Analysis: Children's mental health - Minds that matter

The responsibility for promoting positive mental health among children lies not just with health professionals but also councils, early years settings, schools and members of the public, according to a guide published by the Local Government Information Unit's Children's Services Network (CSN).

The practical guide, Fundamental Health, highlights a lack of understanding of mental health issues. CSN policy analyst Phil Jones says, 'When the term "mental health" is used, people, including children, tend to focus on the first word, which has many negative connotations, rather than the second.

'It's important to recognise the degrees of mental health. For example, anyone can feel sad or angry, but for a significant minority this can turn into a problem unless action is taken early enough.

'It's everyone's business, but we also need positive social attitudes which support work to ensure all children and young people are mentally "healthy".'

Early identification

While initiatives such as the Every Child Matters Programme and Mental Health Act 2007 have reinforced the importance of addressing child mental health, early years consultant Linda Pound says that a major challenge to securing good mental health support for young children is awareness. 'People underestimate how ordinary, everyday things can impact on any child,' she says. 'Unless children get to the stage that they are not coping, people think they are fine. Some people do not regard them as having the same emotions and feelings as adults. Also, policy makers have to understand that they can't just push children into group situations.'

Marie Zaphiriou Woods, the parent-toddler groups manager at the Anna Freud Centre for children's emotional well-being (see box), says that the challenge is to identify potential problems and address them swiftly.

She says, 'It is important that health visitors are trained to spot very early on if there is a problem in the relationship between the parents and child. It is also important for early years practitioners to be trained to observe interactions between the infant and parents so they can pick up difficulties as soon as possible.

'It is terribly difficult for parents to admit their child is not developing as they wished. But often there is the problem of not knowing what "normal" is - are they normal problems for an infant, or is something not right? That is why training and assessment is essential.'

Ms Pound says this underlines the need for well qualified people in the early years. 'Unfortunately, often the people who work with the youngest children are the least qualified and experienced. Observation is a skilful process that takes an experienced and mentally well person to do.'

Funding and policy

Principal educational psychologist for the Royal Borough of Windsor and Maidenhead, Helene Green, speaking at a recent CSN conference, called for parents and babies to be seen as a legitimate focus for funding. 'It is hard to convince people that it is money well spent, because it takes a while to show the benefits, and it is hard to convince people of a problem when they are little babies - does it matter that they are not sleeping?'

The CSN guide acknowledges that the Government has increased mental health funding, but says basic policy challenges still need addressing, including:

- improving intervention at the earliest possible stage
- ensuring that parents have the confidence to ask for help
- promoting multi-level, multi-agency approaches to mental health
issues.

Ms Pound agrees, 'Different professionals bring different judgements. No one group of practitioners can bring a consistent and coherent approach, but working together is much better.

'We need to keep reviewing good practice and making it consistent. It is important to allow people time to get to grips with policies, rather than keep changing them.'

CASE STUDY: ANNA FREUD CENTRE, LONDON

The centre runs two weekly parent-toddler groups on the premises and two funded by Sure Start in the community, at a tenants' hall and a hostel for homeless families. They aim to provide psychoanalytically informed support to toddlers and their families.

Many parents refer themselves to the groups, but some come from health visitors, GPs or social services. Clinical issues identified at the groups are discussed in weekly team meetings.

The groups provide a welcoming, safe environment where parents can raise concerns and gain advice. Manager Marie Zaphiriou Woods says, 'It is important to create a group that parents feel they can belong to, and for them to come regularly so that they can gain a lot from the two workers and other parents and children. We model how to talk and play with their children and how to set limits. The parents then begin to learn by example and from what works for the other parents.

'Toddlers are challenging. Their behaviour can be extremely contradictory - clingy one minute and independent the next. It is bewildering for parents and especially for those who are not in an ideal situation, such as if they are separated from their extended family, have relationship problems, or have financial and employment worries.'

FURTHER INFORMATION

- Fundamental Health (Children's Mental Health: A Guide) is published by the Children's Services Network at the LGiU, £7.50, www.lgiu.gov.uk, 020 7554 2800.