At the Education Policy Institute, our research programme is strongly centered on improving young people’s outcomes. Over the last few years we have published several reports on children’s mental health, which have mainly focused on issues around access to and quality of support services.
But, as well as looking at how readily children and young people are able to get the help they need, it’s also important to consider the wider factors affecting young people’s mental health, in order to effectively tackle the rising level of need in this country.
In this vein, later this year we will be investigating the particular drivers of mental illness and well-being in secondary-school aged children, a period during which emotional problems become increasingly common, especially in girls.
This week is Maternal Mental Health Matters Awareness Week, hosted by the Perinatal Mental Health Partnership. While your first thought on the topic of children’s mental health may not be about the health and well-being of parents or caregivers, research suggests that perhaps it ought to be.
It is increasingly clear that maternal mental health is one of the most crucial determinants of a child’s mental health – which in turn suggests that if we want to improve the emotional health of children in this country we should be focusing on families, not individuals.
Let’s review some of the evidence. Maternal mental illness has been linked to wide-ranging consequences for children, including worse mental and physical health throughout childhood and adolescence. Children of mothers with mental illness are more likely to exhibit internalising and externalising behaviour problems and – some evidence suggests – perform poorly in school.
Women of child-bearing age are the most likely to suffer from common mental illnesses out of all age groups in England. While no national prevalence data are published, a range of studies suggest that between one in ten and a third of expectant and new mothers experience mental ill-health. The Children’s Commissioner estimates that a third of children in England aged 0 to 15 live with a parent with moderate to severe mental ill-health symptoms.
A mother’s mental health can affect her child’s through different pathways, both biological and social. There is likely a substantial genetic component to the development of mental illness, but the relationship also works through less engaged parenting, poor attachment, and worse early childhood development – which itself is critical for positive lifelong outcomes, including attainment, employment and adult health and well-being.
So, what are the drivers of mental illness in mothers – and, importantly, which of these are policy responsive? Some are evidently the same as those that drive mental ill-health in the general population – the effects of which can be exacerbated by the major life event of having a baby – and some are specifically related to pregnancy and motherhood.
It is increasingly evident that poverty is causally related to mental ill-health. One recent nationally representative study found that mothers of children who entered into poverty, independent of employment status, had a 50 per cent increased odds of developing a mental illness compared to those whose socio-economic position stayed the same.
Challenging social and economic circumstances can contribute to other risk factors for poor maternal mental health – however these do not only affect disadvantaged mothers. Adverse experiences in childhood and adulthood, including being in an abusive relationship, social isolation and lack of support and experiencing mental health problems prior to having a baby are important contributors – the latter of which highlights the importance of early intervention to prevent the intergenerational transmission of mental ill-health.
Awareness of the importance of maternal mental health for whole families and their outcomes is far ahead of where it was a few years ago. The NHS is currently rolling out services for expectant and new mothers and their partners with diagnosable conditions across the UK. This is a promising first step – although there is wide geographical variation in terms of what is on offer.
But what about expectant or new mothers who do not meet diagnostic thresholds? Or for a different reason – where they live, internalised or culturally-driven stigma, or a lack of information about services – are unable to easily access the support they need? Given the fundamental importance of maternal mental health to the health of children and families, we need to be actively seeking answers to these questions, as well as thinking about how to integrate maternal mental health into child health programmes.
The increase in awareness and recognition of the importance of mental health is welcome, but there needs to be a policy shift to reflect the mountain of evidence showing that the key determinants of health lie outside of the health care system. If we discount the role played by social inequities such as poverty and social exclusion, it will be to the detriment of children and their outcomes.
Whitney Crenna-Jennings is a Senior Researcher for mental health, wellbeing and inclusion at the Education Policy Institute