Mental health in early childhood (from birth to primary school age) deserves far more attention, according to a policy brief recently released by the Centre for Community Child Health at the Royal Children’s Hospital in Melbourne.
A summary follows below:
Australia has seen significantly increased awareness of mental illness and a major increase in funding available to try to address the issue. However, mental health in early childhood – that is from birth to primary school age – remains a poor cousin to adult and youth mental health.
The focus for attention and funding is primarily on 12-25 year olds and disadvantaged groups – only a tiny fraction of the available mental health funding in Australia is devoted to 0-12 year olds. The next step is to focus on mental illness prevention and mental health promotion from very early childhood; many of the mental health problems encountered in adolescence and adulthood have their origins in early childhood.
The definition of mental health problems in early childhood is complex, but for the purposes of this Policy Brief it includes a range of social, emotional and behavioural concerns.
Why is this issue important?
There are significant social, emotional and financial costs associated with mental health problems.
The number of children with mental health problems is increasing.
Around half of all childhood mental health problems will persist.
The current service system is unable to respond effectively to the needs of children and their families.
What are the implications of the research?
Pathways to poor mental health often start early in life – well before the age of 12 years.
Many parents need support and assistance to give their children the best possible start in life. Parenting practices are a known influence on children’s mental health.
Community acceptance and understanding of the existence of mental health concerns in childhood is poor.
Preventive programs that support parents to parent well may be the most effective option to facilitate good mental health in children.
There are significant barriers to children accessing either preventive programs or treatment which need to be addressed.
It is more cost effective to intervene early when mental health concerns are first identified.
Considerations for policy and programs
More research is needed to determine the effectiveness and cost-effectiveness of preventive programs, including international programs in the Australian context.
The uptake and outcomes of different types of parenting programs need to be evaluated; for example, do programs offered to all families (universal) result in better uptake and outcomes than programs offered only to ‘at risk’ families (targeted)?
Integrated mental health policy and service delivery is needed to tackle mental health problems, with a particular focus on reviewing and improving links and communication between primary, secondary and tertiary clinicians.
There needs to be increased opportunity for service providers who work with children and families (e.g. child carers, kindergarten teachers, family and child health nurses etc.) to increase their skills in regards to mental health promotion and mental illness prevention.
There needs to be increased awareness of the greater risk of mental health concerns in children who have been diagnosed with a chronic illness.
Given the long waiting lists to access services and uncertainty about where to access them, service providers need to establish and document clear referral pathways to help parents and families access the services they need. By mapping available resources and publicising that information, better referral pathways – which allow both the primary and secondary sector to recognise, manage, refer and follow up mental health concerns – can be achieved.
Consideration needs to be given to the potential of implementing a general three-year-old health check in order to monitor all aspects of children’s development, including mental health.
Community and education
Resources are needed to promote mental health and prevent mental illness from a very young age. Only a tiny fraction of the money committed to mental health spending will be directed at children under 12 years. Available funding needs to better reflect where the morbidity load lies.
Community education about mental health and mental illness, including its occurrence in early childhood, is needed in order to increase the knowledge and capacity of both parents and professionals. This can be supported by continuing to provide and to enhance opportunities to understand child development.
Broaden and elaborate the existing contact that GPs and family and child health nurses have with children and families to detect early signs of behavioural or emotional problems.
There needs to be a broadening of responsibility beyond the mental health sector to make it everybody’s business to promote mental health and to help prevent mental illness.