A little more talk about mental health. Please


SECOND OPINION:Learning how to say yes and no assertively, writes JACKY JONES

WHY IS it that when people talk about mental health, the topic is invariably mental illnesses and disorders? Even the WHO chose depression as the theme for tomorrow’s World Mental Health Day 2012. This perpetuates the myth that mental health is relevant only for people with problems, whereas the concept includes: resilience, ability to think, dealing with feelings, behaving assertively and problem-solving. These attributes are relevant for everyone. The WHO argues that mental health develops in early childhood, in particular between birth and two years of age, yet this aspect of children’s health is ignored.

Babies are born pre-programmed for survival, fitting into their environment as best they can, whether it is good, bad or indifferent. Relationships with primary caregivers have a physical effect on the neurobiological structure of the infant’s brain where synapses, or connections, are formed at the rate of one million per second based on the child’s experience at that exact moment. Loving and interesting experiences create pathways to mental health. Most of this “hard-wiring” happens before the age of two, after which it becomes harder to wire the brain for present and future wellbeing.

Getting first relationships right is an absolute necessity and ensures babies learn empathy, emotional balance and thinking skills, all essential components of mental health. Children who spend their early years in unloving, boring and unsupportive environments cannot deal with complex real life situations when they are older and develop mental health difficulties as teenagers and adults.

Despite the importance of mental health in the early years, the topic is not discussed with parents during or after pregnancy and birth. Parent-craft classes cover aspects of physical health, such as infant feeding and weaning. Bonding is mentioned in passing and it is assumed this will happen and automatically take care of the infant’s mental health. The HSE website, What’s Up Mum, has information on looking after newborns, such as sleeping, safety and childhood illnesses, but nothing on children’s mental health.

The HSE also has excellent booklets on caring for babies from birth to five years in which social and emotional development is well covered but no connection is made between these aspects of development and mental health. It is no wonder there is still such a stigma surrounding mental health problems when the “mental” word is not even part of the child health vocabulary of parents and service providers. It is as if mental health is irrelevant to small children.

Children’s mental health is not part of the regular HSE child development programme, which offers several free health checks to all children between the ages of six weeks and five years. The emphasis is on physical health, feeding, weight, hearing, head circumference and so on. Parents are not asked about the child’s mental health. Professionals who carry out these checks observe the interaction between the baby and the care-giver but there is no explicit observation of behaviours that indicate mental health, such as the baby’s level of assertiveness. In fact, a child using the word “No” is listed as misbehaviour in the HSE booklets, not something to be welcomed. Even good parents don’t understand the importance of assertiveness to mental health or they think assertiveness is only for adults.

Learning how to say yes and no assertively is probably the most important mental health skill children will ever learn. Just think how many adults are unable to say no to things they don’t want to do and end up stressed as a result.

Data from the Health Protection Surveillance Centre (HPSC) show that in 2011, 145 children aged 0-4 years contracted measles, 122 whooping cough and 31 mumps. These numbers are very low because children are immunised against these diseases.

Unfortunately, there are no vaccines to protect children from mental health problems. There are more than 350,000 pre-school children in Ireland and about 50,000 exhibit anxiety, depression, stress and aggressive behaviour.

The best way to immunise children against mental health difficulties is to explicitly raise the concept with parents at the regular health checks and clearly identify the connections between all aspects of a child’s development and their mental health. A little less talk about feeding and food and more talk about mental health. Please.

Dr Jacky Jones is a former HSE regional manager of health promotion

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