Infant and early childhood mental health: the case for action (RCPsych, 20 October 2023)

Summary

Research clearly demonstrates that from conception onwards, rapid brain development influences the cognitive, emotional and social development of babies and young children. Pre-conception to five years is an important time in a child’s life and critical for brain and psychological development, the formation of enduring relationship patterns, and emotional, social and cognitive functioning – all of which are foundations for healthy development, but which can also confer protection against mental health conditions. The establishment of sensitive, attuned and responsive relationships is essential for positive mental health and wellbeing and underpins interventions to address problems in social and emotional development, poor mental health and mental health conditions in under 5s.

This report by the Royal College of Psychiatrists (RCPsych) aims to outline the importance of mental health in babies and young children under 5 to policy makers, commissioner and healthcare practitioners.

Content

Recommendations

1. Government across the four nations of the UK to prioritise the mental health of under 5s through the delivery of a cross-government strategy with designated ministerial responsibility, an implementation plan underpinned by appropriate funding to meet the scale of need, a multi-agency workforce capacity and training strategy and a national, multi-agency shared outcomes framework.
2. Government and multi-agency stakeholders to transparently agree on the level of population coverage of different public mental health interventions for under 5s and their families. Stakeholders should include children and young people, parents/carers, primary care, secondary care, secondary mental health care, social care, health and social care leaders, early years childcare, preschool and primary schools, public health, voluntary sectors and government. 
3. Provision of the resources and trained workforce required to deliver an agreed population scale, sustainable, integrated, multi-agency stepped care approach to mental health of under 5s, proportionately targeting higher risk groups.
4. Introduction of routine, regular government-funded data collection on the mental health and wellbeing of under 5s and families, and on the level of provision of public mental health interventions, with a nationally agreed outcomes framework for early childhood development. This will inform regular assessment of the public mental health implementation gap for babies and young children, including for higher risk groups, in order to monitor progress towards agreed coverage targets and early childhood outcomes.
5. Introduction of a national competencies framework for work with under 5s, and a national workforce training strategy. A multi-agency, multi-disciplinary workforce capacity and training strategy should support professionals from all sectors (psychiatrists, psychologists, psychotherapists, paediatricians, primary care professionals, social care professionals, health visitors, midwives, family hubs, early education and care practitioners, public health and policy makers) in their role with respect to the mental health needs of babies and young children.  
6. Development of an RCPsych training strategy for all psychiatrists. The Royal College of Psychiatrists will ensure that the Core Training Curriculum for all psychiatrists and the Higher Training Curriculum for general adult psychiatrists, includes basic training on assessment and interventions with respect to parent-infant relationships, attachment behaviours and the ways in which babies and young children can cue and/or miscue their needs. The Higher Training Curriculum for Child & Adolescent Psychiatrists and Perinatal Psychiatrists respectively, will include relevant specialist training in the assessment and intervention of parent-infant relationship difficulties and mental health conditions in under 5s, including neurodevelopmental disorders and the signs and symptoms of childhood adversity. The RCPsych will launch an online training programme in infant and family mental health for consultant grade and Specialty and Specialist (SAS) psychiatrists which can be accessed by practitioners from other sectors, including, for example, GPs, health visitors, and social workers.
7. Services for babies, young children and their families to be co-produced with those with lived experience. This requires working in  partnership with a range of individuals with intersecting identities across race, gender, ethnicity, sexual orientation, and disabilities (as outlined in equalities legislation) to ensure that the delivery of evidence-based interventions reflects the needs of the population it serves. Meaningful co-production in parent–infant work puts the voice of the child at its centre.
8. Further research in a number of areas, including how to support improved implementation of evidence-based interventions for under 5s to treat mental health conditions, prevent mental health conditions from arising and promote mental wellbeing.
9. Promote population understanding about the mental health and wellbeing of babies and young children. This would include actions to address societal stigma about mental health conditions in under 5s and include increased early years public mental health education that is family focused and highlights the importance of the prenatal care, child–parent relationships, the impact of adverse childhood experiences, and how parents and practitioners can access the relevant public mental health interventions at the right time.