International Conference on

Infant, Toddler and Preschooler Mental Health

University of Auckland Business School

Hon Tariana Turia, Associate Minister of Health

18 February 2010; 11am

Delivered on her behalf by Tania Cargo, MA, PGDipClinPsych

Lecturer, Department of Psychological Medicine, Auckland University

I was delighted to accept the invitation of Professor Des Gorman, the Head of the School of Medicine at this institution, to speak at this first international conference on infant, toddler and preschooler mental health.

Thank you also, to our kaumatua, Rawiri Wharemate, Associate Professor Papaarangi Reid, Dr Trecia Wouldes from the Department of Psychological Medicine and Professor Barry Lester from Brown University in Rhode Island, for the warmth of the welcome that you have extended to us all, for this very important conference.

In the proverbs of tangata whenua, the indigenous peoples of this land, there is an interesting concept about the status of the child.

He kai poutaka me kinikini atu;

He kai poutaka me horehore atu;

Ma te tamaiti te iho.

Pinch off a bit of the potted bird;

peel off a bit of the potted bird,

but save the inside for the child.

It is an interesting glimpse into the approach taken towards children.

In essence, it encourages us to consider the welfare of the children as fundamental to ensuring the future strength of the people.

Our children, the leaders of tomorrow, deserve to receive the very best of care, the finest delicacies. Every child should benefit from the highest quality of educational and social support; to be loved, to be secure, to be protected.

This conference fits well with that theme.

The programme demonstrates that leading clinicians and specialists will be presenting a comprehensive menu of cutting edge research.

Delegates from right across the globe - from the United States, from India, Israel, Australia and the United Kingdom -will join with New Zealanders to focus on how best to enhance infant mental health.

I am interested in the concept of infant mental health.

Internationally this term is used to describe the inter-disciplinary field of research, practice and policy-making concerned with enhancing the emotional, cognitive, social and physical development of a young child from birth up to their fourth birthday.

I am aware, however, that there is some resistance to the use of the term, some seeing it as pathologising infants. I must admit, I have some empathy with that view.

Often the literature about infant mental health is dominated by discussion about disorders and disturbances - in other words an absence of health rather than the presence of wellbeing.

Infant mental health becomes defined by prevalence data such as a recent study of three-year-olds which showed that seven percent of these toddlers had moderate to severe behavioural problems.

The discussion around infant mental health is often based within perinatal and infant mental health services, when a child and or his/her mother has, or is suspected of having, a mental health or alcohol and drug disorder, or a psychological disorder including severe behavioural or emotional disturbance in the child.

There are a couple of points that immediately emerge for me.

Firstly, as mentioned earlier, the debate appears to have an exclusive focus on individual illness rather than a broader perspective around health and wellbeing.

Secondly, in focusing on the individual child one is inevitably neglecting the wider context about the relationships within the family.

Twenty years ago, in a groundbreaking report in this country, Puao-te-ata-tu, a report into the operations of the Department of Social Welfare, it was made blatantly clear that in the case of Maori, no child should be viewed in isolation, or even as part of a nuclear family, but as a member of a wider kin group or community that has traditionally exercised responsibility for the child's care.

That concept, that children are inherently linked to their extended whanau, is one that is even more relevant in the context of the mental health of our children.

As a case in point, yesterday as I was going about my work in Parliament, I received a call that shook me to the ground. Our precious new mokopuna - the baby of our granddaughter - had been admitted to hospital.

All of the hot issues of the day, the pressing priorities of the political agenda, evaporated into thin air as I thought about our little treasure, Mikaere Parinui.

In that moment, my mental health and my wairua was intimately connected to his, and that is how it is with every one of my grandchildren and great grandchildren.

No child stands alone. He is part of me, he is part of us, and that bond can never be severed.

So when we look at the social and emotional development of children, especially during infancy and early childhood, the mental health of their parents, and I would suggest their wider whanau, is a crucial predictor of their ongoing health outcomes.

We call this whanau ora - the fullness of health and wellbeing that provides the strongest foundation for young people and future generations.

Whanau are the obvious sites for nurturing infants and children and ensuring that they grow up with positive values, healthy lifestyles, secure cultural identities and an ability to participate fully in society.

I am sure that all of us gathered at this conference today could share many countless stories of whanau who have raised children who are loved and able to grow to their whole potential.

We must promote these stories and continue to remind ourselves of the amazing achievements families are experiencing every day.

We need to hear these stories as they encourage us all to live by the highest standards, in investing in our future.

Of course there are some of our families who live in circumstances which have not been conducive to positive outcomes; some of our parents live with challenges which impact on their capacity to care and nurture their children in the way we might expect - and there are many reasons for that.

Our responsibility at this conference or in our own homes, is to do everything possible to wrap loving arms around these families, in the best interests of their children.

We must be particularly vigilant in our surveillance and support for mother and child during the period of pregnancy.

We know that about ten percent of pregnant women suffer from depression and up to 15 percent may experience post-natal depression. Are we aware of their needs, are we stepping up our support to be there for them and their growing baby?

When baby is born, are we doing what we can to consider the strengths and needs of the mother, the father, the whanau, the baby? Are we encouraging breastfeeding, and helping to promote the physical and emotional benefits for babies and mothers?

One of the issues that will no doubt be raised at this forum is the recognition that in many countries, including New Zealand, infant mental health services are under-developed and the provision of services is not nationally consistent.

We must be active in our advocacy for a strong and specialist workforce that can be instrumental in identifying and caring for vulnerable children and families.

That workforce must help to join the dots; to strengthen links between the Well Child Tamariki Ora programme and maternity services, primary health care, maternal and infant mental health services and adult mental health and addiction services.

In terms of professional development, it is crucial that we include education around early childhood mental health surveillance, assessment and treatment in both undergraduate and graduate programmes.

And throughout it all we need to remember that every child is unique, and the cultural context they are born into, is to be valued.

Whether it be introducing touch therapies; evaluating infant-parent interventions; studying biological and environmental factors, or caring for the children within our own home; the crucial role of family can not be understated.

And perhaps that's the greatest challenge for us all in thinking about how we respond to infant mental health - can we demonstrate that our responses are not only developmentally appropriate, but also family friendly, culturally competent and strengths based?

Are our processes responsive to family and whanau needs? Are we working in such a way that parents are supported and grow in the way that they nurture their family?

I wish you all a wonderful conference, in which you share your stories of success, you learn about the transformations possible; and most of all you focus on those who offer the promise of tomorrow - our children.

Tena tatou katoa