Written evidence submitted by Cattanach (CYP0099)

This submission is submitted by Cattanach, an independent charitable funder in Scotland, who focuses on supporting registered charities working with early years children from pre-birth to about 5 years of age in Scotland. We also fund strategic work involving policy and research work relating to early childhood development, such as infant mental health, early learning and wellbeing in the early years context.

1. What progress have the Government made on children and young people’s mental health?

Through the work we fund, we can see that the Government’s progress on children and young people’s mental health has been strongly inhibited by an omission of focus on pre-birth and the early years. While health is a devolved matter, provisions mirror each other across the four nations and there is too little or at worst no provision for very young children. A vast array of evidence suggests that pre-birth and infancy is a vital period which builds the foundations for mental health in later childhood, adolescence and adulthood[1]. We believe that the Government’s lack of progress in reflecting this in their provision of mental health services contributes to a lack of progress in the mental health of the whole population, not just the early years.

In consequence of this, negligible progress has been made in improving access to mental health services in the early years, due to the negligible progress in increasing provision of services in the first place. Exemplifying this is the omission of infants and young children from CAMHS services, arguably the most important statutory service for child and adolescent mental health in the UK. In 2019, 42% CAMHS services in CCG areas in England did not accept under 2s[2].

Furthermore, there is strong evidence to suggest that the exclusion of infants and young children from mental health service access has been exacerbated by the COVID-19 pandemic. This is demonstrated in a consultation in 2020 of those working in early years service provision, with 78% respondents stating that there was a ‘baby blind spot’ for under 2s in the government’s response to the pandemic[3]. This has occurred, despite there being evidence in the same consultation of a chronic increase in need for these services, with 98% of organisations surveyed reporting infants’ bonding and responsive care (early definitors of future mental health) to be impacted by parental anxiety, stress or depression during the pandemic [4].

We believe that genuine progress can only be achieved in child and adolescent mental health when there is a cultural shift in the importance placed by the Government on mental health pre-birth and in children’s earliest years[5].

2. The wider changes needed in the system as a whole, and to what extent it should be reformed in favour of a model that focuses on early intervention in children and young people’s mental health to prevent more severe illness developing

Whilst earlier intervention is welcomed by Cattanach, we assert that the most effective model for stopping children and young people developing poor mental health should be based on prevention. This means mitigating risks to mental health as early as pre-birth, rather than exclusively intervening after mental health issues have already started to develop by early childhood.

Our assertion is justified by the substantial evidence which demonstrates a causal relationship between the environments children are born into and their mental health[6]. In particular, the foundations of children’s mental health are determined by relationships with their caregivers, and their ability to form healthy attachments with them[7]. Caregivers’ capacity for nurturing and responsive parenting allowing for health attachment is often defined by their experiences prior to children being born. This is reflected in research on the effects of inter-generational trauma on children’s mental health, whereby caregivers’ unresolved child traumas can begin to manifest in their relationship with their children as early as pregnancy[8]. This evidence strongly suggests that for the effective prevention of mental health issues occurring in children and young people, intervention must take place pre-birth or as early as possible during infancy, with a whole-family approach.

By the logic of the above point, Cattanach believe effective prevention of poor mental health in children and young people can only be successfully achieved through upstream macro-scale socio-economic structural change, rather than internal improvements in the mental health system alone. A vast array of evidence suggests caregivers’ capacity to form nurturing relationships with their children (which build the foundations for their children’s future mental health) is heavily debilitated by their experience of poverty. This has been widely evidenced both globally[9] as well as in a specific UK context[10]

The Government can only adequately prevent mental health crises in children and young people when they implement macro-scale structural change, rather than just internal changes to the mental health system. This involves a diversion from past approaches, where data shows that austerity policies have affected the mental health of children and their families, as well as the services which support them[11].

How the Government can learn from examples of best practice, including from other countries?

There are, as outlined above, clear connections between socioeconomic structures and downstream effects on the mental health of children and young people.

Therefore, examples of best practice involve directly integrating wellbeing into economic processes. This is exemplified well in New Zealand with their Wellbeing Budget[12]. It can also be demonstrated by shifting understandings of the meaning behind economic progression and the purpose of the economy to focus on wellbeing. This is exemplified by the concept of ‘Gross National Happiness’, coined in Bhutan[13] and the Carnegie Trust’s term ‘GDWe’ (Gross Domestic Wellbeing[14].

What measures are needed to tackle increasing rates of self-harming and suicide among children and young people?

Cattanach’s view, expressed in the previous sections, is that a focus on prevention and whole-systems factors can vastly improve mental health for children and young people; we do not have specific expertise in the prevention of self-harm and suicide and will therefore not answer this particular question in further detail.

February 2021