Mental Health Matters: Ministers and ICBs told to act on ‘baby blind spot’

Ministers and health commissioners are being urged to prioritise the mental health of children under five, as leading psychiatrists warned service provision and expansion is not keeping pace with the rise in youngsters developing long-term conditions.

The Royal College of Psychiatrists recently launched a report calling on ministers and integrated care boards to introduce new multiagency specialist services for under-fives.

It comes as rates of probable mental disorders in children aged seven to 16 rose from one in nine (12 per cent) in 2017 to nearly one in five (18 per cent) by 2022.

RCPsych’s report said early action is vital, given that half of mental health conditions arise before the age of 14. It said that in England, before the rise in demand prompted partly by covid-19, more than 100,000 (5.5 per cent) of two to four year-olds struggled with anxiety, behavioural and neurodevelopmental disorders.

Experts warned there is a treatment gap – described as the “baby blind spot” – with most babies, under-fives, and parents not receiving help to address risk factors to children developing a mental health condition, such as smoking during pregnancy and domestic violence/abuse.

The college found almost half of all child and adolescent mental health services in England do not accept referrals for babies and children under 36 months, despite ambitions in the NHS long-term plan to create 0-25 services. 

Consultant perinatal psychiatrist Dr Trudi Seneviratne, also RCPsych registrar, said the period from conception to five is crucial for securing healthy child development.

She added: “The majority of under-fives with mental health conditions are not currently receiving the level of support necessary to help them become productive, functioning adults… That’s why we’re calling on the government to roll out comprehensive services.”

Calls to scale up infant teams

To bridge the gap, some areas have launched specialist parent-infant teams, which sit within CAMHS and social care.

These are multidisciplinary teams of psychologists and psychotherapists offering direct support to families, including targeted work with families experiencing emerging relatonship difficulties. Specialist interventions are used where babies’ emotional wellbeing and development is particularly at risk. 

Interventions include parent-infant psychotherapy and video feedback approaches, where practitioners (usually CAMHS professionals, health visitors, or psychotherapists) film babies interacting with parents/carers.

There are currently 45 such teams in the UK, with 14 more in development. Families are referred due to concerns about difficulties in early relationships, and unlike other mental health services, clinical diagnosis is not required.

The Parent-Infant Foundation, supporting implementation of teams, is calling on ministers to set a target of establishing 400 within five years.

They believe this could support around 59,600 babies and families, and although it means a large scale-up, they believe it is a comparable target to the LTP ambition for at least 66,000 women with moderate to severe perinatal mental health issues to access specialist community care.

Babies’ needs overlooked

Ben Yeo, child and adolescent psychotherapist at a London-based parent-infant team, said their unique role is to offer specialist assessment in response to NICE guidelines relevant to the parent-infant relationship. 

He told Mental Health Matters: “The needs of the baby are really central to that assessment and care planning, which is focused around the baby – not necessarily on a particular adult or parent. It may be the whole network around that baby, so it could be parents, carers, and additional services. 

“The role we are playing is champions for the parent-infant relationship across the system. There can often be a baby blind spot… sometimes the needs of the baby can be overlooked.”

Many integrated care systems have “start for life” as a strategic priority, but services sitting underneath such programmes remain highly variable.

A recent report from Parent-Infant Foundation, which seeks to serve as a summary of available evidence, says barriers cited by commissioners to growing such teams include lack of access to evaulations or good practice examples.

RCPsych cited findings of a UK survey which suggested most geographical areas do not have access to a specialist parent-infant team and, where they exist, most lack sufficient resources to meet demand. 

Its report urges the government to provide a guarantee of a range of universal, targeted and specialist services in every area — through a funded cross-government strategy with designated ministerial responsibility.

The college said such a programme — dropped by government in favour of a major conditions strategy — would help establish national workforce and training strategies to build up provision.

The Department of Health and Social Care recently announced £5m for early support hubs, providing counselling and psychological therapies to those aged 11-25, without a referral. 

While the £5m was welcomed, sector leaders told MHM there needs to be further investment to roll out nationally and for younger chidlren, which RCPsych estimates would cost £103m annually.

A DHSC spokesman said: “The mental health and wellbeing of babies, children and their parents is paramount. That’s why, earlier this year, we announced a £500m package to transform family support.

“This includes £100m to provide mental health support for families and promote positive early relationships between infants and their caregivers.”

In guidance for the programme, DHSC notes the £100m should be used to develop or maintain existing provision to increase access, rather than create new services.