Mental Health (Infants)

Andrea Leadsom Excerpts

Tuesday 26th October 2010 Westminster Hall

[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.

--- Later in debate ---

[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.