Mental Health (Infants)

Tuesday 26th October 2010 Westminster Hall

Motion made, and Question proposed, That the sitting be now adjourned.—(James Duddridge .)

09:30

[Andrea Leadsom (South Northamptonshire) (Con)]

On the face of it, infant mental health might appear to be a bit of a narrow topic, but I want to explain why the mental health of infants in fact makes a huge difference to the whole fate of our society. Human babies are unique in the animal kingdom in terms of the extent of their underdevelopment at birth. What other animal cannot walk until it is one year old or fend for itself until it is at least two years old? Physical underdevelopment is only a tiny part of the matter; the human brain is only partially formed when a baby is born. The billions of neurones in the brain are largely undifferentiated at birth and parts of the brain are simply not there. A human baby’s earliest experiences will literally hard-wire their brain and have a lifelong impact on their mental and emotional health.

I want to set the scene by giving a couple of fictitious examples that are common in 21st-century Britain. I shall then explain how those situations might affect the babies concerned. First, let us consider the case of a fictitious 15-year-old called Sarah who lives with her mum, stepfather and three half-brothers in social housing. Her stepfather abuses her and she has told her mum, but she does not believe her or does not want to believe her. Sarah feels unloved and unsupported and, when she is 15, she meets a boy at school and gets pregnant. She applies for a council house as a single mum and gets it—so far, so good. Sarah is really looking forward to the birth of her son because, at last, she will have somebody to love her. The trouble is, when Jack is born, he does not seem to love her at all. He just screams, messes his nappy and eats. After a few weeks of doing her best, Sarah cannot stand it any longer. She leaves Jack screaming in his cot and goes out for the evening. She gets back late and rather drunk, and Jack is still screaming in his cot. Sarah loses her temper, kicks his cot and screams at him to shut up and leave her alone. We can imagine how things carry on for Sarah and Jack. She is an unloved child herself and Jack pays the price.

Let us consider another fictitious story that is just as common. Liz and John are successful lawyers in their 30s who are well off and enjoying life. They leave it quite late to have a baby and end up using in vitro fertilisation to help them conceive. Luckily, Liz becomes pregnant quite quickly with twins, but the joy stops there. She feels sidelined in her career and resentful of her husband because he is fine and she is not. The babies are born prematurely and are whisked off to incubators for several weeks. When Liz finally takes the babies home, it takes a long time for her to realise that they are truly hers. She is one of the three in 10 women who suffer post-natal depression. She looks after the twins as best she can, but more than a year passes before she can truly say that she loves them.

I am sure that most of us in this room have heard of such cases. Stories of poor bonding or, to use the more technical term, insecure attachment are all too common in the western world. However, what is not so well understood is the impact on the baby’s brain development of a key carer—usually the mum—being unable to meet the baby’s needs. So what is meant by the term “having your needs met”? When a baby cries, they do not know that they are too hot, too cold, bored, tired or hungry. All they know is that something is wrong. So they cry and rely on an adult carer to soothe their feelings. Many of us will remember long nights spent walking up and down the landing, joggling a baby and saying, “Go to sleep, go to sleep.” That is what loving adults do for their babies.

This is not about giving parents a guilt trip. We all feel guilty at times about the things we wished we had done, the times we shouted at our babies or the times we left them to cry because we could not take any more and so on. This is about being a good enough parent. That does not always mean being there the instant the baby cries every single time, but being there enough for the baby to realise that generally the world is a good place and that generally adults are kind. The baby who learns about the world as a good place will retain that sense almost as an instinct for life. The baby’s brain will be hard-wired to expect a certain reaction from other human beings and that baby’s mental health will be secure throughout the child’s life. Such an individual will be more robust than a baby whose needs are not met. However, for the small but significant minority of babies who are neglected or abused, there are two critical impacts on the development of the brain.

A baby cannot regulate their own feelings at all. If their needs are not met, they will simply scream louder and louder. If nobody comes, eventually they will take refuge in sleep. So the first impact is that a baby left continually to scream will experience raised levels of the stress hormone cortisol. Excessive amounts of cortisol can do permanent damage to the baby’s immune system. Evidence suggests that a baby left to scream throughout babyhood will have a higher tolerance to their own stress, and that violent criminals have a very high tolerance to their own stress levels, which they developed back in babyhood. Inevitably, if someone has a high tolerance to stress, they need to indulge in high risk-taking behaviour even to feel the same level of excitement that we might get from an exciting hand of bridge. There are real issues surrounding leaving babies to scream incessantly.

The second and most amazing impact on the baby who is neglected or abused concerns the social part of the brain—the frontal cortex—which starts to develop only at around six months. The peak period for development of that part of the brain is at six to 18 months old. Growth is stimulated by the relationship between the baby and the carer, for example, through things such as peekaboo games, hugging, looking into each other’s eyes and saying, “I love you. You’re gorgeous.” Such activities between a loving parent and a baby all play a very strong role in the development of the social, empathetic part of a baby’s brain.

If a baby does not receive any attention—I am sure we all remember the Romanian orphans who were left in cots to hug themselves, and did not speak to anyone or have any emotional or physical contact whatsoever—that social part of the brain may never grow. There can actually be a long-term brain damage impact on the baby, the child and later the adult. That has profound implications for society. A human being without a properly developed social brain finds it extremely difficult to empathise with other human beings. In particular, if a baby has what is known as disorganised attachment—where one or both parents are frightening or chaotic—they cannot form a secure bond precisely because the person who is so frightening and chaotic is also the person whom the baby should be turning to for comfort. The baby’s brain is confused and they experience disorganised attachment, which leads to very significant problems for that baby.

If we look into the babyhood of children who brutalise other children, of violent criminals or of paedophiles, we can often see plenty of evidence that sociopaths are not born; rather they are made by their earliest experiences when they are less than two years old. Evidence shows that more than 80% of long-term prison inmates have attachment problems that stem from babyhood. It is believed that up to two thirds of future chronic criminals can be predicted by behaviour seen at the age of two. A study conducted in New Zealand showed that a child who exhibits substantial antisocial behaviour when they are aged seven has a twenty-twofold increased chance of criminality by the age of 26.

[Mr Robert Buckland (South Swindon) (Con)]

I congratulate my hon. Friend on securing the debate. She makes a very important point about the correlation between people in prison and the problems she has outlined. Is she also aware that a very large number—I think it is some 75%—of our young inmates have some form of speech, language or communication difficulty that, no doubt, at least partly results from the circumstances of their upbringing and the early years that she is talking about?

[Andrea Leadsom]

I thank my hon. Friend for his intervention, with which I completely agree. There is no doubt that all sorts of developmental issues are affected by the earliest relationship, including communication. Why does poor attachment arise? Often, it is the result of parents’ unhappy lives. A mother who was not attached as a baby to her own mother will often struggle to form a secure bond with her baby, as might a woman who suffers from post-natal depression.

[Annette Brooke (Mid Dorset and North Poole) (LD)]

I congratulate the hon. Lady on securing the debate. Given the examples that she has cited, which clearly are drawn from all sorts of backgrounds, be they deprived or affluent, as in the case she mentioned of post-natal depression, does she agree that keeping the universal service within Sure Start is vital?

[Andrea Leadsom]

I thank the hon. Lady for her intervention. I will come on to my thoughts on Sure Start later, but I believe that public funds need to be focused on the small but significant minority of families whose lives are chaotic and where the outcomes for the children without support can be truly disastrous, not only for them and their families, but for the whole of society.

A woman who suffers from post-natal depression might struggle to form a bond with her baby, as can parents with drug, domestic abuse or unemployment problems. Poor attachment is no respecter of class or wealth and crosses all boundaries. Sadly, the cycle of misery is often passed down through generations, as a woman who did not bond with her mother when a baby can then fail to bond with her own baby.

I stress again that this is not about making parents stay at home or carry their babies around 24/7. Attachment means building a bond with a baby so that they instinctively learn how to be part of a caring relationship. Where both parents work, or where there is a single parent or adoptive parents, attachment can be very secure. The point is that the less caring attention a baby receives from a familiar adult, the greater the risk of insecure attachment. A caring nursery worker could become an attachment figure for a baby, as could a nanny, a child minder and, of course, members of extended families. Where a baby’s home life is disturbed due to divorce, death, domestic abuse, drugs or even post-natal depression, it can be a positive experience for that baby’s quality of life to be in a sensitive and caring child-care environment where a loving key worker can become an attachment figure. Where a baby’s home life is happy and there is a strong bond with the rest of the family, a caring child-care environment is not harmful and can even add to the baby’s quality of attachment.

Where a baby’s home life is disturbed, however, putting it into an insensitive child-care environment can be a disaster. It is common sense that a baby can take only so much stress, change and disorder. If you pile up that stress and disorder, the baby will instinctively resort to the basic strategies of fight or flight, which all animals have, including humans. That translates, in baby terms, into either very passive behaviour, or aggressive crying.

A nursery might measure the contentedness of its baby room by how little crying there is, but ironically, a baby that has given up on having her needs met will sometimes withdraw, not making a sound and appearing very passive. Far from being a good sign, passivity can be an indicator of a future life that is inclined towards depression, a victim mentality or even self-harm. On the other hand, a baby who cries noisily and often could just be a fighter who has instinctively learnt that getting attention requires a huge amount of noise and aggression. Violent criminals have been shown to have a high tolerance to their own stress hormones, which means that they resort to high risk-taking behaviour in order to experience what are, to most of us, only normal levels of stress. Those two examples merely show that one cannot easily judge how contented and secure a baby is by the amount of crying they do. In fact, the quality of attachment experienced by a baby is hard to measure, even for an experienced professional.

Shockingly, research shows that 40% of children in Britain are not securely attached by the age of one. Of course, that does not mean that they will all go on to have behavioural or relationship problems, because other life events will also play a key part, but it does mean that they will be less robust in their emotional make-up to meet the challenges and disappointments of life. They may also struggle as parents later in life to form strong attachments to their own babies, thus perpetuating the cycle of misery through generations.

I draw some conclusions from that. Poor attachment may well lie behind the UNICEF report that shows that British children are the unhappiest of those in the 21 countries in the developed world. Poor attachment might also account for our high teenage pregnancy rate, as mums who are themselves children are looking for love, and for our high divorce rate, with many adults being unable to form long-lasting relationships. Some of the statistics issued by the Office for National Statistics over the past decade show that almost 80,000 children and young people suffer from severe depression and that 95% of imprisoned young offenders have a mental health disorder. All those facts point to the devastating consequences of poor early relationships.

Human misery is only one feature of insecure early attachment; there is also the vast financial impact on the public purse of dealing with its consequences. The charity, Railway Children, estimates that up to 100,000 children are at risk on the streets in the UK every year. Each looked-after child costs the taxpayer £347 a day, or £126,000 a year. Each adult prison inmate costs the taxpayer £112 a day, or £40,000 a year. Each person in acute psychiatric in-patient care costs the taxpayer £225 a day, or £82,000 a year. No assessment is available for how much of that expense is the direct consequence of poor attachment, but in the terrible case of baby Peter, I remember asking myself what mother could allow her boyfriend literally to torture her baby, unless she simply had no bond with him? What would have become of him had he lived to grow up with his appalling babyhood experiences?

Therefore, what can we do to promote better infant mental health? The astonishing thing is that if we tackle insecure attachment early enough, ideally before the baby is one, it can be turned around quickly, to the huge benefit of baby and carer, and to the public purse. I was chairman for nine years, and remain a trustee, of the Oxford Parent Infant Project, which is an Oxfordshire-wide charity providing specialist psychotherapeutic support for families struggling to bond with their babies. OXPIP has worked successfully with Oxfordshire social services, health visitors and GPs for 12 years. Highly trained parent-infant psychotherapists work with a carer, usually the mum, but sometimes the dad, grandparents or foster parents, to improve the quality of their relationship with the baby. It sounds incredibly simple, but it has dramatic consequences for the baby’s lifelong mental health

The average cost of OXPIP-style intervention is £75 a week for each family, and in many cases 10 visits are enough to make a significant improvement in the quality of attachment and to set the family on a positive path. In other cases, families receive support for up to a year or more, at a cost of around £4,000. In a small number of cases, OXPIP provides expert evidence to the family courts when a baby is deemed to be at risk. OXPIP receives self-referrals from desperate parents and also sees clients referred by health visitors, GPs and social services. There is no doubt that it saves lives, and a fortune. The cost of helping a family for a year in that way is around £4,000, whereas keeping a child in care for a year costs £126,000.

I will finish with a specific call to action for the Government. I know that so much good work is being done already through the Centre for Social Justice and the review that the hon. Member for Nottingham North (Mr Allen) is carrying out on behalf of the Department for Work and Pensions. I pay tribute in particular to my right hon. Friend the Secretary of State for Work and Pensions, the right hon. Member for Birkenhead (Mr Field) and the hon. Member for Nottingham North for their commitment to helping children have a better future. There is plenty more than can be done, costing little to the public purse but giving huge benefit to human happiness and the health of our society.

First, I would like the Government to reconsider the 15 hours of educational help for each disadvantaged two-year-old. Instead of money being spent on preparing the toddler for school, it should go to supporting the parent-baby relationship before the baby’s first birthday if the home life is chaotic or frightening. Helping parents to support their baby is the best route to helping the most disadvantaged children in our society.

Secondly, I applaud the Government’s decision to provide 4,200 new health visitors. They do such valuable work for families, but they receive little training in the critical importance of secure early attachment. I urge the Government to require every health visitor and social worker to be trained to understand and spot families at risk. OXPIP provides such training, and it is highly valued by the recipients.

Thirdly, there needs to be an opportunity for onward referral to specialists in parent-infant psychotherapy when a health visitor identifies a real need. I recognise that the budget to do this kind of work is not available right now, but I urge the Government to consider a pilot scheme, perhaps as a result of the review that the hon. Member for Nottingham North is doing, and proactively to seek the evidence that would prove the value of early years intervention.

I am hoping to establish a pilot parent-infant service in my constituency of South Northamptonshire, and I am confident that other pilots could be established and evaluated in children’s centres around the country at a low price to the public purse. In fact, the director of children’s services in Northamptonshire told me that, in a previous role, he was able to balance his children’s services budget by focusing on early prevention. He was able to save on the budget for looked-after children and bring the cost of the entire service down by prevention. The impact on the public purse as well as on the human happiness of children is key.

Fourthly, where a baby spends more than a few hours a day in a child care environment, there should be protocols in the nursery that ensure that the attachment needs of the baby are addressed. They could include a far greater focus on the key worker relationship, so that one adult carer does all the intimate activities with the baby such as nappy changing, feeding, and morning and evening handover to the parents. There are plenty of opportunities to maximise the sensitivity of the child care environment to support the attachment needs of the baby.

Some nurseries and many child minders and nannies make the baby’s emotional well-being a high priority. Some of them recognise the importance of what they do; for others, it is instinctive. One research establishment—again, in my county of Northamptonshire, the Penn Green nursery in Corby—is specifically researching the impact on the very young of life in a sensitive nursery. Such research could be used to develop protocols for all nurseries.

Fifthly, training in early attachment for child care workers is critical. The turnover of staff in nurseries is high, and often the staff are young and inexperienced. All those factors contribute to a greater risk of insensitive care in child care settings.

Sixthly, in the small percentage of cases where the family’s life is chaotic, frightening and violent, and there are child abuse concerns, adoption should be swift, ideally before the baby’s first birthday. I urge the Government to look again at the adoption legislation with a view to putting a greater focus on the attachment needs of the baby. Foster adopter arrangements, where foster parents may adopt the baby if things do not work out with the birth parents, offer much less risk to the baby in cases of doubt. The baby is able to form a bond with the foster parents, who may become the adoptive parents, and the birth parents until such time as a decision is taken in the baby’s best interests. Research shows that the approach has been successful for the baby because the adults bear the risks rather than the baby.

By coincidence, the first time I spoke in the Palace of Westminster about infant mental health was in 2002, on the day that the Victoria Climbié report was issued. Today, almost nine years later, I am speaking on the day that a baby Peter report is coming out. Please, do not let it take another nine years for some real action to prevent the next appalling tragedy. Prevention is not just kinder: in these times of austerity, it is also much cheaper than cure.

09:54

[Annette Brooke (Mid Dorset and North Poole) (LD)]

I wish to make a brief contribution to this debate. We are all the product of many complex factors, and therefore we always have to keep an eye on the whole situation. Having said that, I have had a long-term interest in attachment theory. This shows my age: I still have the original John Bowlby book, which was part of my set reading, on my bookshelf. It became a little unpopular because the women’s libbers of the 1970s were not too keen on the emphasis on mother staying at home, but it is interesting that attachment theory has come to the fore again. We see it in a much wider context, and we understand the point about primary and also secondary attachments. I would like to make a few points to the Minister.

Parts of what we are saying are so obvious when one starts playing with a baby, as the hon. Member for South Northamptonshire (Andrea Leadsom) said. The Worldwide Alternatives to Violence Trust showed me a presentation of an adult ignoring a baby—it almost seemed cruel—and one saw how the baby switched off entirely, and how totally different the situation was when someone engaged with the baby. However unscientific that might seem, all my instincts say that we really must take that on board.

From that follows the importance of early intervention. I applaud the coalition Government for setting up the review. There has been a great deal of work showing right across the board that if we invest huge sums of money in early intervention, we will save in the long run, but the decision was a brave one. It is important to have a formalised review and to plan how we go about early intervention.

I would like to focus on the whole-family approach because, as I said earlier, there are always so many complex factors that affect the life of a child. One might focus on parent or carer relationships with the child, but adult social services issues need to be addressed at the same time. A concern that I have expressed many times in speeches is that if we put the focus on children by splitting children’s services away from adult social services, in some authorities—this is not the case in all authorities by any means—the whole-family approach can be lost. It is vital that we have back-up services to deal with the parent-child situation. Indeed, there could be information from adult social services, such as information that there was an addiction of some kind among the adults. There is a lot of wraparound there.

The figure of 40% of children not being securely attached is striking and makes one think. I have heard of the excellent work carried out by OXPIP, and I congratulate the hon. Lady on that.

I wish to touch on situations where we have not picked up on problems—we have many of them to deal with at present—and on fostering and adoption. Throughout the many Committees on children’s legislation that I have served on, I have been concerned that not enough attention has been given to delivering mental health services. In the last Children and Young Persons Bill, which dealt with looked-after children, I failed to get an amendment accepted on Report. We achieved a requirement for a mental health assessment of children who were to be fostered—that was important—but I could not get an amendment accepted that would have ensured that the necessary health care would follow. I was told that it was an education Bill, and we were talking about health money.

How can we bring all the services together for the child and the family? When we are picking up the pieces later on in life—at the point of fostering, when psychotherapy might be vital—how will we get funding if we are approaching the matter from within children’s services? How will that all come together? In a recent case, problems began to escalate at school when the child of dedicated adoptive parents got to about 12. He felt totally bereft of support. It is interesting that any damage that happened early on may not manifest itself in an unmanageable way until quite a long way into the child’s life. We need to be aware of that. Although we have moved on tremendously—I am proud to have played a part in the previous Government’s legislation to tackle the situation of looked-after children—parents with adopted children need a lot of support. Legislation says that they should have immediate support, but they might need it quite a bit further down the line.

Looking at Sue Gerhardt’s work, the one hopeful thing is that damage can be undone. It is obviously easier to tackle it early on, but with a lot of work, we can make things better for the children and young people who deserve our support so greatly.

All hon. Members will be concerned about the amount of resources in children’s and adults’ mental health services. I should be grateful if the Minister could assure us that these vital services will be protected. We could stray into all sorts of areas in which children need support from their local child and adolescent mental health services; children with autism, for example, face long waiting lists. Parents of children with autism often say that they are talking to somebody in CAMHS who does not understand their needs fully. We need to give better support generally, across the board, and in particular, we need to do our utmost to improve CAMHS.

10:02

[Dr John Pugh (Southport) (LD)]

It is a privilege to talk in the debate under your chairmanship, Mr Bone. It is a tribute to your unswerving party loyalty over the years that you have got to your position.

I congratulate the hon. Member for South Northamptonshire (Andrea Leadsom) on starting an important and significant debate. I think we would all agree that the human infant, as she has analysed, has definite needs that go beyond the basic biological necessities of food, water and shelter. The human infant requires emotional support and, as the hon. Lady and my hon. Friend the Member for Mid Dorset and North Poole (Annette Brooke) have argued, an element of attachment—a mother or mother substitute—in the early stages to bond or imprint with. This is essential for wholesome psychological development.

The evidence for a child’s emotional needs is strong. I am aware of an experiment conducted with primates, in which a young rhesus monkey was separated from its mother but given two alternative “wire” mothers—wire constructions. One was surrounded with soft cloth and the other had milk attached to it. The monkey’s behaviour was interesting. It went to one mother for feeding, but after being fed it needed some comfort and went to the other mother and cuddled up close against it, requiring some tactile contact that was not strictly necessary in terms of its biological survival, but clearly deeply emotionally necessary. Some horrific but illuminating experiments have been done in this field. One recalls the behavioural psychologist, Watson, who endeavoured to bring up his child without any tactile direct contact but provided him with all the necessary immediate needs.

It is obvious that we have a raft of emotional needs over and above our ordinary biological needs. The lack of such contact—and the evidence about this lack—is always fairly apparent, showing itself in infants in rocking behaviour, attention-seeking, unresponsiveness and slow development. We also believe that we have discovered, in addition to these obvious symptoms of emotional deprivation and abuse, other effects that we would not have picked up without the benefit of modern science. For example, it has been argued that hormonal effects lead in turn to neurological effects, some of which are long term. Heightened aggression, for example, is suggested to be an outcome of poor attachment, and other social handicaps may ensue. The hon. Member for South Northamptonshire mentioned that psychopathy can be a consequence of severe lack of attachment.

The exact causal link between all these factors is not as clear as we would like to believe. In particular, ways of treating infants and neurological and behavioural outcomes are matters for debate. The evidence is complex and can be oversimplified; it has been contested in some areas and can be interpreted speculatively. We do not know enough about the effects of cortisol to be totally sure in this respect. We do not want to go down the Watson behavioural route to sort this matter out, conducting horrible, elaborate experiments on infants to find out what bottom-line evidence we ought to rely on.

We must recognise that the emotional deprivation and abuse endured by people in infancy is also overlaid in time by subsequent social and cultural differences. That slightly clouds the picture as well, and makes it rather more difficult to establish the clear causal links that the hon. Lady implied existed. If people believe in free will, there is an element of individual mediation at the end of the day. Despite all this, it is not difficult to spot when a child is turning out underdeveloped, unhappy and antisocial. Even if we disagree, according to our different values, about what constitutes a truly well-adjusted child, we certainly know when we have a severely maladjusted child on our hands. It is impossible to dismiss the role of first experiences in constructing those outcomes—that has been established for some time.

It is easier to identify failure than absolute success. After all, as my hon. Friend the Member for Mid Dorset and North Poole suggested, none of us does a perfect job of bringing up our children. All children—all of us—are brought up by amateurs. People do not get a set of children to practise on first until they get good at it. One recalls a quote from Philip Larkin, which I will not use here because it contains unparliamentary language, about the effects of parents on one’s general well-being. But it is still true that some people mismanage the process far more than others, even if none of us succeeds in getting it totally right. I recall Jack Dee’s remark, questioning the point of having children, because they only grow up to be teenagers and slag you off at parties. There is an element of truth in that.

There is a social policy issue concerning how we reduce incompetence, especially the worst sorts of incompetence that lead to the catastrophic effects that the hon. Member for South Northamptonshire mentioned. It is important that we find out what the state can do to encourage success, given that most parents appreciate some guidance, having never done the job before, and crucial that we find out what the state needs to do to avoid catastrophic failure—as in the case of baby P and other cases we could specify—or general failure, if that is what is happening.

The hon. Lady suggested that there is a general failure in society and quoted UNICEF statistics. She suggested that, collectively as a society—as a social group—we have something to learn. In a sense, that is what the debate on child care in the first two or three years in life has been about. There has been strenuous and long-standing debate about the conflict between the role of the mother as breadwinner and home-maker; about whether the social gains of early interaction in a nursery or child care environment are offset by emotional security; about whether encouragement to return to work is encouragement to short-change one’s child; and about whether the high percentage of nursery and child-minded children in our society correlate in an interesting way with levels of general child happiness. I will pass over that debate and leave it to hon. Members around me who are more expert than me, but I want to make two observations.

It is hard to generalise in this matter. I have two grandchildren. One took to everyone in the family very early and is very social, at home with other children, confident and assured, and I had a close relationship with the child from an early age. The other granddaughter has only just convinced herself that I am not an ogre. For the first few months of her life, she clung to her mother in a way that the first child did not. Not all children are the same, and not all homes are the same, so the consequences of keeping children at home with mum differ depending on whether the mother is middle-class and has lots of books and blocks and things, or is a heroin addict.

I do not want to embroil myself in a matter in which I have no expertise—whether the recommended techniques for dealing with babies in the early stages are correct. I do not want to get into the routine versus emotional spontaneity debate, about which there is plenty of literature that is scoured by many young mums as they take their first steps. However, the fame of experts in that field is usually in direct proportion to their tendency to challenge common sense. Books do not sell if they suggest something that is part of motherhood and apple pie, and has been well understood for years.

My fundamental point is that parenting is an art, albeit a rough art, that in some homes goes disastrously and persistently wrong. I had a chilling experience recently on a train. A young child of perhaps three or younger was being controlled by what seemed to be her grandmother. The child responded by producing expletives, which would have been a disgrace even in a football ground. The grandmother responded by saying things such as, “Please stop that because the man doesn’t like it.” The child showed the classic symptoms of one who has been brought up in the wrong environment with the wrong cues and has been given the wrong sort of discipline. It struck me as a disastrous way of carrying on.

When one witnesses such incidents, which are repeated in many places, and recognises the terrible consequences for the individual and their emotional stability, and the huge collateral damage for society, one starts seriously to think about what society can do to support parenting in general and to support such parents who, for whatever reason—it may not be their fault—are not making a good fist of it. Should good parenting be taught in children’s centres? I certainly believe so. Do we need more health visitors? I certainly believe that we do. Do we need to build the skills of often damaged people? I certainly believe that we do.

One hugely overlooked dimension is that we simply do not do enough in schools to inculcate good parenting, or do what we can to get across to young people who are coming up to being parents how parenting sometimes works and sometimes does not.

[Annette Brooke]

My hon. Friend is making some important points. Does he share my vision that it should be considered normal to have parenting classes, and not a reflection on someone’s inability to do something? If someone has a perpetual headache, they go to their doctor, and if they have a perpetual difficulty with a baby or toddler, it should be the norm for them to seek assistance. My ideal is to reach the cultural perspective that seeking help is the thing to do. We would then be able to move forward.

[Dr Pugh]

Yes, that is an important and valuable suggestion. I am trying to say that we should take pre-emptive action to encourage people to think about parenting and what goes wrong at a time when parents are thinking about all the other important issues of life. There is a lot of good practice on such subjects in personal, social and health education in schools, but the people who are pointed in that direction and encouraged to treat that area of the curriculum seriously tend to be not the most academically high-flying, and tend to be female. There tends to be an exemption for people who have better things to do, but there can be few better things to do than to teach generations to come how better to bring up their children. That can only add value to society as a whole, and happiness to people’s life.

One may waffle on about academies and put money into the pupil premium, but the biggest indicator and determinant of success in the education system and therefore in life is a strong, supportive home in which good parenting is attempted. We are inclined to pay lip service to that and do not spend sufficient time on it. We tend to spend more time thinking about other things such the bias with which history is taught.

[Andrea Leadsom]

On the importance of a supportive family for education outcomes, does my hon. Friend agree that there is a lot of talk about intervening at all levels and all ages, but a supportive family either develops very early or not at all? That is why I focus on the under-twos. That is the point when lifelong good relationships can be set up between family and baby. It is much more difficult to put things right with later intervention.

[Dr Pugh]

I thoroughly agree, and that bears out the point made by my hon. Friend the Member for Mid Dorset and North Poole about the family approach. The arrival of children often puts a strain on relationships and finances, and creates a series of difficulties for couples, which may have severe ramifications. I have attended Home Start events in my constituency at which mothers testified to the initial difficulties and isolation when they became mothers, and the support that they needed. In the past, that might have been provided in the neighbourhood or by an extended family, but is no longer there for many people, who need to be able to plug into facilities and groups—charitable, voluntary, social enterprise and so on—for help with their difficult job. Society must ensure that that help exists because we all recognise the importance of parenting.

One reason for the restraint in our support for teaching parenting is the liberal angst about being too prescriptive in our society, but we must get over that. We must prioritise parenting and invest in it. We must insist on its being taught in schools, and we must assess secondary schools on how well they do that, not only with girls but with boys. Every child in every school is likely to become a parent at some time. Some will do that well and some will do it badly, but unfortunately some will begin without the faintest inkling of what to do and without the experience of a good example, or even the awareness that getting it right matters.

None of us can ultimately escape the inevitable guilt that parents feel about not having been a better parent, but we must not let people go out into the world without knowing what they should do or, worse, not caring whether they do it well or badly. The fundamental point made by the hon. Member for South Northamptonshire was that early years and early months are crucial determinants of someone’s fundamental personality. Freud also made that point, and even said that how someone is born matters. I must declare an interest. I was born easily and during a good summer, and I was a contented baby, which is probably why I became a Liberal Democrat.

10:19

[Emily Thornberry (Islington South and Finsbury) (Lab)]

I congratulate the hon. Member for South Northamptonshire (Andrea Leadsom) on the great passion, and knowledge of the subject, that she has shown us all today, and on securing this debate. I pass on my best wishes to OXPIP—the Oxford Parent Infant Project—for its good work. I hope that it will continue to go from strength to strength. I am today also speaking as a mother of three, and as the former chair of the all-party group on maternity. I have listened with great interest to the debate and to the thoughtful contributions from the hon. Members for Mid Dorset and North Poole (Annette Brooke), and for Southport (Dr Pugh). At times, I thought that I must have strayed into the House of Lords, given the level of expertise that we have heard.

I do not agree with some of the points raised. I do not agree that all parents are amateurs; I believe that the vast majority of parents are experts, but only in their own children. Of course, there are some catastrophic failures, but I believe nevertheless that it is important for parents to develop confidence in their ability to look after their child. I remember beginning parenting with an understanding that I needed to love the child, but with little further understanding. I still remember holding a copy of a book by Penelope Leach in one hand, the baby in the other hand, and looking up how to hold the baby. One struggles on, and that did not make me any less of a mother. I learned quickly on the job and was committed to it. I quickly became an expert, to such an extent that I remember showing off to my mother because my baby did not have a bald patch on the back of his head. My mother pointed out that that was because I had never put him down. Perhaps that was my own version of the application of the attachment theory.

The importance of the attachment between parents—or an adult—and a child in the first two years of life has been greatly highlighted by child psychotherapists. Those years are when the prefrontal cortex develops, which brings awareness of our emotions and those of the people around us. The infant mind is not born, but builds like a muscle over the first two years in response to parental attention and attachment. That theory has been around for some time. Attachment is considered to be a bond that develops from a child’s need for safety, security and protection. Positive attachment experiences stimulate feel-good chemicals and help build pathways in the brain that support the development of higher-level functioning and help with things such as attention, memory and impulse control. Missing attachment can give a sense of insecurity, suppress neural development and stimulate stress hormones in the brain. The weight of research has been brought to the attention of policy makers and the public by people such as Sue Gerhardt, who founded OXPIP, and who has built consensus for the view that we must focus on intervening earlier than we had thought.

The importance of early intervention was recognised by the Department for Children, Schools and Families in its report, “Early intervention: Securing good outcomes for all children and young people”, which made a strong case for expanding early intervention policies. According to the Prime Minister, the new Government will be the most family-friendly ever, so perhaps expectations are high that increased support will be available to new parents. Unfortunately, as the Institute for Fiscal Studies has pointed out, families with children seem to be the biggest losers in the comprehensive spending review.

The fierce debate about the long-term detrimental effects, or not, of day care has been fuelled by superficial and irresponsible reporting in the media. The question is whether the day care is good day care. What plans do the Government have to ensure that day care remains of a high quality, so that those parents who choose to put their child into day care do so in a way that benefits the child and assists in their development?

As highlighted today, maternal depression is an important issue. Under the previous Government, there was the introduction and great expansion of psychological therapies. Do the Government have any plans to target new mothers who have post-natal depression? There is also the problem of parents and substance misuse.

Another policy issue that has been raised is that of health visitors. I welcome the Government’s announcement that the number of health visitors will increase by 4,200. They will give support and encouragement to new parents, which, from my own memories, is invaluable. When will those new health visitors be in place? Will they receive specific training in mental health, and if so, what sort of training? Where will the funding come from? I understand that it is likely to come from Sure Start, and although the Government have said that Sure Start is safe in cash terms, if a large amount of money is taken out to pay for health visitors, how much will Sure Start be short?

Sure Start has an important role in bringing together cross-disciplinary services and providing an atmosphere of trust. In areas such as my constituency of Islington, Sure Start services are interesting because we have the very rich living next door to the very poor. If the Government’s new policy is to target Sure Start services on the poor, the concern is that there could be some form of stigma attached to getting involved in Sure Start.

Alison Ruddock, the head of Islington’s early years programme, fears that Government plans could set such services back 20 years in a borough such as mine, which ranks as the sixth most deprived in the country, despite there also being great wealth in it. She says:

“The fact that we have a mixed population is hugely to our advantage…We haven’t got rich centres and sink centres. So the most disadvantaged children are shoulder to shoulder with the most advantaged. If you have a service for poor children, it’s very difficult to prevent that from becoming a poor service.”

If one says to a parent, “There’s a stay-and-play centre on your estate; it’s really fun, why don’t you come?”, they will often say yes. However, if one says, “Let’s sit down and fill in a massive form, and you can tell me all your problems,” the parent is likely to say no. The problem will be the effectiveness of Sure Start, which over the past few years, as far as we are aware, has given huge support to parents.

Action for Children estimates that for every £1 of public money spent on Sure Start, we save £4.60 in the long term. Ofsted only began inspecting Sure Start in April, and it may be too early to judge matters technically. However, in our heart of hearts we know that Sure Start has been a good policy lever. If it is to be changed, we must be confident that it will not be undermined. I understand that there will be early intervention grants. Can the Minister provide any further details about those? I am sure that she has heard concerns from councils that that might not be enough, and that early intervention projects might close, as opposed to expanding.

I would also like to highlight the issue of GPs. Although health visitors are important for new mothers, GPs are important, too. However, up to half of GPs have no formal training in paediatrics and child care, despite a quarter of their patients being children. In many terrible tragedies, some of which have been mentioned today, we see an involvement of GPs that has simply not been up to the mark. I echo the question from the hon. Member for Mid Dorset and North Poole about whether the Minister can provide an assurance that funding for child and adolescent mental health services will not be cut. If the Government go ahead with the proposed abolition of primary care trusts, will they have the policy handles to ensure that such vital services are not cut?

I conclude by congratulating the hon. Member for South Northamptonshire on raising this issue. The quality of the debate this morning has been high, and it is a great shame that there are not more people in the Chamber to contribute to it.

10:28

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

It is a pleasure to serve under your chairmanship, Mr Bone, which I have not done before. I start by echoing the comments by the hon. Member for Islington South and Finsbury (Emily Thornberry): it is a shame that more people do not listen to some of these debates. This debate has been of a high quality and is particularly poignant in that the serious case review on baby Peter is published today. Perhaps somewhere out there a member of the press will pick up on it, and realise that hon. Members across the House from all political parties are working together, to a large extent outside party political lines, to ensure that we get this issue right for families.

I congratulate my hon. Friend the Member for South Northamptonshire (Andrea Leadsom) on securing this important debate on a subject that is almost fundamental to everything else that we do. I am aware that she has maintained an active interest in infant mental health for a number of years as the former chairman and trustee of the Oxford Parent Infant Project. Its work was rightly recognised earlier this year when it was one of five winners of a national award from the Centre for Social Justice. I congratulate it on that; it is good to see its invaluable work recognised in that way.

My hon. Friend described with some clarity the significant impact of early parenting, the huge challenges that exist for some families, and the problems that ensue from poor parenting that falls short of the therapeutic, loving and securing attachment that children so desperately need. She mentioned the UNICEF report that cited us as the lowest of 25 industrialised countries. It is shocking that we are at the bottom of that table for the well-being and mental health of our children. She highlighted the fact that there is not one best route to get this right. The hon. Member for Southport (Dr Pugh) also talked about it. A huge variety of support is needed if we are not to lose people in the gaps. It is vital that we approach the matter from a multifaceted direction.

Early years intervention is being actively examined by the Minister of State, Department for Education, my hon. Friend the Member for Brent Central (Sarah Teather). We are working closely together. I have been hugely impressed by the work that we have achieved to date and the work that is ongoing. There is no doubt that we will not achieve what we want if we come at the issue from different silos of Government Departments. My hon. Friend the Member for South Northamptonshire is right to cite the growing evidence for what interventions work and to refer to fostering, looked-after children, adoption and a number of other issues on which I can assure her that I am working and will continue to work with other Departments.

There is increasing evidence about the importance of early life and warm parenting. An infant’s early experiences have a long-lasting impact on their future health, relationships and happiness. There are also important intergenerational effects. Warm, positive parenting and a strong bond between a mother and baby, as well as the father, lay the foundation for health and happiness throughout life.

I am a mother of four children, aged from 26 to 14. I feel like getting out my 26-year-old from a cupboard and saying, “This is one I prepared earlier,” to demonstrate to those who are struggling through the teenage years with their children that it does all turn out right in the end. However, parenting, from whatever background we come, is a challenge. I found it challenging. Even though we might not be in quite the situation that other parents are—we might be better resourced; we might have more money and be in better housing—all of us, in our lives as parents, have had a taste of the tensions and stresses that people feel, and can only imagine what things might be like if we did not have adequate housing and were living with three children in a one-bedroom flat.

The Government are determined to ensure that all families have the right support at the start of life. Health visitors are central to that by providing advice and support through pregnancy, after birth and through the pre-school years, supporting healthy child development and promoting parent-child attachment and positive parenting models. It was a pleasure for me to talk at the health visitors conference last week and re-emphasise our support for health visitors. We want more people in the profession and more people back in the profession to ensure that we have that universal visiting service. That is why, as my hon. Friend will be aware and as hon. Members mentioned, we are investing in 4,200 new health visitors by the end of this Parliament. That is an ambitious target, but we will do everything, pull out all the stops, to ensure that we achieve it. In last week’s spending review, my right hon. Friend the Chancellor of the Exchequer confirmed that the money is there to recruit and train those health visitors.

We also have the healthy child programme to provide the opportunity for health professionals to identify where additional parenting support is needed. Leading and delivering the healthy child programme, health visitors are well placed to identify those families, give them extra support and help them to access more specialised services. We have seen quite a significant decline in the number of health visitors, from just over 13,000 in 2004 to just over 10,000 in 2010, at a time when the birth rate is increasing, and we need to turn that round. The message must go out loud and clear to health visitors: “We want you, we need you and parents and the future generation need you.”

The chief nursing officer is working with the Community Practitioners and Health Visitors Association to define what makes a modern health visitor. The hon. Members for Mid Dorset and North Poole (Annette Brooke) and for Islington South and Finsbury mentioned training and whether there is adequate training on things such as mental health issues. It is extremely important that we get that right. The service model that has been built makes clear the value of health visitors and the contribution that they make to better family and community health. Next year we shall move on to a national recruitment drive for health visitors, and we are working on better training options for returners and new recruits, so that a bit more flexibility can be built in to attract people into the profession.

I want to say a few words about family-nurse partnerships for the more vulnerable. The family-nurse partnership is a preventive, intensive programme for first-time teenage parents and their babies, whose outcomes are not good and fall well below those for other parents. Specially trained nurses work with girls from early in pregnancy until their children are two, giving them support to help them to adopt healthier lifestyles, provide good care for their babies and plan their future life goals. Following the spending review, we shall be extending the family-nurse partnership programme, so alongside the support that health visitors will offer for all families, there will be increased access to the highly targeted, highly specialised support that the most vulnerable families need. We shall set out our plans for that shortly.

The outcomes from family-nurse partnerships are very significant. Over the past 30 years, the evidence in the US has shown that family-nurse partnership children have better health development and better educational achievement and are less likely to be abused, neglected or involved in crime. Cost savings are also substantial. Early evidence in the UK is very promising. Family-nurse partnerships successfully engage disadvantaged young parents, including fathers; 87% of those offered a family-nurse partnership take up that offer, so they are significant.

There are many examples of mental health services for infants being improved. A number of regions have set up perinatal and infant mental health networks to encourage partnership working and the sharing of good practice. Volunteers from the charity Home-Start do valuable work in increasing the confidence and independence of families by visiting families in their own homes to offer support, friendship and practical assistance and by reassuring parents that their child care problems are not unusual or unique. My goodness, I could have done with someone from Home-Start myself. We believe that we are the only person going through what can feel like a rather traumatic experience. Those volunteers also encourage parents’ strengths and emotional well-being for the ultimate benefit of their children and try to get the fun back into family life.

[Annette Brooke]

I declare an interest in the point that I am about to make. Along with many other voluntary groups, organisations such as Home-Start are very concerned about their funding. I am a patron of my local Home-Start, and already there has been a cut. I ask the Minister to do everything that she can to support the vital work by the voluntary sector, because, as we all know, it can get into places that the statutory services cannot.

[Anne Milton]

I thank the hon. Lady for her intervention. She took the words out of my mouth: I, too, must declare an interest as a patron of my local Home-Start. The important message to councils is that when funding is tight, they should think about what works, and as is always the case with the voluntary sector, £1 of taxpayers’ money buys significantly more than £1-worth of care and services. Councils need to think imaginatively about how they spend their money and how they get good value for money. That often involves looking to organisations such as Home-Start. It can be extraordinarily short-sighted to cut back on such schemes at a time when they offer much better value for money than can be had almost anywhere else.

There is no doubt that the need for early intervention has been recognised by us all. The hon. Lady rightly pointed out in her speech the huge variety of reasons why we end up in life where we do. I, too, must admit to having been a mother of the Penelope Leach generation, holding baby in one hand and my Penelope Leach book in the other and trying to look up what exactly parents do at 4 o’clock in the morning when their child will not go to sleep. Having been a chairman of the Hackney and Islington branch of the National Childbirth Trust, I must also admit to having been influenced by the likes of Sheila Kitzinger and Susie Orbach, who added to my knowledge base. Some of Susie Orbach’s words might still haunt me now, as my daughter approaches the age of 17 and I wonder what sort of effect I have had on her.

The hon. Lady emphasised the point about the nonsense of seeing, say, the fostering of looked-after children through the eyes of one Department. Clearly, that is nonsense—we have to look at it across the board.

I can give the assurance that mental health remains a priority. The Department is working closely with stakeholders to put together a mental health strategy—a child and adolescent mental health services stakeholder event was held earlier this year—and the mental health strategy will take a life course approach. I am determined, and I know that the Minister of State, Department of Health, my hon. Friend the Member for Sutton and Cheam (Paul Burstow), who has responsibility in the Department, is determined that we have a mental health outcomes framework that sits alongside physical health outcomes. For too long we have concentrated on physical health, to the detriment of mental health.

The hon. Member for Southport went into some detail about the research, especially the problems with causality and, probably, the need for Governments to take account of continuing research that emerges, to see if we can better define why we are as we are. He is right that we do not do enough to talk about and inculcate parenting in school life and in the upbringing of our children. He is also right to highlight that one of the biggest determinants of educational outcomes is within the family.

In 2008, the hon. Member for Nottingham North (Mr Allen) and my right hon. Friend the Member for Chingford and Woodford Green (Mr Duncan Smith), now the Secretary of State for Work and Pensions—to whom my hon. Friend the Member for South Northamptonshire paid tribute—published “Early Intervention: Good Parents, Great Kids, Better Citizens”, which devoted a chapter to the importance of nought to three-year-olds and parental early intervention.

In July this year, the hon. Gentleman was asked by the Government to conduct an independent review of early intervention delivery. The review will focus on three key things: the identification of early intervention best practice, which goes back to the point about research; how we spread best practice, so we do not see the rather patchy outlook that we have at the moment; and new ways to fund early intervention in the future. What is impressive, and what we have seen again this morning, is the cross-party approach that has been adopted.

The Government have a role to play, but we all know that the first place that people turn to for help and advice is often their family and friends. We should not forget that. So, it is the individuals and organisations rooted in the community that can often have the greatest influence and impact, including local community groups, the voluntary sector and Sure Start centres.

Health visitors, as public health professionals working with families, are uniquely placed to bring people together across local communities to drive change on the problems that families face. As the health-visiting work force grows, there will be more opportunity for them to develop that wider role. We will provide support through a new training programme for health visitors, to be launched next year, to refresh and extend their community health skills.

The hon. Member for Islington South and Finsbury raised a number of issues. I hope that I have got them all down. I would like to touch on them before I conclude. We need to remember in so much of what we do that the issue is not necessarily about the quantity of money but how we spend it. We have an imperative to spend it more wisely than ever before, but the quality of what we get out of it is what matters, not necessarily the sum that goes in.

The hon. Lady rightly mentioned the importance of day care and the need for it to be of a high quality. It is not about whether parents stay at home or work, nor is it about making value judgments on how people live their lives. It is about providing a framework in which parents and children can thrive. Sure Start health visitors and the need for good-quality mental health awareness and intervention are crucial, and increasingly so. If one in four of us suffers from a mental health problem, we are looking at similar statistics among parents. The hon. Lady is right that universality is important—on stigma and access.

I must also point out that massive forms have been a feature of past Governments. They are always a feature of anyone trying to be a gatekeeper to scarce resources and are rarely effective. The Government are determined to banish them. The hon. Lady also mentioned early intervention grants. I can assure her that I met to discuss the matter with the Minister of State, Department for Education, my hon. Friend the Member for Brent Central, only yesterday. We are looking at it.

I have responsibility for public health, so I sit on a number of committees—a very large number—which is useful. I am in a group on families which the Prime Minister set up and a number of inter-ministerial groups, including the Cabinet Social Justice Committee. The same theme runs through all those areas—we have got to get this right, we have got to get the money focused in the right areas and we have got to get the money focused on areas giving us good outcomes.

In conclusion, I thank my hon. Friend the Member for South Northamptonshire for securing the debate. She made a number of important points about the mental health of infants. I hope that the NHS White Paper gives us a chance to refocus on achieving better results for them. The public health White Paper, which will be published later this year, will build on that. We also need an outcomes framework that will be a central driver of improvement, ensuring that the NHS treats the person as a whole—holistically—and not the disease.

Meeting parents’ needs effectively depends on good local partnerships. Groups such as the Oxford Parent Infant Project are a good example of that. I am keen on a strong dialogue with the voluntary sector. Indeed, the White Paper is all about opening the door to such organisations. By working together in that way, we can do much better for the mental health of our infants, families and communities. We have a duty to secure the future generation of parents.

[Mr Peter Bone (in the Chair)]

Thank you for that splendid debate. The sitting is suspended until 11 am.

10:47

Sitting suspended.