Infant Mental Health Awareness Week

Sheryll Murray Excerpts

Thursday 16th June 2022 Westminster Hall

[Dame Andrea Leadsom (South Northamptonshire) (Con)]

I beg to move,

That this House has considered Infant Mental Health Week 2022.

It is a great pleasure to serve under your chairmanship, Mrs Murray—I think for the first time. I am delighted to have secured this debate.

Infant Mental Health Week is an annual opportunity to highlight that human beings are the most underdeveloped creatures on earth at birth. Our brains, and therefore our responses, our reactions and our knowledge, are completely undeveloped. In fact, many people would say that we are born about two years premature. What other animal cannot do anything for itself until it is at least a year old? That is the plight of human beings.

Infant mental health is therefore, without any shadow of a doubt, more important than mental health throughout the rest of a person’s life. It is in that critical period when a person is so small and does not know what’s what or where’s where that their ability to have secure lifelong mental health is laid down.

From conception to the age of two, a secure and loving relationship between a baby and his or her carer literally shapes the way the baby’s brain develops. That is when the building blocks for lifelong physical and emotional health are laid down. Like a sponge, the baby’s developing brain will soak up the atmosphere around them and the environment that he or she is born into. In the womb, a baby whose mum is terrified of childbirth or is being treated with violence by her partner, or who is misusing alcohol or drugs, will be profoundly physically and mentally impacted by that experience.

Infant mental health, or, more specifically, early intervention in the first 1,001 critical days of life, from conception to the age of two, has been a passion of mine for more than 25 years. I chaired the Oxford Parent-Infant Project in 1999 and set up NorPIP, the Northamptonshire Parent Infant Partnership, providing parent-infant psychotherapy to families who are struggling to form a secure bond with their babies. I established national charity PIPUK—the Parent Infant Partnership—which went on to establish and support a number of other parent-infant teams right around the country. I also wrote the 1,001 critical days manifesto, which went on to become the First 1001 Days Movement. Infant mental health is a subject incredibly dear to my heart.

Science tells us that a secure and loving relationship with the key carer will shape the way in which the baby’s brain develops, with long-term and positive consequences for that baby’s mental health. Fundamentally, it is about self-regulation. A baby who is secure in his or her earliest relationships will later on be able to experience anger, fear, jealousy and disappointment, and will be able to regulate their own responses appropriately. It is the earliest relationship between parents and their babies that constructs that ability to self-regulate and hence delivers that pathway to good lifelong mental health.

Research released today by the Royal Foundation shows that 91% of parents and carers agree that early years are important in shaping an adult’s life, but only 17% recognise how uniquely important the period from birth to five is. As the Duchess of Cambridge has said,

“Our experiences in early childhood fundamentally impact our whole life and set the foundation for how we go on to thrive as individuals, with one another, as a community and as a society.”

In 2015, the National Childbirth Trust found that one in three first-time dads were worried about their mental health following their baby’s birth, and according to the Maternal Mental Health Alliance, up to one in five mums, sadly, suffer due to the lack of focus on support for mental health in the perinatal period. Unfortunately, we do not really have the granular information on perinatal depression among parents and carers that we would need to properly impact-assess the mental health effect on babies, but the mental health of the parent clearly impacts on their baby’s development. A good example is that a pregnant mum who, for whatever reason, suffers from stress will produce more cortisol—the stress hormone—in her bloodstream, which will pass through the placenta into the unborn child. The more stressed the mother, the more frequently the foetus is exposed to higher levels of cortisol, and we know that exposure to high levels of cortisol in the womb can lead to modifications in gene expressions before the baby is even born, so even in the womb, the potential for lifelong emotional and physical health is already being determined.

Once out of the womb, being left to cry unattended for continuous, lengthy periods of time, or being terrified by witnessing violence and anger within the family or loud and aggressive behaviour in their environment, will have the same impact on the baby: raising their levels of cortisol. Over lengthy periods, there is evidence that this damages the baby’s immune system and will give him or her a lifelong predisposition towards higher risk-taking behaviour. When a baby is born, they have no cognition at all: they can only cry, sleep or look around. They do not know if they are cold, hungry, bored or in pain. They only know that something is wrong, so a baby cries to attract the attention of a loving adult carer. When that carer turns up and takes the time to soothe, change, feed or sing to the baby, the impact of that tender and loving response brings the baby back to a state of calm and reduces their level of stress. This continues until the baby is old enough to understand how to regulate his or her own feelings.

Even more important is the fact that at birth, a baby’s brain is only partially formed. It is understood that a baby’s brain puts on up to a billion neural connections every minute during the first year of life. Those neural connections are stimulated by the quality of attention of the principal loving carer and the baby’s experiences of the world around them, which is why parental attunement and loving attention are fundamental for the healthy brain development of a baby. Simply put, what we do with a baby from conception until the age of two is about building the human and emotional capacity of that infant; what we do after the age of two is almost all about trying to reverse damage that is already done. A wealth of evidence demonstrates that poor mental health, substance dependency and domestic abuse among parents lead to significantly poorer outcomes for babies and young children. Research from the Maternal Mental Health Alliance highlights that the locations with some of the greatest levels of socioeconomic deprivation are also those where poor maternal mental health is at its highest. When they start school, children from such disadvantaged backgrounds are on average four months behind their peers, and it gets worse from there.

The quality of attachment that a baby has to their principal adult caregiver therefore has a profound impact on their lifelong mental health, and our society’s ambition should be for every baby to achieve a secure attachment to that caregiver, be it mum, dad, kinship carer or adoptive parent. Secure attachment is the foundation for good lifelong mental health, its possible effects having an impact on parenting from one generation to the next: if a person was well parented, there is a high likelihood that they will become a good enough parent, and their baby will form a secure attachment to them. Examples of insecure attachment are therefore found where care giving is inconsistent.

Babies who suffer from insecure attachment are not given the consistent, loving care that they need in order to feel that the world is a good place and that people are generally kind. Neglect of a baby has a very damaging impact. The baby with insecure attachment will of course have other chances in life; we never write anyone off. Babies who are insecurely attached in the very early stages will have lots of other opportunities to make good friends and to have other key adults in their lives who might help to turn things around and help them build their own emotional capability, but there is no doubt that insecurely attached infants will always struggle a bit more in later life to deal with life’s ups and downs. It will be those babies who might struggle to keep friends and relationships and also to cope without help with parenting when their time comes. This is sometimes known as the cycle of deprivation, where a general lack of good mental health is passed down from one generation to the next.

The most challenging early mental health impact is reserved for babies who develop a disorganised attachment with their principal caregiver. That is where the person they rely on to look after them, soothe them and keep them alive is also the most dangerous person in their life. The person they turn to for comfort might one moment hurt them and the next moment hug them. Such babies often find that making sense of the world becomes very difficult, and many of the most damaging outcomes in society—criminality, suicide, self-harm, sociopathic behaviour—are enacted by those who suffer disorganised attachment as a baby. It should be blindingly obvious to all that whatever we do to invest in giving every baby the best start in life will pay us back a million times over—a billion times over—in terms of general wellbeing, healthy communities and a stronger society.

We had a long way to go before the covid lockdown, but there is no doubt that Infant Mental Health Awareness Week is vital because it shines a spotlight on the huge damage done by two years of pandemic lockdowns: dads and co-partners not permitted to be with mum and the new baby; face-to-face health visits and other support such as family hubs moving to virtual only; wider family and friends unable to meet the new arrival and provide support; babies not able to meet other babies; and an exacerbation of existing problems such as addiction, domestic violence and poor mental health.

Above all else, there was the devastating isolation at a time when we all know that new parents are desperate to get out of the house to go and chat to another parent about the sleep that they did not get last night, what size nappies the baby should have, what they are doing about weaning, and whether the baby has had its first tooth yet. All the chats, empathy and consolation that new parents give each other were missing during the covid lockdown. A report carried out by the Parent-Infant Foundation, Best Beginnings and Home Start, titled “Babies in lockdown”, revealed that six in 10 parents were concerned about parental mental health in lockdown, and two thirds said that covid had affected their ability to cope with caring for their baby.

We know that health visitors provide a vital support service to families who are struggling. Every family in England should be offered five mandated reviews from a health visitor between pregnancy and age two and a half as a minimum. Local authorities, many of which are still using phone and virtual appointments to count as reviews, have reported in their latest quarterly data, from May, that 18.6% of babies missed out on their nine to 12-month review and more than a quarter of toddlers missed out on their two to two-and-a-half-year review. That includes all those who got the telephone-only service. There were still many who did not get anything at all.

Data, again published in May, shows that only 85% of children in England were at or above their expected level in communication skills, compared with 89% before the pandemic, and 79% were at or above the expected level in five key development assessments at the review stage, compared with 83% pre pandemic.

A report by Ofsted in April 2022 found:

“The pandemic has continued to affect young children’s communication and language development, with many providers noticing delays in speech and language…The negative impact on children’s personal, social and emotional development has also continued, with many lacking confidence in group activities”

and

“social and friendship-building skills have been affected.”

There continues to be an impact on children’s physical development, including delays in babies learning to crawl and to walk. Lockdown has caused many challenges and exacerbated many existing ones.

The early years healthy development review, which I chair, could not have come at a more important time. Since the summer of 2020, the review has focused on ensuring that every baby gets the best start in life. Its vision sets out six key action areas, which were made Government policy in March 2021. The action areas will deliver, first, a joined-up set of Start for Life services for every family in England; secondly, the roll-out of family hubs as a welcoming place, providing physical, virtual and outreach services for every family in England; thirdly, trusted digital, virtual and telephone support designed to meet the needs of the baby and their carers, as well as the development of the digital red book, which will allow much greater continuity of care for every baby; and fourthly, a modern, mixed-skills workforce that will provide much greater continuity of care and that works, with the baby at the centre of everything we do, to deliver wraparound, empathetic support.

Fifthly, we need much more understanding of the impact and potential of early intervention, so we will improve data collection and evaluation, and outcomes for the mental health and wellbeing of babies and their families, and we will develop proportionate inspection of services. Sixthly, these action areas will require real leadership locally and nationally. Fundamentally, we need to ensure that the Treasury will continue to fund the “Best Start for Life” vision in the long run.

I am delighted that the vision is shared cross-party, and I have no doubt that the spokespeople here today on both sides of the Chamber will want to support giving every baby the best start for life. It is a fantastically cross-party issue, and I pay tribute to the many colleagues here today, as well as to those who could not be here, who have lent their support to this agenda over so many years.

The views and lived experiences of babies and their carers have been at the heart of the early years review. From Blackpool to Stoke-on-Trent, from Worthing to Bexleyheath, from Camden to Cornwall, parents have shared with us the good and the bad. My “1,001 Critical Days” podcast has highlighted the mental health journeys of parents and their babies, and an LBC phone-in made clear the challenges faced by so many dads and co-parents, and the particular support they need, which is currently lacking, in their amazing journey to parenting.

Time and again we have heard that every parent wants to know how to be a good a parent, where they can access early years support, what is on offer for them and why they might need that support. They want companionship and not to be isolated, and they want to be able to share their stories with parents in a similar situation.

We heard from parents of babies with disabilities that they do not want to be left out, stigmatised and treated as different. We heard from many parents from different ethnic backgrounds, as well as LGBT parents, single parents and foster parents, that they do not want to be treated any differently from other parents either. All parents, of every type, asked for a seamless, joined-up approach to accessing the support they need. Face-to-face support is a priority, but in this 21st century, parents and carers also want access to services virtually when things are urgent, they are pressed for time or they just have a quick question.

Parents also want to avoid telling their story over and over again to different early years professionals, and there is huge support for a digital version of the red book, where parents can keep a permanent record of their baby’s birth experience, first tooth and first photo with Granny, along with all the other lovely records that parents want to have, as well as communicate with the professionals who are supporting them.

The positive to take away from today’s debate is that if we provide support and reach out to make sure that every family knows where to go to get help, and we educate families as to what good looks like, we can transform our society for the better. To end, in this platinum jubilee year, I would like to use the words of the Queen, who said:

“in the birth of a child, there is a new dawn with endless potential”.

[Mrs Sheryll Murray (in the Chair)]

I intend to call the Front-Bench spokespeople at a few minutes before 4 pm. I hope Members will bear that in mind. I call Munira Wilson.

--- Later in debate ---

[Sarah Olney (Richmond Park) (LD)]

It is a pleasure to serve under your chairmanship, Mrs Murray. I congratulate the right hon. Member for South Northamptonshire (Dame Andrea Leadsom) not just on securing the debate but on her ongoing passionate advocacy for our youngest citizens. It is a mission I am always happy to support her in.

One of the things that awoke my interest in this area was during the covid lockdown; both the right hon. Lady and the hon. Member for Strangford (Jim Shannon) have spoken movingly about the impact that lockdown had on many families. I spoke to mums in my constituency who were having their first child in lockdown, with all those pressures on them, such as not having contact with their partner or their family during labour, or with informal or formal networks afterwards. I reflected on how different their experience was from mine over a decade ago, when I had my babies. My first impression was of the impact of that on maternal mental health—I was pleased to secure a debate on that topic in March 2021—but the issue of infant mental health is so closely linked to that. I am grateful to the right hon. Member for South Northamptonshire for her really detailed opening speech. We have the data and the evidence, and it very much underpins the anecdotal evidence from our own personal experiences and those of our constituents.

A number of great points have been made about how much the baby’s mental health is based on the quality of the parent-infant relationship, and how the parent’s responses shape how babies experience emotions, regulate their own emotions and express themselves. We have referred a great deal to the research, but 15% of children—more than four in an average classroom—will have developed a problematic relationship with their main caregiver as a result of unpredictable or hostile care. As we have already debated, that troubled start increases the risk of children having poorer social and emotional wellbeing across their lives, and the ongoing and lasting impact that that can have.

My constituency neighbour, my hon. Friend the Member for Twickenham (Munira Wilson), talked about some of the gaps in services to support infant mental health. We really must focus on that. There are currently 42 specialised parent-infant relationship teams in the UK, which focus on strengthening and rebuilding those early relationships. That means that most babies live in an area without access to such a team. They are multidisciplinary teams led by mental health professionals with expertise in working with babies and families.

A key area of focus is working with families that have experienced intergenerational trauma. With the right care, the trauma experienced by parents does not have to inform their infant’s development. However, it is so important that specialised services are there to detect such instances and are equipped with the skills and funding to intervene and support families where needed.

I will briefly touch on the experience of dads, which has been raised on a couple of occasions. I recently visited my local maternal mental health crisis unit, and I was surprised to find that there is no systematic care given to dads who experience mental health problems when their partners are pregnant. It might get picked up if their partner is coming for care, but it very much flies under the radar. In particular, we know that domestic violence can often commence during pregnancy. I see that as a direct result, perhaps, of men’s struggles with mental health as they become fathers. I therefore think it is a matter of real urgency that we pick up the matter of dads’ mental health, particularly from the beginning of pregnancy.

It is also important that mental health professionals can spot the signs of poor mental health in our youngest children, who cannot express their emotions in the same way that older children are able to. The hon. Member for Strangford mentioned the reviews of some of the horrific cases of child death that have been carried out recently—I am thinking of Star Hobson and Arthur Labinjo-Hughes. I do not want to talk too much about them, for the same reasons as he did not. I just cannot—it is just too much. But I really hope that someone is looking at that and thinking about what could have been done to detect the signs of mental distress in those young people who could not express it for themselves. We must be training people for some of these crisis situations, so that they can pick up on the mental health of young people who have difficult, damaged or problematic relationships with their caregivers and do not know how to express themselves, but are at risk of real harm if that mental distress is not picked up on.

Whenever I get the opportunity, I like to highlight the importance of health visiting. That is something that I picked up when I spoke to the first-time mums during lockdown. For full disclosure, my own mother is a health visitor, so I have been raised to regard health visiting as a wonderful thing, but that has been my experience as well. The importance of health visitors is that they visit—or should visit—every new mother, and her family, in her home. For those mothers who are finding it hard to reach out, it is an invaluable service to have somebody coming to them and asking if they are okay. We really must continue to support it. On infant mental health in particular, health visitors are uniquely placed to identify concerns, spot issues in early relationship and attachment forming, and identify where infant mental health may be an issue.

Families should receive a minimum of five mandated reviews by a health visitor between pregnancy and age two and a half, but even before the pandemic, many children were not receiving those core contacts. Over the course of the pandemic, the number of missed contacts has increased further, despite the fact that many reviews were conducted online or over the phone. One thing I am really concerned about is that we must not allow telephone or Zoom visits to become the new normal, because we will miss out so much from not visiting mothers in their home. Evidence of domestic violence and, in particular, the subject we are discussing today—those attachment disorders—will not be so evident if health visitor visits move to some sort of digital contact.

In 2015, responsibility for health visiting was transferred to local authorities. Since then, it is estimated that 30% of the health visiting workforce has been lost, with further losses expected. As with many local services, there is something of a postcode lottery in the availability and quality of support. My team and I have spoken to health visitors in north Kingston—the team that supported me when my children were babies—and they reiterated that currently, their biggest challenge is workforce issues. Almost 25% of their current health visiting team is due to retire in the next few years, and they are struggling to find candidates for the vacant roles. They recently advertised a vacancy that received just one application, and that person then decided that they would not take the post.

Health visitors work in relatively small teams with large case loads; in north Kingston, there are about 600 cases for every health visitor. That is unsustainable, not least because it forces health visitors to focus their resources on the most at-risk families. As we know, these problems can occur in all kinds of families from all backgrounds and income groups, so it is really important that we push for health visiting to remain a universal service with home visits.

I will end by stressing the importance of face-to-face contact, and that the health visiting service needs support and investment in its workforce. More than anything, we want to join up the agencies, so that the Department of Health and Social Care is working closely with the local authorities to make sure that the right information is being passed between agencies. If health visitors pick up anything concerning, they must be able to speak immediately to the other agencies surrounding the family, so that we do not have to read too many more distressing case reports like those I mentioned. The £300 million Start for Life programme that has recently been announced is wonderful—it will be great—but there is no funding in it for health visiting services. The funding sits within the DHSC, which is separate from health visiting; again, joining that up would make a huge difference.

With fragmentation, there is a risk that things will fall through the gaps. The one thing that we have all said clearly today is that the consequences of allowing that to happen are too big, both for our individual children—all those future MPs who we are looking forward to welcoming to this place—and for our society as a whole. We want to do everything we can to give little babies and children in every corner of the United Kingdom—in every part of the country—the best possible start. That includes supporting their mental health from the earliest days.

[Mrs Sheryll Murray (in the Chair)]

I call the Scottish National party spokesperson, Dr Lisa Cameron.