Infant Mental Health Awareness Week

Gillian Keegan Excerpts

Thursday 16th June 2022 Westminster Hall

[The Minister for Care and Mental Health (Gillian Keegan)]

It is a pleasure to serve for the first time under your chairmanship, Mrs Murray. I thank my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom) and congratulate her on securing the debate. I soaked up her speech—when she used that phrase, I felt that that was what I was doing. It was insightful and educational, and all of us got the benefit of her 25 years of experience and understanding of what we need to do and how we should do it. As we know, in this place quite often we can appreciate the problems, but it is much harder to come up with the solutions. I know that her work has been vital in doing that and in helping the Government shape policy in this area.

I thank all hon. Members for their contributions and their support for this initiative. We are at the very beginning of this journey and we want to keep that collegiate approach. We have a real opportunity to shape this and, as in many of the areas that I am responsible for, it is not particularly party political. It is really about how we impact real people’s lives, and in this case babies.

It is clear to us all that the development of babies is incredible and needs lots of vital support in the first years. They are born with more brain cells than there are stars in the Milky Way galaxy. If a baby is loved and receives care, their brain flourishes, laying the foundations for good future physical and mental health. That is why the first 1,001 days have been described as critical for development. There is a real understanding of that now, and that is undisputed. It is also why I am delighted to speak about this important topic and also work on developing the new services. I welcome being able to do so during Infant Mental Health Awareness Week.

Infant mental health refers to social, emotional and cognitive development. For good infant mental health, babies need parents or carers who will consistently meet their needs, as outlined by my right hon. Friend, because that leads to secure attachment relationships. Over 60 years of research tells us that that is related to positive long-term developmental outcomes, from improved emotional development and school readiness to reduced rates of offending, as mentioned by the shadow spokesperson for the SNP, the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron).

Having a baby can be a time of great joy, but also a time of challenge and change. Many new parents get the support that they need from midwifery and health visiting teams, as was mentioned by the hon. Member for Richmond Park (Sarah Olney), whose mother I thank for her service. I am sure she has helped a lot of parents and families in her time. Many new parents get support from family and friends as well. We talked about how a lot of that could not happen during covid when it was a very difficult time for many new parents. We know that having a baby can be a time of great challenge. With or without a pandemic, it is a time of great change. There are many reasons why a new parent may struggle, from social isolation, as has been mentioned, financial stress, a traumatic birth, relationship difficulties or their own experiences of early trauma. Without the right support this can impact parents and babies alike.

Perinatal mental health difficulties are common. Approximately one in five mothers and one in 10 fathers experience mental health difficulties during the 1,001 critical days. They are critical days, but also difficult days, which is why the numbers are so high, and parental mental health difficulties are associated with increased rates of mental health difficulties in children. As has been mentioned by a number of hon. Members, these difficulties can be passed on.

Parent-infant relationship difficulties are common. They can involve a parent struggling to bond with their baby, or may relate to a perinatal mental health difficulty. Although exact prevalence is difficult to establish, some estimates indicate that approximately 40% of babies have insecure attachment and 10% have a disorganised attachment style. Both are associated with an array of long-term developmental outcomes.

I recently visited Knowsley’s building attachment and bonds service, which is one of the new services being trialled and introduced. It is on the same estate where I went to school—I literally passed my old school—so the area was very familiar, and I was familiar with the problems the service was trying to deal with. I saw at first hand that relationships are everything and that early intervention is crucial. I met a mum there, with her baby. She had had several children and had problems, and she was no longer with the children. With this baby, the service had put in a lot of effort to keep mum, dad and baby together, and to make sure that they built that family. It was making a massive difference, and her other children have since come back to join her. The service was changing everything about the outcome not just for the baby, but for the other children in the family as well. These issues are why ensuring that every baby gets the best start in life is of central importance to this Government.

As all hon. Members said, this is an investment in the youngest and most vulnerable members of our society, and it is part of our ambition to level up health outcomes and opportunities across the country. Our vision is for every parent and carer to have access to high-quality universal services in their local area. That is set out in “The Best Start for Life: A Vision for the 1,001 Critical Days”, published by the early years healthy development review in March 2021. I thank my right hon. Friend the Member for South Northamptonshire for her inspirational work enabling us to support the implementation of this vision.

The Government are investing £302 million to improve start for life services and to create a network of family hubs in 75 local authorities in England. The funding will help bring services for families together into one place, improving their access to support, advice and services. This funding package includes £100 million for perinatal mental health and parent-infant relationship support, £50 million for breastfeeding support and £50 million for parenting support. This significant £100 million investment will improve access to mental health support for babies from conception up to the age of two, as mentioned by the hon. Member for Twickenham (Munira Wilson). It will help us build the workforce in order to fill the gap we see at the moment.

The funding will tackle entrenched inequalities in communities, as mentioned by the shadow Minister, the hon. Member for Tooting (Dr Allin-Khan), and we announced the 75 local authority areas that are eligible for a share of this funding in April. The funding will be targeted at local authorities with disproportionate poor health and educational outcomes, and I am pretty sure that Knowsley, where I am from, has been included in that group. Indeed, my right hon. Friend the Member for South Northamptonshire once stood for election in Knowsley. Since that announcement, we have been working with the eligible local authorities and a range of expert stakeholders to further develop the programme. We will share a draft programme guide, detailing how local authorities can make the most of the funding, in the coming weeks.

The investment will complement the ambitions set out in the NHS long-term plan, as referred to by the hon. Member for Twickenham. It will deliver the fastest expansion in mental health services in NHS history, with 345,000 more children and young people having access to specialist, NHS-funded mental health care. That ambition is backed by the additional £2.3 billion a year for mental health, but we have not actually spent a penny of it yet, because it is by 2023-24. That is when this amount kicks in, and it will be for years thereafter.

Obviously, the workforce is vital. It is clear that we have to invest in developing the modern, diverse and highly skilled workforce that we will need to support babies and families by trialling and evaluating innovative workforce models in five local authorities. That is what we will be doing to ensure that we have the right mix and blend. Obviously, health visitors are also a key part of that; they were mentioned by the hon. Member for Richmond Park.

With regard to 2029, we obviously know that the training of more clinical psychologists, child and adolescent psychotherapists, psychiatrists and the perinatal workforce will require additional capacity across the current education and service providers, all of which are currently operating at full capacity or are limited. We have immediate action —at the moment—to model the workforce to support the development of new roles, new ways of working, and upskilling, particularly with regard to the perinatal, primary and community workforce, including health visitors. We are working with Health Education England, NHS England and NHS Improvement to ensure that we have this workforce plan to sit alongside the new 10-year mental health plan. When we publish that, we will be putting that together, so we absolutely recognise that this is critical. The training time, as the hon. Lady will be able to vouch for, is a long time, so we have to innovate; we have to do things differently. Otherwise, it will take too long and too many people will not benefit from what we all know is required.

We have heard from families that stigma is a real barrier to their seeking support. I really identify with that; I definitely saw it growing up in Knowsley. My friend used to run the Sure Start centre there, and it was clear that she found it very difficult to access the people that she knew she needed to access, because stigma got in the way. To reduce the stigma associated with perinatal mental health difficulties and parent-infant relationships, we must have a multifaceted approach. That includes ensuring that the family hub is a welcoming place for all families; sharing key messages about perinatal mental wellbeing and good parent-infant relationships; and enabling the workforce, paid and voluntary, to feel comfortable and confident to have conversations with families about mental health, bonding and attachment. Those are difficult conversations to have.

Needless to say, there is little point in tackling stigma if not enough support is available. As has been mentioned, there is currently huge variation in the availability of early intervention and preventative support across the country. Some areas have robust and very good offers, including universal antenatal education classes, peer support services for breastfeeding and mental health, and drop-in sessions at the local family hub. In other places, support may be available only if difficulties become particularly severe. That feeds into the stigma, because only when something is going wrong do people get access to the services. That is why the universal nature of the services is vital.

There is also a discrepancy in the perinatal mental health support that is available for mothers and for fathers and co-parents. That was mentioned by the hon. Members for Twickenham and for Richmond Park. We know that more than one in three new fathers are concerned about their mental health in the perinatal period. We identified that gap in provision of support for fathers or co-parents experiencing perinatal mental health difficulties, particularly if the mother is not experiencing any difficulties—then they will not be picked up in the same way. That inequality of access has an impact on the baby’s mental health and wellbeing. A positive relationship with both carers would lead to better long-term developmental outcomes. That is recognised; it is identified as a gap, so support will be provided.

Lastly, none of this will be achieved and achievable without a knowledgeable, skilled and confident workforce. This investment is an opportunity to improve workforce capability and capacity. We understand the workforce challenges and will encourage local areas to create capacity by incorporating greater skill mix in clinically led teams, relieving the pressure on existing teams. The funding available through the Start for Life programme will enhance capacity across a range of professions and volunteers, and improve capability through training. That will build the knowledge and confidence of the workforce needed to provide mental health support. The family hub model will enable families to receive support with perinatal mental health and parent-infant relationship difficulties. That investment will build on existing provision while responding to local needs.

Before I draw my speech to a close, I want to acknowledge the important contribution of two other Government initiatives. First, there has been an additional £200 million investment in the supporting families programme. That will enable local authorities and their partners to provide help earlier, and promote better outcomes for an additional 300,000 families, including families with babies. Secondly, we have launched a consultation to develop a new 10-year plan for mental health. The consultation is open until 7 July. We are concerned to try and get more people responding to that, particularly from black and ethnic minority backgrounds. Members could help to spread the message, to ensure that we get more representations from people with those characteristics. The mental health plan includes specific questions relating to babies and their parents or carers, in recognition of the distinct needs in the first 1,001 critical days. We look forward to seeing the results of that consultation. As I have said, please spread the word.

I will end by reassuring my right hon. Friend the Member for South Northamptonshire that early intervention and prevention sit at the top of this Government’s mental health priorities. We are committed to ensuring that babies and their families get the support they need to make sure they get the very best start in life.