Mental Health and Early Childhood Development
Find out more about our #MHForAll webinar series here.
Zeinab Hijazi, UNICEF
Andrea Torres, Bernard Van Leer Foundation
Bruno Rivalan, Global Financing Facility (GFF)
Giselle Dass, CAFS (Child, Adolescent and Family services)
Ben Perks, Head of Campaigns and Advocacy, UNICEF
Thank you everyone for joining, and to all our panellists for being here. Today we are excited to delve into childhood mental health, particularly as this has become more serious in recent months and years. Now is an especially critical time for the global community to elevate the importance of childhood mental health and take joint action to optimise impact.
Starting with families, how does the mental health of caregivers impact early childhood development?
The mental health of parents and adult caregivers is crucial in shaping their children’s futures. It can have a great impact in many ways, even before the child is born. In LMICs, there is a lot of evidence showing a link to maternal mental health with rates of respiratory diseases, increases in hospital admissions and emotional problems among children, for example. The impact of this will also continue well into adulthood, such as with cognitive development and the greater risk of ill mental health. Attitudes and behaviours are also at risk of being passed down generations. These problems tend to be most severe in environments with prevalent stressors, such as in humanitarian settings.
It’s important to stress that a strong parent-child relationship can help build the child’s resilience, mitigating the impacts of trauma, for example. They can help brain development, and therefore physical, mental and emotional health. At the Bernard van Leer Foundation we want to provide the best possible start in life to children, and we believe that this can be done by supporting parents and caregivers to deal with issues that might negatively impact children, and promoting activities such as breastfeeding and play.
1 in 4 children is living with a parent or caregiver with a mental disorder, so this is a really important topic. Turning to Bruno, how does the work of the Global Financing Facility (GFF) positively impact the mental health of children?
Before getting too specific, I want to quickly present what the Global FInancing Facility does. We are a country led mechanism at the World Bank that prioritize and fund the most cost effective interventions, and look to build resilient health systems. Our financing is flexible, and we work to support governments and institutions to support themselves. We provide technical assistance to fund the individual priorities that help each country to meet their specific goals, working with ministries of finance and health on resource allocation and looking to ensure sustainable financing. [See more here.]
We don’t have a specific mental health lens in all countries, but can impact positively by ensuring that prevention and treatment is integrated in other programmes. In Nigeria we have worked with local governments to ensure support as part of a childhood health programme. We’re also working in the Democratic Republic of Congo, and in other countries to improve the mother-child relationship and working to prevent some of the issues outlined just now.
Have you worked on mental health investment cases? Mental health is a multisectoral element of health, so are you looking at other sectors too?
We’re trying to take a broader health investment case, with all the relevant health related reforms to make care accessible. So we are trying to get a really comprehensive approach. In some countries there is a particular emphasis on mental health, such as in Nigeria and the DRC, but this is still integrated into the broader healthcare discussion.
In terms of the multi sectoral nature of our work - we had investment related to education etc., but this was in a broader sense and not necessarily related to mental health in particular.
How does Child, Adolescent and Family Services (CAFS) take a more community based approach to children's mental health?
At CAFS we take on a homely-space approach rather than the standard clinical setting for families seeking support. Stigma is quite high, especially in a country such as Sri Lanka, and people are more comfortable seeking support in these kinds of settings.
Another approach we take is in our campaigns and workshops, where we work to create awareness to reduce the stigma in the community. We also have an internship programme for budding psychologists and other professionals in the field, to help them learn another way of providing care and support.
There is a need to improve and coordinate our advocacy efforts at all levels. Can you tell us a bit about UNICEF’s new advocacy strategy on mental health and key focus areas?
UNICEF’s global advocacy priority on mental health means we are elevating this topic in UNICEF’s advocacy work, working to call governments to action in 3 areas, or “the 3 C’s”.
First is commitment. We need commitment from governments to invest. This needs to be not just in health care but in education, child protection and other areas that will help with promotion, prevention and treatment. We must recognise the cost of inaction, and put forward a robust case
Next is connection. This means recognising that a major risk factor for children is when connection is disrupted, in the family, in the community and in the school. We can promote good parent-child connections through low-cost evidence based solutions, and this is arguably the best and most important preventative action that we can take during the life cycle. We must ensure that every child has a sense of belonging in their community, as this is now known to be a major preventative factor when it comes to developing a mental health condition.
The third “C” is conversation. We need to have a global, public conversation. We still don’t have data in many countries, and most countries have not had a real, open conversation about mental health that is not clouded in shame and judgement.
The Bernard Van Leer Foundation has programmes in a range of countries. How are you integrating mental health into your early childhood development programmes and your support for caregivers?
As I mentioned, at the BvLF, we believe that every child deserves a fair start in life. For us parents and caregivers are essential to that goal. We have been trying different pathways for integrating mental health into our work.
Last year we built an internal strategy, seeking to address three specific goals.
We want to increase funding and awareness for mental health globally, and consider how we can engage leaders.
We are also aiming to expand our experience of what mental health and psychosocial support means, in terms of the best practices to support individuals and communities. We know that less than 1% of development assistance for health is spent on mental health, for example.
We have already partnered with United for Global Mental Health and the World Health Organization to do work in this area. We are also currently working in India, Brazil, Peru, the Netherlands and other countries, and we aim to have at least one investment in mental health and psychosocial support.
Our project Urban 95 invites planners to look at urban planning from a child’s perspective. We must consider environmental factors that can impact mental health, such as access to public spaces, air pollution etc. We need to think more about cities, and how these cities play a part in parent and caregiver mental health. We’re inviting leaders to look at their city and experience it from the perspective of a three year old. What more can we be doing? Most of the time we think about mental health relating to social protection, health etc., but in terms of the ecological framework, how cities are built is also crucial.
What opportunities do you see within the GFF for increasing funding and access to mental health services?
It’s important to consider the COVID-19 impact and recovery. We’ve seen how the pandemic has threatened to turn back progress, and seen disruption in services of around 25% in interventions such as vaccinations, access to services and support during childbirth. There is a secondary health crisis with gender based violence, job loss etc. The impact on mental health and psychosocial wellbeing is hugely significant.
Our strategy for the next 5 years includes ensuring access to services, and securing funding for mental health that are crucial for women and children’s mental health. We need to scale up the inclusion of mental health in primary health care settings.
Ensuring commitment and conversation at country level is also important, particularly in terms of dialogue. We are trying to expand the number of stakeholders involved in these, and improve the diversity of those involved in these conversations. We are considering possible connections and networks of those who weren’t previously involved. This can help some of the campaigning of positioning of mental health as a prerequisite to health.
We want to reimagine delivery of services, and processes around decision making. We are looking at the rate of depression in maternal and childhood mental health, with a focus on prevention and intervention, and seeking to gather more evidence to make the investment case on this.
We want to develop a practice note with the country level teams and country counterparts to show how to operationalise these things and push the agenda further.
What is the most pressing issue with child mental health at the moment? How has this changed with the COVID-19 pandemic?
As we’ve been talking about, how children exist in the context of their carers is hugely important. Carers are under huge stress with this pandemic - with job losses, uncertainty and home schooling.
Carers are now also educators, and this creates huge stress and a new set of challenges for both parents and children. Both groups are unable to access their social networks - children spend more time in front of screens. There are sleep issues, arguments and tensions within families. Lots of these issues keep coming up. There is an increased need to strengthen the family dynamics and address the mental health issues of both children and parents.
What is the State of The World’s Children Report, and how will it catalyse policy change to enable better access and investment in children's mental health?
This is UNICEF’s flagship publication that focuses on a really important thematic issue. The last was about nutrition, and it was used to advocate for the issues addressed within the publication.
In October we will launch this year’s publication, focusing on mental health. It will bring together the prevalence of mental health, and the limited evidence we have to draw a picture of where we are in terms of child and adolescent mental health globally. It will look at what the science is telling us about what the risk factors are, what makes individuals more likely to develop issues etc. And it will also look at policy solutions and investments. We are now at a unique time in history, and know more than ever before about both the risks and issues to childhood mental health.
Turning to a question for the audience, is there a way that parenting and maternal mental health resources can be accessed by practitioners, particularly in the Middle East? For example in Bahrain there is a huge burden, with minimal support currently available.
The question about stigma is really important. To improve the situation on the ground we need to understand the specific cultural factors on the ground. Coaching can be a very cost effective solution in terms of supporting caregivers and promoting practices, and this needs to be adapted to the specific characteristics of each country. There are some global funding efforts too, and I expect there are global actors who can invest in these sorts of cost-effective interventions. Often it is about reorganising service provision and highlighting the key factors for addressing, rather than just getting more funding.
This week finance ministers around the world are attending the World Bank and International Monetary Fund Spring Meetings. If you could increase funding in one area, what would you prioritise?
We must invest in early screening and treatment for maternal depression. This will have a high return of investment not just for women, but for the whole family and the whole of society. If you don’t put money on this, then it is not a priority.
We need more money in support for caregivers. We need to support those who are directly involved in the lives of children.
Investing in the comprehensive health of women and children must be a priority. We must accelerate investment. If we don’t increase investment now, lives will be lost.
We should invest in parenting programmes in the same way that we invested in vaccines, to be universally accessible for all. That is the most effective intervention we have.