Infant Mental Health Awareness Week

Sarah Olney Excerpts

Thursday 16th June 2022 Westminster Hall

[Sarah Olney (Richmond Park) (LD)]

It is a pleasure to serve under your chairmanship, Mrs Murray. I congratulate the right hon. Member for South Northamptonshire (Dame Andrea Leadsom) not just on securing the debate but on her ongoing passionate advocacy for our youngest citizens. It is a mission I am always happy to support her in.

One of the things that awoke my interest in this area was during the covid lockdown; both the right hon. Lady and the hon. Member for Strangford (Jim Shannon) have spoken movingly about the impact that lockdown had on many families. I spoke to mums in my constituency who were having their first child in lockdown, with all those pressures on them, such as not having contact with their partner or their family during labour, or with informal or formal networks afterwards. I reflected on how different their experience was from mine over a decade ago, when I had my babies. My first impression was of the impact of that on maternal mental health—I was pleased to secure a debate on that topic in March 2021—but the issue of infant mental health is so closely linked to that. I am grateful to the right hon. Member for South Northamptonshire for her really detailed opening speech. We have the data and the evidence, and it very much underpins the anecdotal evidence from our own personal experiences and those of our constituents.

A number of great points have been made about how much the baby’s mental health is based on the quality of the parent-infant relationship, and how the parent’s responses shape how babies experience emotions, regulate their own emotions and express themselves. We have referred a great deal to the research, but 15% of children—more than four in an average classroom—will have developed a problematic relationship with their main caregiver as a result of unpredictable or hostile care. As we have already debated, that troubled start increases the risk of children having poorer social and emotional wellbeing across their lives, and the ongoing and lasting impact that that can have.

My constituency neighbour, my hon. Friend the Member for Twickenham (Munira Wilson), talked about some of the gaps in services to support infant mental health. We really must focus on that. There are currently 42 specialised parent-infant relationship teams in the UK, which focus on strengthening and rebuilding those early relationships. That means that most babies live in an area without access to such a team. They are multidisciplinary teams led by mental health professionals with expertise in working with babies and families.

A key area of focus is working with families that have experienced intergenerational trauma. With the right care, the trauma experienced by parents does not have to inform their infant’s development. However, it is so important that specialised services are there to detect such instances and are equipped with the skills and funding to intervene and support families where needed.

I will briefly touch on the experience of dads, which has been raised on a couple of occasions. I recently visited my local maternal mental health crisis unit, and I was surprised to find that there is no systematic care given to dads who experience mental health problems when their partners are pregnant. It might get picked up if their partner is coming for care, but it very much flies under the radar. In particular, we know that domestic violence can often commence during pregnancy. I see that as a direct result, perhaps, of men’s struggles with mental health as they become fathers. I therefore think it is a matter of real urgency that we pick up the matter of dads’ mental health, particularly from the beginning of pregnancy.

It is also important that mental health professionals can spot the signs of poor mental health in our youngest children, who cannot express their emotions in the same way that older children are able to. The hon. Member for Strangford mentioned the reviews of some of the horrific cases of child death that have been carried out recently—I am thinking of Star Hobson and Arthur Labinjo-Hughes. I do not want to talk too much about them, for the same reasons as he did not. I just cannot—it is just too much. But I really hope that someone is looking at that and thinking about what could have been done to detect the signs of mental distress in those young people who could not express it for themselves. We must be training people for some of these crisis situations, so that they can pick up on the mental health of young people who have difficult, damaged or problematic relationships with their caregivers and do not know how to express themselves, but are at risk of real harm if that mental distress is not picked up on.

Whenever I get the opportunity, I like to highlight the importance of health visiting. That is something that I picked up when I spoke to the first-time mums during lockdown. For full disclosure, my own mother is a health visitor, so I have been raised to regard health visiting as a wonderful thing, but that has been my experience as well. The importance of health visitors is that they visit—or should visit—every new mother, and her family, in her home. For those mothers who are finding it hard to reach out, it is an invaluable service to have somebody coming to them and asking if they are okay. We really must continue to support it. On infant mental health in particular, health visitors are uniquely placed to identify concerns, spot issues in early relationship and attachment forming, and identify where infant mental health may be an issue.

Families should receive a minimum of five mandated reviews by a health visitor between pregnancy and age two and a half, but even before the pandemic, many children were not receiving those core contacts. Over the course of the pandemic, the number of missed contacts has increased further, despite the fact that many reviews were conducted online or over the phone. One thing I am really concerned about is that we must not allow telephone or Zoom visits to become the new normal, because we will miss out so much from not visiting mothers in their home. Evidence of domestic violence and, in particular, the subject we are discussing today—those attachment disorders—will not be so evident if health visitor visits move to some sort of digital contact.

In 2015, responsibility for health visiting was transferred to local authorities. Since then, it is estimated that 30% of the health visiting workforce has been lost, with further losses expected. As with many local services, there is something of a postcode lottery in the availability and quality of support. My team and I have spoken to health visitors in north Kingston—the team that supported me when my children were babies—and they reiterated that currently, their biggest challenge is workforce issues. Almost 25% of their current health visiting team is due to retire in the next few years, and they are struggling to find candidates for the vacant roles. They recently advertised a vacancy that received just one application, and that person then decided that they would not take the post.

Health visitors work in relatively small teams with large case loads; in north Kingston, there are about 600 cases for every health visitor. That is unsustainable, not least because it forces health visitors to focus their resources on the most at-risk families. As we know, these problems can occur in all kinds of families from all backgrounds and income groups, so it is really important that we push for health visiting to remain a universal service with home visits.

I will end by stressing the importance of face-to-face contact, and that the health visiting service needs support and investment in its workforce. More than anything, we want to join up the agencies, so that the Department of Health and Social Care is working closely with the local authorities to make sure that the right information is being passed between agencies. If health visitors pick up anything concerning, they must be able to speak immediately to the other agencies surrounding the family, so that we do not have to read too many more distressing case reports like those I mentioned. The £300 million Start for Life programme that has recently been announced is wonderful—it will be great—but there is no funding in it for health visiting services. The funding sits within the DHSC, which is separate from health visiting; again, joining that up would make a huge difference.

With fragmentation, there is a risk that things will fall through the gaps. The one thing that we have all said clearly today is that the consequences of allowing that to happen are too big, both for our individual children—all those future MPs who we are looking forward to welcoming to this place—and for our society as a whole. We want to do everything we can to give little babies and children in every corner of the United Kingdom—in every part of the country—the best possible start. That includes supporting their mental health from the earliest days.

[Mrs Sheryll Murray (in the Chair)]

I call the Scottish National party spokesperson, Dr Lisa Cameron.