Several years ago, my sister and I watched my 2-year-old nephew’s behavior change dramatically. He started wetting the bed, throwing temper tantrums and getting frustrated so quickly.
In any other child, it might have been normal “terrible twos,” but in him we knew something was definitely wrong. At the time, my sister and her husband were getting divorced. Ultimately, we found out that my nephew thought it was his fault, thus the acting out. This was my first exposure to the impact of family dynamics on mental health in very young children.
Infant and early childhood mental health centers on emotional well-being and the ability to form close relationships with the people around them. Scientific studies vary widely in estimates of the prevalence of mental disorders in very young children, but a recent literature review on existing evidence finds that approximately 16%to 18% of children from ages 1 to 5 experience a mental disorder, and half of those are severely affected.
California is fortunate to have invested significantly in public services to support young children. Looking forward, the budget of Governor Gavin Newsom (D) supports steps that will lead to universal preschool, full-day kindergarten and expanded child care subsidies across the state. In addition, it supports screening for children (and adult) Medi-Cal recipients for adverse childhood experiences every three years.
However, this begs the question: To what extent will this be helpful to our littlest citizens? Our society has done an incredible job destigmatizing mental health and stressing the importance of seeking treatment. Yet the supply of mental health providers has not kept up with increasing demand. The federal Health Resources and Services Administration predicts a national shortage in the tens of thousands in almost every type of mental health practitioner by 2025.
To begin addressing this issue in California, Newsom’s budget also calls for $50 million to support mental health workforce training next year. However, to be effective, a coordinated effort is essential. Mental health issues are not the same in an infant as they are in a teenager (or an adult), and neither are the specializations, quality and qualifications of mental health providers.
Appropriate support for our mental health system requires those leading efforts to train future mental health providers to consider the specializations needed, identify specific geographic locations of shortages, and ensure high-quality (and continuous) training for providers. Efforts must include special attention to training an adequate supply of practitioners skilled in specific age groups, including infants and toddlers.
Earlier this year, the California Behavioral Health Planning Council approved the Workforce Education and Training Plan for 2020-2025. The plan details a strategy that brings together diverse stakeholders to address workforce training, diversity and experience engaging with individuals and families utilizing the public mental health system.
Supporting these aims, Gov. Newsom’s budget incorporates $100 million over the life of that workforce plan to advance behavioral health transformation efforts across the state. Critically, it would support scholarships and loan repayment for mental health professionals, develop an evidence base of workforce pipeline programs, and support the inclusion of peers and persons with lived experience to provide support to individuals and families entering the system. In this model, parent peers could provide emotional support to other parents as they navigate the system to obtain services for their children.
While these efforts are under development, we must get creative to create a community-oriented model around mental health. As the state is recognizing, our community — including family, friends and neighbors — is critical to ensuring the well-being of our littlest citizens.
Community organizations can host more baby- and toddler-friendly events and increase opportunities to provide resources and education to new and expecting parents. Collaborations between neighborhood organizations, faith communities, businesses and others can support activities centered on early childhood development for relative caregivers, significant others and friends of young families to ensure they are equipped to support the young children and parents in their sphere of influence.
We could also implement practices utilized in communities around the world, such as those where elder women have “adopted” younger, newly parenting women to help train them in raising children. Home visiting models can replicate this type of relationship; however, they may not always replace the benefits of informal relationships existing in communities.
Finally, family, friends and neighbors can offer to babysit or provide respite when times get a little tough for parents. Infant and early childhood mental health is impacted by the emotional well-being of the people around them — most importantly, their caregivers. By supporting their caregivers, we are also supporting them.
My family built a bridge of support around my sister and my nephew while he was trying to comprehend his new reality, and he is doing very well today.
In this, we can truly create a community “village” to raise our kids.
Andrea Lowe, MPH, CPH, is a Foster America Fellow working with Los Angeles County on child welfare system reform. The opinions expressed in this article are her own.