This week is Mental Health Awareness Week and a range of events and activities are taking place to increase understanding of mental health, address stigma and campaign for change.
Many people will use the term mental health without pausing to consider what they really mean by it. The same words can often mean different things to different people.
Being mentally healthy is a positive state that enables us to enjoy life and deal with challenges. It is not just the presence or lack of diagnosable conditions. Helping people to be mentally healthy involves a wide range of different activities to promote well-being and prevent illness; to identify and understand problems or illnesses when they do occur; and to provide effective treatment, management and care.
However, when the term mental health is used, it is often used in a way that is synonymous with mental health problems. We see this reflected in some statements and discussions during Mental Health Awareness Week, which focus on the accessibility, availability and quality of NHS mental health services – rather than setting out a broader vision for a mentally healthy society (where they might be a reduced need for such services).
I’ve written before about how the UK Government’s decision to move from a Mental Health plan to a Major Conditions strategy marks a transition from a focus on a mentally healthy population, to a focus on treatment of mental illness – a missed opportunity to consider how we ensure our babies, children and young people are mentally healthy now and are building the foundations for a happy and healthy future.
In the new UNICEF UK and PEDAL toolkit, Understanding and Supporting Mental Health in Infancy and Early Childhood, we unpack some of the traditional conceptions of mental health which focus on diagnoses and an individualistic, deficit model of mental health. We also set out a new framework which describes what it means for babies and young children to be mentally healthy.
Our positive framing of mental health, and our aspiration for children to have a mentally healthy childhood, reflects how The United Nations Convention on the Rights of the Child frames governments’ roles in childhood. The UNCRC states that governments must do all they can do ensure that children develop to their full potential (Article 6); that children have the right to the best possible health (Article 24) and that children have the rights to play, relax and take part in a wide range of activities (Article 31).
This also reflects the desires of parents and wider communities: we want our children to be happy and healthy. As a mum, I do want mental health services that are timely, appropriate, accessible and effective for babies, children and young people who need them. But, ultimately, I would much rather that my kids do not need to use mental health services. I would like the Government to have a mental health strategy grounded in an ambition that more children have a mentally healthy childhood, not only to focus on the provision of mental health services for those who are struggling. Polling for the Royal Foundation found that across the wider population, most people identified reducing mental health problems and creating a happier society as the most important reasons for investment in early childhood.
Not all mental health problems are preventable, but at a population level, we can reduce their prevalence. At PEDAL, we are contributing to understanding of what can be done to promote and protect babies’ and young children’s mental health. Our research – such as the Healthy Start Happy Start trial – shows that effective interventions can reduce the incidence of mental health problems.
In the new UNICEF UK and PEDAL toolkit we share a socio-ecological model of mental health, which cites mental health within families, relationships and communities. This describes the wider levers that can be used to help more babies and children to be mentally healthy. Addressing child poverty, for example, would make a substantial impact on our children’s mental health. Moving away from understanding mental health in terms of diagnosed conditions and individual deficits also opens our minds to different models of mental health services.
I know from nearly 15 years of working in infant mental health, that people are uncomfortable with the idea of infant mental health provision because they try to fit babies into a model that sees mental health services as individual therapeutic services for those with clinical diagnoses.
I’ve written and spoken many times about the Baby Blindspot in mental health care in the UK. Many mental health services do not provide suitable therapeutic care to babies and young children who need it. Progress has been made in addressing this across the UK in recent years. But we still hear that some mental health commissioners do not believe it is within their remit to commission services for babies and young children, because these services operate differently from traditional mental health services.
Mental health services for babies and young children do not work only with individuals but with dyads and relationships. They work therapeutically with babies, with their parents or caregivers, and with the vitally important relationships between them. These services also work with families on the basis of risks to early relationships rather than working with individuals based on clinical diagnoses.
Reframing what it means to be a Mental Health Service is critical to ensuring we have services that meet the needs of all of our children, including the youngest.
If we continue to hold on to a definition of mental health focused in deficits and diagnosable conditions, we will – to paraphrase Desmond Tutu – remain fixated on pulling people out of the river. A broader view of mental health also enables us to look upstream to see what we can do to stop people from falling in.
I hope that Mental Health Awareness Week can encourage a moment of reflection on what mental health means, and the role we can all play in ensuring more babies, children and young people have a mentally healthy childhood.