Wellbeing for wee ones

This discussion brings together experts with perspectives from art therapy, psychology and psychiatry to address what we mean by wellbeing for babies and toddlers.

Children and young people’s mental health refers to the mental health of all children from conception onwards; however, older children usually tend to be the focus. This panel will share their reflections on how we think, talk and address infant’s mental health (ages 0-3), considering how parents, carers and specialists can meet our very youngest ones’ needs.

Please note transcripts are automatically generated, so may feature errors.

Professor Jeremy Smith FRSE
Well, ladies and gents, I’d like to welcome you to our event today ‘wellbeing for wee ones’, which is sponsored by the Royal Society of Edinburgh. My name is Jeremy Smith, and I’m a Fellow of the society. And I’ve been asked to chair the events today, since I have the honour of being the young people’s programme convener for the society, which is something which is very dear to my heart. We’ve got an exciting event today, we have four speakers, three speakers. And the event is going to be dealing with questions of children and young people’s mental health, very much part of the story in recent months, because of the COVID, of course, but underpinning it other things, we’re going to bring together some experts with perspective, some art therapy, psychology, and psychiatry, they’re going to be discussing questions like, what are the features of early relationships that support baby’s wellbeing? How do babies develop secure attachments? And what support may we need to offer when relationships are having difficulties? And so these are very much issues current in debate about mental health, especially with small children. So that’s essentially what we’re going to do and it fits very much with the remit of the Royal Society of Edinburgh. Which, according to our strapline, is knowledge made useful. We’re always keen to leverage research and thinking into addressing some of the bigger questions that society faces, especially those relevant to Scotland. Okay, right. Well, one is to do next is rather a pleasant thing. Because I’m going to introduce the first speaker, the first speaker is Vicky Armstrong, whose avatar appears rather attractively on the screen she’s doing what looks like a yoga pose, Vicky. So I think, Vicky, you could turn on your image now, and unmute yourself. Because we have something of a special moment for Vicky ahead of her presentation. Vicky, apart from being an art therapist, and a postgraduate researcher in psychology from Dundee. She’s also the recipient of something rather grand and special, which is a medal from the Royal Society of Edinburgh for her public engagement, which is exciting stuff. And I’m going to embarrass Vicky, by asking her now to hold up this metal. There it is. See? There we go.

Vicky Armstrong
Thank you very much.

Professor Jeremy Smith FRSE
It’s a great pleasure and a great honour to have you as our first speaker. And as I said to Vicky earlier on, I think it’s quite important you should leave it casually about so.

Vicky Armstrong
Behind me?

Professor Jeremy Smith FRSE
That’s what that’s what mental pieces are all about. So that’s for you. Anyway, I’m going to shut up talking now each of the speakers are going to talk for about 10 minutes about their agenda. And at the end of it, we’ll have the q&a discussion, we should have about 20 minutes or so for q&a. So I hope we’ll be able to, to get some interesting discussion going. I understand there’s a lot of people in this in this virtual room. Of course, we can’t see you. But we know you’re there lurking. So if I miss your question, please don’t feel hurt, racing down as much as we can. But I will try and make sure that everybody gets their fair shake of things that are interesting to say. All right, I got a shout out. And Vicky, I believe the screen is yours. I’m going to turn myself off and go mute. Oh no it’s not as it’s going to be Rachel, I’m sorry. You see, I was sticking my old script, what a terrible thing to do. So I’m going to turn to Rachel, who is going to introduce herself, then we’ll come back to Vicky while she preens herself with her medal, which I think is quite an important thing to do. Thank you, Vicky. And I gotta shut up Rachel would you like to introduce yourself. Make your piece.

Dr Rachel Fraser
I want to start well, I’m just getting the slideshow going. Hopefully you can see that now, by thanking Vicky, while thanking the RSE also but really thanking Vicky, because if it weren’t for you being so generous as to share your platform after winning your prize, then we wouldn’t be here. Anne and I wouldn’t have been invited and we wouldn’t have the opportunity to speak to what’s a completely bewildering number of people. So I’m really pleased that you’re all here. And I have a very short space of time we all do today to talk to you about something really important and it’s impossible to do justice in such a tiny space of time. So it’s my task to give you a sort of introduction to what we mean when we’re talking about wellbeing for wee ones which in clinical terms we call infant mental health. And just to give you a bit of an introduction really to that I am, perinatal psychologist by training, which means I work with families through from the entire perinatal period from conception through to around three. And for the past couple of years, I’ve been lucky enough to be working with the Parent Infant Foundation, which is a UK wide charity, which helps the development of specialist parent infant mental health teams, relationship teams, but I am moving between that and a post in Perinatal Services with NHS Lothian, so forgive me if I get my we and they a little bit mixed up in this presentation, when we’re talking about wellbeing for wee one, which is a huge topic, I just want to rest a little on what it is we’re actually talking about. We are talking about environmental provisions, which you know, having something in the tummy being warm enough, and having a clean nappy, perhaps. But we’re talking about something really quite far beyond that into the emotional health of little ones, because what we know now is that later well being in all areas of life is contingent on a really good start emotionally. So yes, absolutely, environmental provisions, but something beyond that also. And with an acknowledgement to the zero to three website, which is one of the websites that I flagged in the resources. They’ve divided emotional wellbeing into three quite neat sort of blocks. And they are, you know, the opportunity and the capacity to develop good, secure, warm, trusting relationships for little ones, to experience and to be able to express safely a full range of emotions, and to feel safe enough and motivated enough to explore and to play and to learn, which is obviously something that Vicky specialism, and I hope she’ll say a bit more about all of that for tiny ones happens within relationships. There’s psychoanalysts, Donald Winnicott was very famous for saying there’s no such thing as an infant and what he was getting at when he said that was that an infant can’t survive on its own. And that’s something that it’s sort of logical to us in physical terms. Babies can’t talk to us, and babies are dependent on us for survival, their brains are dependent on us to so babies brains need brains and from others and their bodies need bodies from others to. And that happens within the family context, the cultural context and the community context. So that’s where we start.

Dr Rachel Fraser
Babies brains are such a mystery, because they can’t talk to us. And so the question arises, what is happening in there, and they do have ways of telling us but it’s not in words. For a start. dizzyingly, I think more than a million neural connections are starting per second, on average, in the first couple of years of life, just extraordinary, particularly for those of us who are old enough for that very, definitely not to be happening anymore. And we know that brains are built from the bottom up. So we come pre programmed with some existing structures in there to basically regulate in very basic terms to breathe, to suck, to swallow, to cry. And beyond that, not a huge amount, and, and even our genetic makeup, we now understand a bit more about how dependent our environments and our relationships are in facilitating the development of our own characteristics, our own sense of selves, as well as our physical and cognitive capacities. So everything is built on these basic building blocks. And the initial structures which are built and built on and built on and built on. So those first two years of life are the foundations really, for everything that comes afterwards. Which I think for many of us as parents, it’s quite a sort of daunting idea that there’s everything is so open to influence and, and it is daunting, and we do have responsibility. But the happy flipside of that is that baby’s brains are incredibly plastic, and they learn and they relearn. And the possibility for repair is huge when babies are little. So it’s not, you’re not to be too worried about that. Those blocks depend upon relationships of safety, and relationships which are warm, consistent, and where there’s enough safety for them to be playful as well. I suppose what I really want to get across is that everything which comes after it relies upon the quality of relationship in those in those first couple of years. Why does it matter? Well, if we’re a compassionate society and I think we hope that we are, then people having the foundations in which they can become fulfilled and happy content individuals is is important, it’s an important thing morally in and of itself. It’s also important socially, because we know that many of the necessary, although not sufficient, lots of variables going on, mainly the necessary precursors to difficulties later on in childhood and adulthood. Their origin is in these key developmental periods and infancy. And that’s, you know, events. Things like mental health problems, for sure. But also, maybe some are a bit less clearly related, as you might think, like, physical health, pathology, cardiovascular disease, that sort of thing. So it’s, it’s really important, it’s not just important for a sense of well being, but for, for physical health as well. And, and it’s economically important, which is something that’s perhaps less comfortable. For some of us who work in the NHS or public servants who work in the third sector, we like to think about that a bit less, but there’s been loads of work now, which demonstrates that if you invest as a society, in the human capital, if you like, in the early years, you get far more return than you do in investing further upstream, later on. And that’s also you know, it’s important because if you invest in the early years, then you’re talking about perhaps less of a burden and some of the services that are so horribly burdened at the moment, like CAMHS, child and adolescent mental health services. So there’s something really important in all those aspects, morally, socially and economically about investment in the early years. Many of you will have heard about adverse childhood experiences, there’s a lot of work going on, to try to prevent that in Scotland and to try really hard to think about what we do as a society, but adverse childhood experiences. And it’s very closely related to what we’re talking about here. It’s not all it’s more complex than that, because in infant mental health, we’re not just talking about the absence of adversity, we’re talking about the presence of positive and particular relational qualities and attributes. And in order that babies can thrive and grow into thriving children, and then thriving adults.

Dr Rachel Fraser
I’m going to give you some examples of those building blocks that we want to see in early relationships, which we know relate to better function and to contentment, and good brain development and development of the self socially, cognitively, I wish there was a holistically might be the way of putting it, I’m not going to go through all of them because of time. But to kind of chunk them, we’re talking about three things. Largely, we’re talking about parents and caregivers having the capacity to think of their babies to reflect upon the fact that their babies are people in their own rights with needs and with thoughts and with wishes and with preferences, and different from them, but connected of course, and reflective capacity, you know, that ability to really conceive of your baby, as, as a person and with a mind is really important. And then when you move through things, you get attunement and sensitivity and repair, which is about having the capacity to guess and to work out what your baby’s communicating to you doing that accurately. And crucially, not doing it perfectly. We know that it’s imperfect, in good enough parenting about 70% of the time, something like that. So it’s certainly not about being perfectly attuned to your baby that can be perceived as intrusive, if anything by your baby. But what’s important is the capacity to repair that to notice and to be okay with that and to repair that. And to tolerate the fact that most of us have quite mixed feelings often, especially under stress towards our babies. And there’s a vast majority of mums in the postnatal period who have very difficult thoughts and feelings towards their babies, in the context of sleeplessness and all the massive change and stress that happens. But the ability to tolerate that and to integrate that is really important. And then lastly, these last three, and that’s what I hope Vicky is going to beautifully illustrate with ‘Art at the Start’ is scaffolding and the creation of structure and safety for babies not so that it restricts them, but so they know what to predict. So they feel safe enough. And parents feel safe enough for babies and little people to explore and to play and to express themselves and to start to foster a sense of independence. So these are some of the things I’m sure there’s plenty of clinicians who are watching this webinar and thinking oh, you forgot this or that. I know what I forgot. But it’s very hard to get it all in there. These are some of the important ones. But when we think about that, those of you who are not working specifically in infant mental health or with very, very young children, I want to mention what that means that families need. If this is what we want to create, the conditions for this can happen, what families need, in order for that to happen. Well, they need social and financial safety and good health. It’s very hard to be parentally preoccupied, if you don’t know if you have enough money for your electricity metre or if you’re malnourished yourself, because you have to make the choice between feeding yourself and feeding your baby. These are really important setting conditions if you like to create parents and caregivers who are able to look after their babies in the way that in the right circumstances, of course they can. People need a sense of connection to their community. And tricky at moment, the tricky at the best of times, certainly tricky at the moment. And then they need services which are sufficient, which are reflective and timely. They need those from the universal services. So that’s things like health visiting and when things are difficult and there is relational strain and there is the dark stuff and the difficult stuff and trauma. People need access to timely containing accessible specialist, non stigmatising specialist services. And that’s what Anne is going to come to in her presentation to just talk a little to what loads of us from different sectors have been trying to help establish in Scotland in the last couple of years. That there are people from lots of professional backgrounds who use lots of different theories to do lots of different types and levels of intervention with families which are non stigmatising and which are non judgmental, and which helped to foster some of the conditions which make these things here a possibility.

Dr Rachel Fraser
So, when we talk about well being for wee ones, in part, we are talking about ACEs adverse adverse childhood experiences, and, and we’re talking about it being incumbent on all of us whether we work in infant mental health or not, or early years or not, to work towards reducing stress, reducing poverty and structural inequality, creating a sense of safety for people, by which I mean, people who are facing issues like domestic violence, or for any minoritized or marginalised community feel excluded, and where their barriers and to access health care. So the message is that there isn’t any such thing as a baby, there is only a baby in a caregiver and the care that they get in those first couple of years of life shapes everything that comes later. But in order for that to be good enough, we have to look after the people who are looking after, as well as the interventions for the baby and for the baby and on the caregiver. It’s complex stuff, and I make no apology for not rendering it less complex. There’s so much good information out there for people. Here are some of the websites that you can look at UNICEF and the Parent Club Scotland has got great information for parents, zeros three Parent Infant Foundation, AIM UK, which is the Association of infant mental health. And the first thousand and one days movement, loads of information for campaigning and for all sorts of different services and clinicians on the Anna Freud central support for training. I hope you fall down a rabbit hole for the stuff because it’s ever so important. And we will always welcome contact from people who would like to be involved or ask questions and my contact details you’ll be sent along with two staff at the Parent Infant Foundation, Karen, who runs the development side of things. And Sally who is the head of policy and looks after the first thousand and one day’s movement, whose entire being is predicated and aims to campaign on the importance of emotional well being in the very early years from conception through two. I’m so grateful that you’ve listened and put up with such a whistle stop tour, and that’s really whetted the appetite. I’m grateful to the organisations whose information I have used. And I’m grateful to my two little friends Irene and Sonny and their grown ups for for letting me use their images in which they’re deeply content because they’re looker after grownups have them have enough support. And that’s what it’s all about. And there are some, that’s Sonny there that are some resources that I’ve used for this talk, which are in this section here. And yeah, welcome contact from any of you. It’s, it’s been a pleasure speaking to you and I’m going to hand over the baton directly. Thank you Jeremy. Sorry, I I thought I was going to get a time prompt, but I haven’t seen anything but I’ve probably just gone horrifically over. I can’t see anything, it’s not popping up on my screen is my defence. Going to hand over to Vicky, who is the reason that we’re here and who’s going to tell you about the most gorgeous project, Art of the Start, which is fostering wonderful relationships through art in families in Dundee. So, over to you, Vicky.

Vicky Armstrong
Thank you so much, Rachel. Just bear with me for one second, while I work me to share my screen. Here we go.

Vicky Armstrong
Hopefully that is working for everybody. Thank you so much Rachel. So I’m going to look at a specific example of how we might support wee ones and their families in the context of our project art at the start. So myself and Josephine Ross, who’s a developmental psychologist have been collaborating with Dundee Contemporary Arts, which is a really lovely art space in the centre of Dundee. And we’re looking at how helping very young children to make art together with the important grown ups in their lives can strengthen their relationships, their communication and support their well being. So I think this photo already gives a really nice sense of why art making can be positive for one’s well being, there’s such a nice moment of connection between them here. And as Rachel’s outlined, wee ones social and emotional development is happening within the context of their central relationships. We talk about secure attachments. And at its simplest, by that we mean that babies learn to trust that when they’re distressed, and they cry, the adults in their lives respond most of the time and help them to feel better. And that in turn frees them up to feel safe to explore the world. It’s more than just safety. So babies are born looking for communication and connection with their caregivers. And their interactions, use all their avaliable channels for communications. So thier sound, their sight, there’s movement. And it’s where we see that really nice serve and return rhythm between baby and caregiver. And when we look at these conversations, they’re amazingly well timed. And they’re also mutually rewarding to both the baby and the caregiver. Who feel really good doing it, and art can be really amazing for developing these kinds of things interactions. So in the DCA, we’re taking a few different approaches to encouraging shared early art making. So for everybody to get involved. There’s participative art, which is about getting as many nought to threes as possible making art with their families. So we run things like messy creative sessions using lots of process based art making, we encourage parents to follow their wee ones lead, and we add them to the drop in activities that the DCA also offer. And then lots of outreach to community groups across the city. So we’re particularly thinking about how we can get families who have maybe have not visited the gallery before or who don’t feel it’s for them involved from a very early age, where families are vulnerable and more supports media, we have art therapy groups. So those are small, closed groups of parents and infants always run by a qualified Art Therapist, with families referred by health visitors, family nurses and some voluntary groups, where they’re worried about their attachment relationships. So where parents might be struggling with their own mental health, there’s therapeutic support there, which in turn will help them to be more emotionally available to the baby. We also help parents pick up on their babies communications and response. So we’re really gradually building those serve and return conversations that we know are important. The art itself is quite direct intervention. And they really draws the peanut and infant into interactions and encourages them to be playful together. So increasing that connectedness. During COVID, restrictions we had to adapt a bit and we felt we really need to act quickly to keep offering support for families who are struggling over that time, maybe not getting their usual supports. So we developed art boxes to send to families at home. These we’re focusing on encouraging shared artmaking with lots of baby safe materials, some information on ways you might use them and a bit of psychoeducation on why these may be beneficial and what they might see from their baby, we sent out over 200 of these to families were referred to us. And there’s some nice examples of images that have been shared with us by families using them. And we’ve now turned these ideas into more of a public project by developing the ideas into a book to get families started in Dundee’s Festival of the Future. So some of the other next images that I’ve been using the backgrounds here were taken with families who came in to develop ideas with us and help co-create that book. In all these different approaches. And with all those different levels of need, what we’re looking to do is to build these really nice relational moments through the process of art making. So I’m going to hopefully if the tech works. Want to show you a video that illustrate this while I’m talking it probably does a better job. So this comes from sessions that we ran with volunteer families rather than Anywhere referred to us for art therapy, but to show you a little bit about what we might do in the art therapy groups. And there’s no sound so don’t worry that you’re missing it.

Vicky Armstrong
So in this clip, you can really see that when babies and toddlers and their caregivers make art it’s drawing them together into those nice interactions, there’s loads of eye contact, that are babies and adults sharing attention on the artwork, and there’s pleasant physical contact as they try the sensory materials together. We’re also working to encourage parents to wonder about what their baby may be feeling and to help parents to see their infants communications meaningful. So art is really useful for that, because of all those new textures and colours that wee ones can explore, we see really clear reactions for them. So when they try paint for the first time, you might absolutely love it and get straight in there. Or you might be a bit surprised or even dislike the texture, but there’s usually quite a clear response. So there’s lots for caregivers to notice and respond to. And we can encourage parents to be curious about their wee ones experience, you can see wee one trying shaving foam for the first time. So we also see that when they use art materials to make marks, babies can see their own impact on the world. So in in psychology, we might describe that as agency, so being able to see that they can make things happen. So that’s really fundamental to wee one sense of self. So it’s nice to see it being so clearly demonstrated in artmaking. And when the caregiver responds positively, babies learn that there mark in the world is valued and their self esteem is boosted. So another positive comes from caregivers noticing their wee ones making their mark or showing preferences for different materials or colours. All these things are about seeing the baby as an individual little person that they can relate to with their own personality and choices. So rather than seeing them as a passive being to look after, it’s about seeing them active participant in the relationship. And that means that caregivers can relate to them and really enjoy their emerging personalities. We can also see babies getting to try these new sensory experiences. And because they’re doing that in a safe space with their grown up, and they’re having positive experience, they’re learning that new experiences are a good thing, which sets them up for future learning. Ending sessions in a bathtub. So I don’t want to bombard you with data, but I did want to tell you a little bit about some of the changes that we’ve measured over the different activities. So you’ve been using a mixture of ways to gather evidence of change. Some of these were asking parents to fill in questionnaires and interviews. And because we felt it was really important to capture the infants experience, we’ve also been doing close observation from video footage to look at how their experience might be different in the last therapy session compared to the first. So the outcomes of the art therapy service showed the parents on well being had increased by the end of the art therapy group. And our video analysis shows that we also saw more of the behaviours which we know support attachments. So things like positive touch and shared attention that we’ve been looking at in the video. And then looking at videos for the wee ones experiences, we saw more opportunities for them to experience their own agency, we saw them more engaged in the activity, showing more interest and pleasure. We saw more developmental opportunities and also more positive experiences of the relationship with their caregiver. And our results from the homework projects are also really promising. So we spoke with parents use the art materials at home with their young children. And they told us really encouraging things they’ve noticed. So they talked about feeling better within themselves, and also about being more involved in the play than usual. One parent gave a really nice example of how it was quieter than usual when they were using the artbox. Because for this activity, they turned off the TV. And several others spoke about being more down on the floor joining in than they normally would do with toys. Parents also told us that we noticed the baby’s behaviours. So things like them turning around to show them things, or inviting them into the play. And that connects back against that desire to communicate with grownups. And also to agency if you feel that you can direct the parent and get them to join in, then they feel they have the ability to make change around them. Parents also described wee ones showing excitement when the art materials came out. And we can think of that as anticipation. So the babies were expecting to have fun with their parents when they’re making art, and expecting to enjoy time together that really gets to just the heart what attachment and well being is.

Vicky Armstrong
So we’re really pleased with the results you’ve seen so far with those clinical outcomes, but also what we see in here back ourselves anecdotally. So wee ones enjoying playful time with their caregivers, families, maybe finding support from others who’ve shared similar experiences, and seeing the benefits themselves and doing art together, and perhaps also feeling more ownership of the gallery space. So with families who’ve come for art therapy, or who we’ve met through outreach, then joining the public offering in the gallery, we find that the art gallery setting itself maybe holds less stigma than a mental health setting for this kind of work. And the art also acts as a bit of a hook for engaging families, particularly those from marginalised groups who maybe would find services less accessible. So for me, one of the most exciting things to observe, is payment seeing their baby as a person in their own right, with a really interesting personality to relate to. And that comes back to what I said during the video that the baby is an active participant in making choices and expressing themselves. And that stance of seeing babies as an active participant has really obvious relevance if we want to think more widely about the benefits, and how do we give them a voice? And how do we take their perspective into account. So we’re just now we’re starting a new phase to scale up what we’ve been doing in Dundee across four different gallery sites in Scotland. And we’re really hoping to see the same positive results and also learn a bit more about different local conditions that make the project successful, and how we can meet specific local needs for families. So really exciting within our project, but it’s also happening at really good time in Scotland, I think we’re lots of development is going into perinatal and infant services. So I’m very pleased to hand over now to Dr Anne McFadden, who is the infant mental health lead for the perinatal Mental Health Network, and she’s the chair of the Scottish Government’s infant mental health implementation and advisory group. So she’s really well pleased to be able to give us a broad Scotland wide perspective on those developments and our hopes for how we best support Scottish wee ones. So very pleased to pass over to Anne.

Dr Anne McFadden
Right. Well, there I am. That’s great. Hello, everybody. And thank you so much, Vicck, it’s really great to hear about your work and to see your work. It’s just such a bonus to be able to look at those videos. And I noticed several comments on the on the chat that were really positive. And one was from a nursery teacher in Dundee who will be coming to see you sometime soon, I think. And as Rachel said, it’s great to have the opportunity to be here at the RSE because it’s all about you and your the acknowledgement of your great work. That’s that’s got us here. A little bit of repetition, perhaps. But I don’t think that we’ll do any harm. As Rachel has said in the first 1001 days from conception to age two, babies brains and minds grow exponentially. Millions of neuronal connections are made in the context of special early relationships. Babies who are deprived of these intimate relationships have brains that look very different from those who’ve got an attachment to a primary caregiver. In the context of relationships, babies develop the capacity to experience, express and regulate emotions, to form close interpersonal relationships, have a positive sense of self, to explore the environment and learn to adapt to the environment. And all of this is really, really important. And when early relationships are misattuned, or absence, babies are particularly vulnerable to abuse and neglect, the development, their development falls behind, and they’re also more likely to have problems later. We know that mental health in infancy is really, really important for later mental health. It also contributes to the capacity to be productive as an adult, to be satisfied with our lives. We learn, we don’t learn. We acquire the ability to have empathy and self regulation, and the capacity to make and sustain relationships. So some of you will know that my next question is a favourite. We know this. We’ve got loads of scientific evidence now that has really built on people like Bobby’s early work about how good how important good early relationships are. So we’ve got good scientific evidence. So why is it so hard for us to pay attention to babies and make sure that they get the best possible start? One theory might be this, is it because we’ve forgotten what it’s like to be a baby? I won’t remember anything about what’s happening to me now, but it will affect me for the rest of my life. Okay, is it cause of stigma and a lack of understanding? So I want to just share some brief points from a study that was carried out by medical student Alicia, psychiatry trainees Fifi and Fionnuala, Professor Helen Minnis, Andrew Dawson and I. Professionals were asked about their views about infant mental health. And on this page, you can see a few quotes. The first one, anytime I tell people what I’m doing, they’re like, babies with mental health difficulties. You are kidding. So there’s a bit of a challenge getting our head around the idea that babies have a mental life. I think the other thing belongs to us. So, you know, maybe we can’t bear to think about babies suffering. As Rachel said, maybe we have mixed feelings towards them. Babies don’t always arrive looking pretty. Many mothers and fathers, co parents and birth partners feel very traumatised by the experience of labour and birth. Looking after babies is hard, some cry a lot, some are inconsolable. Some of you will remember that. When you when your babies were little, you had that feeling of desperation as you were trying to soothe them, trying to stop that incessant crying. We feel their distress in our own bodies and our minds. So maybe if we’ve got the choice, we choose not to think about it. Mostly, but not always these negative feelings are these feelings of frustration and exasperation, are tempered by intense feelings of love, and a wish to protect. That maybe this is why as a society, it’s hard for us to prioritise the earliest months and years. We are trying, and as Vicky’s work has shown us things like attending to baby’s agency, helping parents tune into the baby’s thinking about the to and through between babies and the carers is really, really important and art at the start has done a wonderful job there and is a brilliant example of us doing that.

Dr Anne McFadden
So now to move on to the more boring part of my presentation really. In 2019, the Scottish government committed to creating multi agency models of infant mental health provision to meet the needs of families experiencing significant adversities including infant developmental difficulties. parental substance use, domestic abuse and trauma. And we knew that these things can make a difference to families. Really important to say the in the mix there. And very much part of the perinatal mental health service development agenda is that when parents have depression or anxiety, psychotic illnesses, obsessive compulsive disorder, eating disorders, is kind of one of those you name it. And then that impacts on the relationship with infants to. Our vision in Scotland is that there’s a shared understanding and definition of infant mental health, and the importance of Parent Infant relationships. We want that to span policy and practice and be part of the familiar concepts that are held by families and their communities. We want to support parents or carers to build positive relationships for their babies, with their babies, and we want to prevent later mental health and relationship problems. When concerns are identified, early intervention should be offered with universal care providers being able to access specialist services through clear care pathways, so that babies and their families receive the right care at the right time, either from universal service providers, or if necessary from specialist services. And I’ll say a little bit more about that in a minute. But first, I want to return to our first thing. I’m grateful to many people who helped us work on the well being for wee one section of the parent club website. This can be accessed by anyone and we are particularly keen that new parents look at the information provided to you. So when we launched this a year ago, we had a brief spell of having adverts on the telly. And this is one of them. And now I’ve got my fingers crossed to hope that you can all see and hear this

Video
You’re not just having fun. You’re not just making up stories. Green dragon. You’re not just doing silly noises. You’re doing much more than you think you’re helping your wee one feel happy and loved and boosting their social and emotional well being now and in the future. Keep helping your baby’s brain grow. Find out more at parent club dot scot slash wellbeing.

Dr Anne McFadden
So for those of you working in education, this could be a good resource for ACE teaching, I’ve now losy my slides, not to worry. I hope that thinking about baby’s well being and their relationships will become a core part of the curriculum. In some parts of the country this is already happening. For example, in Dumfries and Galloway, a former colleague of mine Lynn Cuddihy, was delivering Solihull training to pupils in some local secondary schools. And there are other good examples to. Know I’ve got a challenge everybody. So I’m just going to see if I can move the slides on. I’m going to stop sharing and start sharing again. And while I’m doing that, I just want to see what I’m going on to next is just to talk briefly about, about the systems that we’re trying to set up in Scotland to do this, let’s just come out of here. Okay, what’s important to us, what are our values. And it’s really important to think about this because as we want to go on and create services and systems, infant mental health systems across the country, we want to think about what’s important, and one of the things that’s really important for us to be thinking about is equality. We’ve heard through Rachel and others that families who live in poverty or with insecure housing, they find it harder to access services, and also are more likely to have pressures on them that make it that make it tricky to focus on parenting. We knew that adversity in childhood is correlated with socio economic disadvantage in the first year, and we need to make sure that our services reach them. We need to evaluate our services, and we need to make sure that interest right are central, and the principles of GIRFEC and the promise are adhered to. We know that babies and carers were more adversely affected by the pandemic than others. And as we move into recovery from the pandemic, we need to ensure that those families are a priority in relation to services, but also the wider social situation. I’m apologise, I apologise for not being able to move this back to a slideshow but I’m not going to risk it. So this slide shows many of the services to report of infant mental health systems, including, of course, the baby indicator at the centre. And you can see here that they’re surrounded by universal services, health visitors, midwives and family nurses are a really important first port of call for families. On this diagram, we can see around the circle, the services that the Scottish Government has funded. And we have specialist interventions on offer in specialist infant mental health teams, perinatal mental health teams, in hospital, maternity and neonatal teams, and third sector. And I want to just take a moment to pause on third sector because third sector services offer an invaluable support to many, many families. They do things like help them with the practicalities, scaffolding them and making sure that they get to services if they need them. And they are also have specialist practitioners working within some of them who offer really informed and specialist interventions for families to improve baby’s well being, the other teams and sets of people on this diagram are all really really important to we’ve got people working in adult mental health addictions, learning disability. We’re doing a big project just now trying to improve services for women who substance use and their families. We need to be linked up with acute and community paediatrics with neurodevelopmental services. And of course with social work. And with early years in education services. Early relationships between babies and their parents are crucial for the building of healthy brains and minds. And I’m just going to finish with my favourite quote from my favourite film, which is The Angels’ Share and this. This is Leone summing up really the point of this whole afternoon.

Dr Anne McFadden
Leonie and Robbie are living in not great circumstances and Robbie is to all intents and purposes, a young offender. They have a little baby. So the midwife said to me, the only half its brains developed and the next half depends on us. You only get one shot at being a wee baby.

Dr Anne McFadden
Thank you.

Professor Jeremy Smith FRSE
Thank you very much indeed for three fantastic presentations, folks. That last quotation, was really quite well. I’m a bit of a solid sort of fellow, but I felt slightly tearful. So there you go. Thank you for sharing that. You only get one go at it. Well, there are some questions. You have 10 minutes or so for some questions. And I see the q&a has been going strong. We’ve had quite a lot of folks have already had their answers, because my colleagues have been typing away here. But there was one right at the end, which I’ll pick up and then we’ll sort of work my way back. Susie Dick. What’s the plan to enable equal access resources for those in remote rural areas, Island setters, the aim to target those urban areas first. So maybe that’s, who would like to answer that one. Is there was a priority or is there going to be in the more out and about?

Dr Anne McFadden
Well, one of the things that’s happened with the rollout of infant mental health services is we, at the government, in its ultimate wisdom decided to do this in a waved way. So we started with a service and Fife and a service in Lanarkshire, both of which are mixed, are mixed, rural and urban. And then in our next wave, we had to city sites, and NHS Highland, and Rachel in her role as the Parent Infant Foundation. supporter of all activities to do with infant mental health in Scotland, lent a specific hand to Highland and Lothian to build their services. The progress is variable across the country, but we are regularly, I regularly meet with people in Shetland, Orkney, Highland Dumfries and Galloway,Ayrshires, I mean, all of the boards across the country, and they’re all varying stages of it. And it’s not the case by any manner of means that the urban areas are cracking on with it any better than the rural ones. So it really is a concern to us. And I think we have to be very innovative about the models of how we deliver this in areas that have got a large geographical area with a small population.

Professor Jeremy Smith FRSE
Yeah, thanks very much for that. There’s a pick up on this, I think by something by definitely the size.

Dr Anne McFadden
So we got a follow up on that?

Professor Jeremy Smith FRSE
Let’s have a look, it’s great news. Here’s someone who said love to be involved in Edinburgh. But there’s something there. And Susie says thanks for answering.

Vicky Armstrong
On the remote one that from our point of view, we’re just on our roll out, one of the places is going to be Lewis where we weren’t ever really like amazing art therapist on Lewis. Be in a gallery there’s like, almost as remote as you can get, so trying to do a mixture.

Professor Jeremy Smith FRSE
Yeah, I did notice that something here from Deborah Dawkins, who asked about who’s taking charge of the art therapy thing in. So that’s a little connection there. More stuff is coming in. Here we go. Anonymous. Attendee says, is there anywhere else our family can get support other than CAMHS in relation to mental health.

Dr Anne McFadden
I must come in there. I’m afraid. Infant mental health is really, really important in terms of thinking about further upstream. And, and actually the things that we can do if we attend to infants, mental health, actually, me help, the incredible demand that we have for come services at the moment. And infant mental health services, by and large in Scotland are not part of CAMHS services. So shouldn’t be affected by the incredible waiting lists. And you will all understand that waiting lists are an impossible concept for infants, because if you’re on a six month waiting list, more than half your life is gone. So really, we need to make sure that we are attending to infants needs promptly, and really, as I say, trying to do a lot of preventative work that will stop children needing CAMHS later on.

Professor Jeremy Smith FRSE
Yeah, there was a good point, I think, in one of the earliest chats from who was it now? It was a Graham Schulman. Who addressed Rachel, I think you got back about that. Did you? Rachel, would you like to add something to that? Or maybe go over it again?

Dr Rachel Fraser
Yeah, I mean, Graham makes a really good point, which is that we talk a lot about what the implications for adulthood are of difficulties in relationships and emotional well being in babies when they’re babies. And we quite easily get sidetracked into thinking what the what the implications are further down the track. And Graham makes a very important point that of course, the pathology and the very grave difficulties in the risk can be there at the time for babies. And my response to him was to absolutely agree and it’s one of the reasons why we have, it has to be a multi systems process to look after wee ones in Scotland know, we have to be thinking, you know, we talk about upstream spending or upstream resources. And we were talking often about the life course. But there’s a sort of upstream of infancy also, and thinking about how we give enough resources and we spread very thin resources across preventative services and the extremely difficult, risky professions interventions which do dyadic work with caregivers in their infants. It’s really it’s really difficult and, one that we’re constantly grappling with, I think, and absolutely, yeah.

Professor Jeremy Smith FRSE
Thanks very much for that. Sarah. Just aked question. And I’m afraid I’m using some ignorance here, because I’m not quite sure what ELC stands for off the top of my head. Are you concerned about the impact of the ELC expansion? I presume on the relationships for young children their primary care, what’s what’s what’s some ELC people? Sorry, I’m afraid, Early Learning Centre.

Dr Anne McFadden
Yeah, it is. I think, on one hand, the concern is that there’s some notion out there, that increasing the number of hours that babies are entitled to in Early Learning Centre is a good thing. But actually there’s some concern that actually we’re taking them further away from their parents. And I would like to see that develop and we have been discussing it in various groups into something that became more like a family centre, Early Learning Centre should be able to support infants and their parents to to get to know each other better, and some of them are doing a really good job of that. So really important just to see more hours at nursery is not the answer. So yeah.

Professor Jeremy Smith FRSE
Sorry about that. It’s since my time, so moving that on. Just for my antiquity there. Thanks for that. There’s a whole lot of questions here about art classes in areas people seem terribly keen on I think your presentation Vicky got people carried away. Grateful my family’s the under threes. And here’s somebody says, I recommend the colour Monster Book that people know of the colour Monster Book. A great resource for us to encourage everyone to identify and express emotions. So if there are monsters out there in colour, that that’s jolly good. Here’s getting a few more now. Services available for babies with visual impairment is an interesting one. Anyone got views on that. Any of our speakers know about this.

Dr Anne McFadden
Nobody should be excluded. And I think the question is, is do they require specialist services. And I know, when I was training, which is a very long time ago, there were some child psychotherapists, who specifically were looking at babies with visual impairments. And I think it would require some thought about that. But but no infant mental health service should be excluding a child because they’ve got a visual impairment. And there was another question here, which I thought was really interesting, which was about should should the investment be in universal or specialist services? And I think the answer is actually we need to build systems that include these and make sure that we’ve got good pathways and good communication between them.

Professor Jeremy Smith FRSE
Yeah, very good. Good,

Vicky Armstrong
I’m going to say on the question around visual impairment is that we’ve worked with the ones in the art therapy group and that I think they can be really useful way to communicate you think of the kind of sensory ways that you’re communicating as well. It doesn’t have to be kind of visual art. It’s a full body experience for wee ones there’s that like, yeah, all those kind of textures and different ways to communicate to them that could be useful and that was something they were thinking,

Professor Jeremy Smith FRSE
Yeah, there was some good going plasticine there. So that’s good stuff. And the colour monster there seem to be all over the place. We’ve had several colour monster here. And all the time do anything to people know this colour monster again, and since my time is obviously quite a big thing. And people have asked questions one or two obvious ones here about people may have joined later to say, is all this going to be up and about on the YouTube? It’s gonna be on the RSE YouTube channels Kate. So yes, we’ll have all that. And also people have asked about links and things that and we can send that out later on. After to that to attendees that can we do that? Yes, RSE is going to send them round to everybody afterwards. So that’s very good. What it here’s someone who says I work here ELC, which I now know what it means, and freedom come across So far, we can’t support trial to three from outside. So something others are finding, too. This is something that fits in for some of the questions of equality we’re raising?

Dr Anne McFadden
Well, it fit into the idea that people don’t understand that infants can have mental health needs in their own right. And I think there’s a bit of a, there’s a bit of a stigma attached to to babies. And I’m very sad to hear that that’s the message that the people are getting that services don’t exist under three, because this is exactly what we’re trying to do is create services and systems from conception to the third birthday is, is that area. But of course, we’re also thinking about making sure that babies don’t then fall off a cliff that were collected up to three to five services to later on services. So we need to be we need to be very careful that we don’t prejudice against children because of their age. In the same way that in our society, it’s now accepted that we shouldn’t prejudiced against older people because of their age, we we must have prejudice against babies.

Professor Jeremy Smith FRSE
Well, Rachel’s presentation was very strong, telling us all of those neurons zoom around in that early period. Going back into conception. Here’s a question from Erika Childress. Is there any concern about stress in the mother during pregnancy phase? How that’s built

Dr Rachel Fraser
Enormous concern.

Professor Jeremy Smith FRSE
I guess.

Dr Rachel Fraser
You know, it’s it’s, the point often of crossover between what. We call perinatal mental health services, perinatal mental health areas, but we mean, like Anne was explaining. The mental health of the mother in the perinatal period, it doesn’t mean that, you know, everything, otherwise infant mental health would come under that,. But yes, absolutely. And if we’re talking about creating conditions, where people can have the best hope of avoiding having to be in a specialist service with their baby, then we’re talking about helping people process trauma, have a decent standard of life, have access to education, and community and support. Absolutely. None of these things necessarily mean anything stress in the perinatal period doesn’t mean you’ll be a bad parent, of course. But the more obstacles you have in front of you, the more strength you have to muster to get through it on. We want people to not have to struggle in the way they have done.

Professor Jeremy Smith FRSE
Yeah, I noticed that Gail, here is talking about bereavement during the period that something like those is, well maybe that’s something that a lot of us would think about.

Dr Rachel Fraser
Yeah, I think that’s maybe one thing that neither myself and nor Anne mentioned, which is alongside the perinatal and infant mental health developments that are services being funded across the country for psychology in maternity and neonatal services, and they all need to speak to each other. Of course, they’re slightly separate speciality, but then at the National bereavement care pathway for perinatal loss for lots of different reasons. Absolutely, people need access to those things, too. What’s important is that those of us who are creating services, create services where people don’t feel it very, very brutal to go between one and the other, you know, when that’s a seamless experience for families,

Professor Jeremy Smith FRSE
Alison Walker responded with a little email, videos about mother’s mental health. Anne sorry.

Dr Anne McFadden
I was just going to say, you know, that that loss of a baby can impact on the next pregnancy. You know, loss of someone close to you during pregnancy, obviously, you know, grief affects people in different ways. So I think it is really important to be sensitive to individual’s needs in that period of pregnancy and the postnatal period, to think about to think about how about how best to support them? And again, I mean, I know I said earlier, and it sounded rather glib, that there’s no right way to do this. But actually, what’s really important is the relationship between the professional who’s who’s helping the family and the family, and what that then brings forward in terms of understanding their difficulties because they’re unique to them.

Professor Jeremy Smith FRSE
Yeah, I think one or two of the questions here have been coming in about which place the baby the baby within the context of the large group, you’re answering I see what Rachel what is important to think about re mental health with become a big brother or sister, which is interesting one here. I’m conscious that we are actually coming towards the end of our time. Because it’s, well in fact we’ve gone over it, which is terrible. Everyone’s wanting off to have their tea. But I’d like to sort of finish off by saying how much I’ve appreciated this event. I think it’s been fantastic. I’d like to thank our speakers, Rachel and Vicky, for giving us a fantastic set of talking points and discussion points. I can see from the chat that a lot of folk a terribly keen to hear more. And I should flag up that the event is being recorded, as I said at the very beginning, and then we’re going to be putting it up on the RSE YouTube channel. So you can watch it at your leisure, watch it at your leisure, but also the links and things and we’re going to be sending out to be mentioned again, sent out to the participants after this event. So it’s hard to do this really, what I’d do now is have a round of applause. There were at one point getting over 300 participants, I think people are beginning to head off of their tea. So I’m going to simply be a kind of proxy applauder. So I’m going to go CLAP, CLAP CLAP like that. And maybe my speakers could imagine that everybody else is clapping, using using the marvels of imagination, and thank you so much. Thank you so much. It’s been a really lovely event. And I look forward to hearing much more about it. Thank you.

Dr Anne McFadden
Thank you, Jeremy.

Dr Anne McFadden
Thank you, Vicki.

Professor Jeremy Smith FRSE
It’s a pleasure. Well done. All of you. Super job. Super job.

Dr Anne McFadden
Bye.

Professor Jeremy Smith FRSE
Bye bye. Bye bye.