“Mental health issues are the great epidemic of this generation” were the impassioned words of musician and mental health campaigner Niall Breslin (Bressie) as he addressed the Oireachtas Joint Committee on Health and Children last week. “Agonising suicide rates, disturbingly high anxiety and depression rates, self-harm, eating disorders, obsessive compulsive disorder... young people are being exposed to too much... we simply cannot ignore this anymore”
Also addressing the Oireachtas Committee was Dr. Paul D’Alton, Head of the Psycho-oncology department at St. Vincent’s University Hospital and Former President of the Psychological Society of Ireland. He emphasised the importance of a whole society response to the alarming increase in self-harm and consistently high rates of suicide in Ireland. He highlighted the pivotal role played by social deprivation and inequality in predisposing individuals and families to ill health and mental health issues: “Equality is the best form of therapy”, said D’Alton during his address.
So where does positive mental health begin? How can we help those suffering now and ensure that mental health issues do not become the “great epidemic” of the next generation? As Mr. Breslin pointed out, there is no doubt plenty of work is to be done in improving access to services, in increasing funding to existing mental health services, and in further promoting mental health and wellbeing in the education curriculum. In relaying his personal story, he described the protective role of his family “My greatest support and emotional scaffolding was the fact that I came from a loving, stable and caring family… what could have happened if I didn’t have this, like so many others out there?”
“Infant mental health” refers to the child’s healthy social and emotional development in the first three years of life within the context of the relationship or “attachment” with the primary caregiver, usually the mother. Attachment is the most important task of infancy and refers to the availability of the caregiver to provide safety and security to the baby; to attune to and respond to their needs; to provide comfort when they are upset; to share in joyful experiences; and to enable the child to feel special and begin to develop a positive sense of self. Positive infant mental health is synonymous with a child’s ability to form secure relationships, to regulate emotions, to explore the environment and to learn and develop cognitive capacities across the lifespan.
Professor Kevin Nugent, one of the world’s leading experts on early child development, referred to infant mental health as “fast becoming a very significant public health issue, spurred on by a growing field of research and practice”. In an address to the Oireachtas Joint Committee on Health and Children last November 2015, he described the “revolution” that had taken place in our scientific understanding of the capacity of babies and in the workings of their brains.
My difficulty in my current role as a primary care psychologist lies in children not being seen for developmental assessments or support around behaviour or emotional issues until they are generally aged 3 and above. This may not be early enough, given that research points to a critical window of opportunity that exists in the first three years of life where the rapid brain growth and formation of pathways will not be repeated again in later years.
Infant mental health can be easily disrupted when the parent is not able to provide optimum care to the baby, which creates vulnerability to a child developing long-standing psychological difficulties. Reasons for this range from maternal mental ill health to the occurrence of stressful life events, lack of social and professional supports, and wider social deprivation issues. Equally, the first 3 years provide clinicians with a tremendous opportunity to affect change in a child’s life due to the plasticity of their brain and the ability to nurture the child’s relationship with their primary caregivers.
In the words of Bob Dylan, “I feel a change comin’ on”. Last week, over 100 professionals met to develop an early years plan to strengthen prevention and early intervention support for children aged 0-3 in Galway (EYS, 2013). There are pockets of amazing community initiatives being carried out around the country who have demonstrated that there is significant uptake when services are available to families promoting the mental wellbeing of parents and infants.
The recent establishment of a Special Interest Group in Perinatal and Infant Mental Health of the Psychological Society of Ireland has been welcomed by many. They recently drafted a position paper and are calling on the government to establish a review group to consider best practice models used in other countries. Other recommendations include the benefit of a national perinatal and infant mental health strategy; universal screening for parents and infants; clear pathways of care; resourcing existing services; specialist perinatal services; raising awareness amongst the public, staff and policy makers on the importance of infant mental health; evidence based-practice and the collaboration of multiple sectors including health and education (PIMHSIG, 2015).
One of the most effective ways of tackling the mental health “epidemic” now and for future generations is to focus on improving mental health from the very beginning, given how significant this period is “in laying the psychological foundation for later life”. Infant mental health is everyone’s business (D’Alton, 2015). The research and facts stand for themselves, preventing mental health issues from birth is hugely important and makes sense on all levels. It won’t solve all of this country’s mental health problems, but it will certainly go a very long way.
D’Alton, P. (2015). Infant mental health: Giving children the best head start. Irish Independent, 17th November 2015.
D’Alton, Dr. P. (2016). Social injustice and inequality play a pivotal role in mental health of citizens; Irish Independent, 26th January 2016.
Early Years Strategy (EYS; 2013). Right from the start: Report of the expert advisory group on the early years strategy. Department of Children and Youth Affairs, Ireland.
Menton, A. (2015). Perinatal and infant mental health: Draft position paper and recommendations. Psychological Society of Ireland (PSI) and Perinatal and Infant Mental Health Special Interest Group (PIMHSIG).