These are the statistics that the NSPCC’s All Babies Count initiative is dedicated to reducing. As well as campaigning to raise awareness of the risks facing the most vulnerable small children, the charity is trialling four new programmes to support parents and protect babies.
Chris Cuthbert, head of strategy and development for children under one at the NSPCC, says the schemes aim to prepare mothers and fathers for the challenges of caring for a new baby and to promote strong bonds, or attachments, between children and their parents.
"A lot of research evidence highlights the critical importance of the early parent and child relationship, so that’s central to our thinking," he explains. "There is a whole spectrum of interventions for families with young children, but they are few and far between, so we want to use our voice to raise awareness and to showcase the best programmes."
To make the financial case for investment in services for infants and their parents, the charity will undertake a comprehensive evaluation of its new programmes. "We know we’re not in the flush years, but we need to think about where there are significant savings to be made through certain interventions," Cuthbert says. "Commissioners have to make some hard decisions, so we’re trying to help them with that."
The charity is also calling for a significant expansion of parent and infant mental health services across the country as crucial to protecting babies. "Infant mental health is a new and emerging field, but it’s really the frontline in terms of early intervention," he says. "So we need to break down the barriers between health and children’s services, adult and children’s mental health services."
Psychotherapist Sue Gerhardt is a founding partner of one such service. The Oxford Parent and Infant Project (Oxpip) offers therapy to parents and children from birth to the age of two. Based in a Sure Start children’s centre and funded by the local authority and primary care trust, it offers one-to-one support and group sessions to 50 families a week, who can self-refer or access the service through professionals such as GPs.
"There was a gap in provision in Oxford for this kind of work," Gerhardt explains. "It’s estimated that 40 per cent of all children grow up with an attachment problem of some sort, which can shape their whole lives and future mental health. So really there needs to be a universal service to deal with that."
The service works with infants and parents together, to boost parental confidence and help parents understand their baby’s needs. "We have to learn to recognise our emotions when we’re born and we have to learn that from adults," she says. "More parents than we’d like to admit are unable to provide that sensitive care that babies need. This is so important because a child’s early experiences are actually shaping their neurology. The brain of someone who has experienced early stress is more sensitive to stress in later life."
Gerhardt believes there should be an infant mental health service in every Sure Start centre and that the government’s Family Nurse Partnership (FNP) scheme, which offers intensive support from health visitors to young mothers, should be available to all families, not just vulnerable first-time mums.
"That should be seen as a basic level of support that everyone can access through pregnancy and the early years," she says. "You need lots of layers of support and opportunities for people to access services. Even short-term therapy can have a big impact if you get in at the right time."
While Oxpip offers a universal service, other parent-infant mental health services provide higher levels of support.
Amanda Jones is a consultant psychotherapist and clinical lead of the Perinatal Parent Infant Mental Health Service at the North East London NHS Foundation Trust. Her service covers the boroughs of Barking & Dagenham, Waltham Forest, Havering and Redbridge and is made up of psychiatrists, psychotherapists, clinical psychologists and perinatal community mental health practitioners and social workers. The team has extensive adult mental health experience and an in-depth understanding of infant development.
"The service is funded by adult and children’s mental health budgets from the four boroughs," Jones says. "This is unusual, but a really good model because it recognises the fact that we’re dealing with the wellbeing of both the parent and the forming mental health of the baby."
Mothers suffering with a serious mental illness make up at least four per cent of live births and up to eight per cent of new mums will be emotionally ill enough to warrant a referral to a specialist parent-infant mental health service, Jones says. That equates to about 55,200 mothers and babies every year.
Although National Institute for Health and Clinical Excellence (Nice) guidelines recommend that such services should be available to all, provision across the UK is "hit and miss".
Jones believes that one reason parent and infant services are being overlooked is that policy-makers, commissioners and clinicians can find it too difficult to imagine what it is like to be a baby with a parent who is severely depressed, anxious or obsessive for 24 hours a day.
"If a parent has a premature baby that needs emergency care in a neonatal intensive care unit, it is taken for granted that such provision will be available," she explains. "But if you are a baby at grave risk because your parent has a serious mental or emotional illness, it’s completely dependent on where you live as to whether you will have access to a specialist perinatal psychiatrist. Those babies are really being deprived of the emotional oxygen they need to develop."
Jones argues that all children’s centres, GPs, midwives, health visitors, social care and adult mental health services need to have a service like hers to refer to when a pregnant woman or father is at risk of or suffering from serious perinatal mental or emotional illness. "To have that kind of provision available to families across the UK would need about 45 services," she says.
The economic case for investment in parent and infant mental health appears overwhelming. "We did a cost-benefit analysis on one case of a damaged mother and her baby son who received our service for two years," Jones says. "The cost was £10,987.20. It sounds expensive to provide services like this, but if you think about it in terms of the future mental and physical health of the baby, or keeping that child out of prison, it’s actually very little."
PROTECTING BABIES: FOUR NEW NSPCC PROGRAMMES
- Minding the Baby is an intensive home-visiting programme for vulnerable first-time mothers aged under 25. Developed at Yale University, it is distinctive from other home-visiting services in that social workers and nurses work together to provide support to families from pregnancy until the baby turns two. It aims to promote secure attachments between babies, mothers and their families. It is being offered to 320 families in York, Sheffield and Glasgow.
- Parents Under Pressure works with parents receiving drug or alcohol treatment with a child under two in their care. Therapists work with mothers and fathers in the home to help develop parenting skills and safe relationships. Developed in Australia, the 20-week programme has been proven to reduce the risk of child abuse. The NSPCC is delivering the programme to 650 families in 10 locations across the UK.
- Preventing Non-Accidental Head Injuries in Babies is a hospital-based education programme for parents of all newborn babies. Midwives show parents a DVD suggesting ways to cope with crying and sleeplessness and highlighting the dangers of shaking an infant. The programme will reach parents of 80,000 newborn babies over two years in 12 UK hospitals. It is inspired by US research, which showed that non-accidental head injuries could be reduced through parent education.
- Pregnancy, Birth and Beyond is a new parent education programme that the NSPCC is developing for vulnerable expectant parents. The programme consists of eight group-based sessions on parenting, including two that take place after birth. It focuses on helping at-risk parents manage the major transition to parenthood. It will be delivered to 2,000 parents in eight areas across the UK. An evaluation study will examine whether the programme is successful in engaging families, and compare its cost effectiveness to routine antenatal education.
