health alliance, http://maternalmentalhealthalliance.org.uk
• - World Association for Infant Mental Health, www.waimh.org
• - NSPCC report on perinatal mental health, www.nspcc.org.uk/Inform/resourcesfor professionals/underones/ spotlight-mental-health_wdf96656.pdf
• - Young Minds research, www.youngminds.org.uk/news/news/ 2094_devastating_cuts_leading_to_childrens_mental_health_crisis.

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