Three years ago, NSPCC Scotland and Maternal Mental Health Scotland produced a snapshot of practice in managing postnatal mental health disorders in Scotland and found serious shortcomings in provision in many areas. It seems that little has changed since then.
The impact of maternal mental health on child development outcomes is well recognised and reflected in primary health care policies in Scotland. Yet new findings published last week from the Maternal Mental Health Alliance showed that the country is still lagging behind other parts of the UK when it comes to caring for mothers and babies who experience mental illness post-partum.
In Scotland, a body of evidence has developed which guides policymakers towards the need for early intervention and a commitment to shift resources towards prevention, early detection and help. It identifies the need for greater emotional support and care for all women during pregnancy, but particularly for those living with known, and often multiple adversities.
Support and services must not be limited to those experiencing serious psychosis but should also reflect the needs of parents facing a range of adversity and therefore likely to require additional support as they make the transition to parenthood.
The research has also produced an emphasis on parenting. For babies and very young children this means helping parents give the sensitive, responsive and consistent care needed to promote good parent-child attachment and healthy infant development.
But the new findings show little improvement, with specialist care remaining patchy and inadequate in large parts of the country.
The government’s ambition is not being matched by investment on the ground. Both England and Wales have moved swiftly to plug gaps in perinatal provision to reflect learning around the importance of investing in early life and the potential this has to transform later outcomes.
The government’s own Growing up in Scotland research shows that the degree of a child’s exposure to maternal mental ill-health affected child development outcomes. “Supporting mothers with mental health problems may have a direct impact on young children’s development and well-being and could enhance children’s early school experiences,” it said.
If the Scottish Government is to deliver on its ambition to reduce the attainment gap in education, tackle adverse childhood experiences and give every child in Scotland the best possible start in life, then a commitment to deliver specialist perinatal mental health services – as set out in the clinical guidelines – must become a political priority.
Action to improve the mental health of children from birth onwards must recognise the links between maternal mental health and child development outcomes. Perinatal mental health must be viewed holistically and placed at the heart of the government’s approach to improving mental health throughout a lifetime.
A healthy and secure parent-child attachment is the most important protective factor for infants and a strong predictor of good outcomes. Mental health issues experienced by women in the perinatal period can affect this by inhibiting a mother’s ability to provide the sensitive, responsive care a baby needs.
To reduce the impact on babies, it is important that mothers receive timely support for their own mental health needs and that this support specifically addresses their interaction with their babies.
Early childhood adversity and associated disorders carry a heavy social cost. Mental health services are one of the most cost-effective ways of improving mental and physical health and tackling health inequalities.
The government must now make use of the ring-fenced Westminster government funding it has received to swiftly address the gaps in maternal mental health provision in Scotland.
Every child has a right to develop a secure attachment to a positive care-giver. By supporting this attachment, we are enabling Scotland’s youngest children to develop a capacity for love, empathy, respect, resilience and positive relationships.
All this is already government policy. The test is whether we are actually identifying and responding effectively to the needs of our most vulnerable infants and families. The ever-increasing demand for child and adolescent mental health services suggests that we are failing in this aim.
An investment in perinatal mental health protects two generations at once. It supports child development outcomes as well as improving mothers’ mental health.
There is now overwhelming evidence for this approach. The case has been made; now is the time for action.
Joanne Smith is policy and public affairs manager for the NSPCC