Being and Becoming Mentally Healthy: A framework for understanding the mental health of babies and young children

Summary:

Although there is increasing interest and investment in infant mental health, the term itself is not well understood. To support professionals to work together to protect and promote babies’ and young children’s mental health, we have worked with UNICEF-UK to create a new framework describing what it means to be mentally healthy in this life stage. The framework has two parts, “Being” and “Becoming” capturing both babies’ and young children’s current mental health as well as the capacities they are developing that will enable them to be mentally healthy in the future.

It is Infant Mental Health Awareness Week, a good time to take stock of how mental health services are meeting the needs of our youngest children. Having worked in this field for many years, I celebrate the increasing investment in infant mental health services across the UK. I also know there is still a long way to go before the right support is available to all babies and young children whose health and development is at risk.

Whilst there is increasing focus on “infant mental health” there is often still little understanding of what it means, and sometimes discomfort surrounding the term.

Last year, I tweeted about meeting the Princess of Wales to discuss Infant Mental Health, and the tweet generated some disbelief and disdain; “What the heck is infant mental health?” said one reply. “I would like to know IF an infant has mental health issues…if an innocent infant has mental health issues then who or what the hell is causing it?” said another.

The misunderstanding is not limited to a public response on social media. Research for the University of Oxford (Homonchuk & Barlow 2022) found confusion about infant mental health amongst local commissioners too.

Effective action on infant mental health requires professionals across different services to have the capacity, opportunity and motivation to work together to drive change. A lack of clear, shared understanding of what infant mental health is is clearly a barrier to achieving this, and something I was keen to address.

My colleagues in PEDAL and I, together with UNICEF-UK, developed a new framework describing what it means to be mentally healthy in infancy and early childhood. This is part of a wider toolkit that will support local action for this age group.

The framework describes what it means to be “mentally healthy.” Building on the World Health Organisation’s definition of mental health, we recognise that being mentally healthy is a positive state that enables us to enjoy life and deal with challenges, not just the presence or lack of diagnosable conditions.

The framework describes the different (albeit overlapping) elements of mental health – emotional, social and behavioural. Broadly, being mentally healthy involves understanding and managing emotions, experiencing nurturing and meaningful relationships and being able to explore, play and learn in age and developmentally appropriate ways. What being mentally healthy means in practice depends on a child’s development stage. Mental health exists in the context of relationships, particularly for very young children. Babies will need adults in their lives to support elements of mental health, such as emotional regulation. Cognitive and language development is also inextricably linked to mental health, for example, as a child grows their language skills, it will support their ability to recognise and describe their emotions.

There are two elements to the framework: “being” mentally healthy captures what it means to be mentally healthy now, and “becoming” captures the capacities that young children are developing to enable them to be mentally healthy in the future.

Capturing the “being” element is important because it creates a clear space to consider the mental health of babies in its own right, and to capture what can be done to promote their wellbeing and reduce stress and distress. Often the drive to improve services for babies and young children focuses on future outcomes. There is compelling evidence that supporting mental health in early childhood improves later outcomes and generates future savings, but we must also recognise that babies and young children also have a right to the best possible mental health now, just as older children and adults do. The United Nations Convention on the Rights of the Child describes all children’s right to the best possible health. Babies’ and young children’s rights should not be conditional on whether protecting or promoting their mental health will generate a later return on investment, and yet so often infant mental health services are required to prove this case in order to exist.

I hope that the framework can provide a useful basis for shared discussions between professionals about infant mental health. Using the framework, different services can see their complementary contributions to infant mental health: early education settings support social and emotional development for example, while specialised parent-infant relationship teams can repair and strengthen early relationships. The framework can also help professionals talk to parents about their babies’ health and development in easy-to-understand and consistent ways. The positive framing of infant mental health, we hope, will also make it easier to talk to parents, describe services, and design policy in a way that goes beyond seeing infant mental health as purely focused on addressing disorders, deficits, or problems.

The new toolkit not only contains the framework, but also other information, resources and case studies to support local action. It sets out a socio-ecological model, which describes how different levels of a child’s world can influence their mental health, including their relationships with their parents; their family and home environment; their community and wider society. Local professionals in areas looking to improve their infant mental health provision might want to map services against the framework and also use other tools in the toolkit, such as the example scenarios which enable local partners to think together about whether and how they would meet the needs of babies in specific situations.

We encourage local partnerships to adapt and build on the definition of mental health to co-produce a local version with their communities. Ultimately, the toolkit is intended to support reflective discussions together that build a deeper shared understanding of infant mental health, which we hope will lead to more effective action to support our youngest children’s wellbeing and development.

References

• Homonchuk, O., & Barlow, J. (2022). The commissioning of infant mental health services in the United Kingdom: A study of stakeholder views. Child: Care, Health and Development, 48(2), 217-224.
• Understanding and supporting mental health in infancy and early childhood
• A toolkit to support local action in the UK. https://www.unicef.org.uk/campaign-with-us/early-moments-matter/early-childhood-mental-health-toolkit/