Over 200 million children under five in low and middle income countries will fail to reach their full developmental potential because of inequality, according to Unicef. But even in OECD countries and emerging economies, that number is increasing.
Between birth and the age of three, a human brain grows more than during any other period of life. A foundation is built for all future development and outcomes — physical health, education, interactions with the criminal justice system and more — which can in many cases be dictated by the experiences of infants within this period.
But despite the profound impacts of mental wellbeing in infancy, international public policy has been inconsistent in its approach to addressing it. Could a focus on the mental health of under-threes be key to preventing a range of issues in later life?
According to leading American organisation Zero to Three, Infant Mental Health (IMH) refers to an infant’s capacity to experience, regulate and express emotions, to form close relationships, to explore their environment and to learn.
These are vital for healthy social and emotional development, and are best achieved when kids grow up with a loving and supportive family, in a safe community, and with plenty of cultural and educational opportunities.
The value of a focus on IMH lies in the importance of the first three years of life in development, and the impact that experiences within this period can have on future outcomes.
In this sense, policies addressing IMH can pay for themselves: the Institute of Medicine in the United States estimates that the direct and indirect costs of emotional and behavioural disorders total $247 billion per year in costs relating to health, education, criminal justice, child welfare and economic productivity.
The field also finds itself politically prescient, as the related global challenges of climate change and mass migration, as well as widespread child poverty, result in particular trauma and vulnerability for infants, and stress for their caregivers.
In high income countries such as the UK, USA and Australia, IMH is gaining ground among policymakers thanks to the work of dedicated practitioners and political champions.
But in low and middle income countries, says Professor Jane Barlow — who specialises in evidence-based intervention and policy evaluation — awareness is still very limited.
“There’s such a preoccupation with simply surviving that the issue of the child’s ability to regulate themselves emotionally doesn’t get on the agenda,” she explains, pointing out the irony that an IMH focus is vital for producing strong and healthy citizens who are able to advance society.
Professor Barlow highlights the success of home visiting programmes globally — for example the David Olds nurse-family partnership model which was conceived in America and is now being developed in a number of African countries — as an example of strong evidence-based IMH policy which can be adapted to environment and local context.
Also impactful has been the UK’s 1001 critical days manifesto, which identified infant mental health as a priority and secured cross-party and multi-agency support.
The manifesto has been cited as good practice in places as diverse as Iceland, Florida, Finland and South Africa, but also serves as an example of the need for ongoing funding and attention.
“Six years on there is more to be done,” says Janaya Walker, Policy and Public Affairs Officer at UK children’s charity the National Society for the Prevention of Cruelty to Children (NSPCC), who were involved in the manifesto’s development. “There is a concern that the offer of mental health support available to families following perinatal checks — up to two and a half years — and when a child starts school is variable and inconsistent across the country.”
What does good policy look like?
IMH tends to sit within early years policy but has implications more widely: for example, policies around child poverty and adult mental health can also have a positive impact.
Zero to Three therefore advocates a multi-agency approach in which a core IMH team is formed with representation across health, social care and child services to ensure practices are embedded everywhere they are needed. It also recommends improved training for all relevant workforces, and public health campaigns and resources to raise awareness of the issue within the general population.
In 2016, the World Association for Infant Mental Health (WAIMH) adopted its first formal public policy statement, intended both as a standalone document and as a supplement to the United Nations’ Convention on the Rights of the Child.
They emphasise the importance of focusing on infants specifically, given their unique needs and rights which aren’t always addressed elsewhere, but point out that this focus could also guide support for parents and carers.
Among social and health policy areas that could be informed by the principles of IMH are adult access to mental health service and the provision — and raising in status — of shared parental leave.
Infant Mental Health is therefore both a neurological field and a highly sociological one. Its strength as an approach may lie in precisely that overlap — but so too do its challenges.
Where IMH policy is strongest it has required a cohesive body of practitioners and political champions willing to commit to sustained learning and investment. Those who do, say its advocates, will reap long-term benefits across all of society. — Eve Livingston
(Picture credit: Pixabay)