Parenthood, mental health and the effects on future generations
In this article, Dr Hollins offers her advice to GPs on the most appropriate support that can be offered to new families and explores the importance of providing early help, for the future wellbeing of children.
Being a parent can be the toughest, yet most satisfying experience in equal measure. Our own childhood experiences and our relationships with our own parents, as well as current mental health can influence how we shape our relationships with our children.
We split our journey into three main sections:
- Taking action – why it’s so important
- Building connections – what you can offer as a GP
- Clinical interventions – what treatment is available
A is for action
Why is it so important for GPs to take action to support parenthood?
The first 1001 days of our lives, from conception until the age of two, is when the majority of our neural pathways are formed. An infant’s brain makes one million new neuronal connections every second, based on their early experiences. These early connections are literally the foundations for later life.
An infant’s minute-by-minute experience of being responded to sensitively by their primary caregivers sets the foundation for:
- How they expect relationships to be
- Whether they have a belief that people can be trusted
- Whether they can ask for help when they have a problem, in the ordinary expectation that they will feel better for receiving support
The study of epigenetics also shows that genes can be switched on and off during sensitive developmental periods, and by stressful and toxic relationship experiences, and that these genetic changes can be passed from one generation to the next.
Early interventions for parents and their young children can help to change this genetic story for the next generation. Starting in pregnancy can help because there is a growing body of evidence linking the impact of the antenatal environment on the developing foetus and baby.
If our own experiences of childhood are negative, it is still possible to create a positive experience for our own children. This may require psychosocial support and sometimes specialist intervention. This help can have a positive impact not only on the mental health of future generations, but also on their physical health.
Adverse Childhood Experiences (ACEs) account for significantly higher levels of physical and mental health problems in adulthood, examples being cancer, heart disease and depression, and can reduce life expectancy by as much as 20 years.
ACEs may include:
- Emotional, physical, or sexual abuse
- Living with someone with mental illness or substance misuse
- Witnessing domestic violence
- A close family member being imprisoned
All of these adverse experiences are relational and what makes them so damaging is that they can take place within a child’s closest relationships. Babies and young children have extremely malleable brains, making them highly vulnerable to stress and disturbance. This, in turn, causes their brains to be wired differently from children growing up in secure and emotionally safe households.
There are unmet social needs, poverty, loneliness, domestic violence and lack of childcare support in many families. Michael Marmot's book ‘The Health Gap' explains the links between social inequality and health. Addressing these issues on a local and national level will improve life chances and health outcomes for children.
Thankfully it's never too late to intervene. Prevention and early intervention can help to stop the cycle of intergenerational trauma. Interventions that address the effects, and prevent ACEs occurring in the future, are vital.
B is for building connections
Case study of a family consultation
A mother comes into your consulting room, pregnant and carrying a screaming two-year old girl. She looks exhausted, frustrated and embarrassed. You look at the clock and wonder how you will complete the appointment in the time available.
You look at her notes and see that she had a traumatic labour and postnatal depression following the birth of her daughter. You wonder what the impact is on her current pregnancy and on her relationship with her daughter. You may ask your patient the following questions:
- Does she have any worries about giving birth to her new baby or the early postnatal period? Given her history, is she depressed or anxious? Is she beginning to bond with her unborn baby?
- How does the patient feel about the relationship that she has made with her daughter so far? On observation, has she developed an attuned relationship? Do they need support in their relationship?
Your intervention, care and interest may enable your patient to become the mother that she wants to be for her children. Finding out if anything is blocking her ability to respond to the needs of her unborn baby and her toddler may make all the difference. Speaking with her midwife and health visitor may help her to feel better supported and able to prepare for the next birth.
In order to be available minute-by-minute, parents need to be surrounded by the practical and emotional support of their partner, friends and family. And yet we live in a society in which parents are often alone with their children for many hours a day, managing this difficult task without affirmation or support. It helps for parents to realise that they are not alone in their experiences and to be encouraged to reach out to others at the same stage in life. Strengthening social networks has been shown to significantly improve health.
Local community resources
Let parents know what drop-in groups are available for families from pregnancy onwards. For some people, this may be too daunting and involving a health visitor or family support worker may be needed to facilitate the process of becoming part of a community. Use your waiting room as a place for parents to find out about what is available locally, from groups, to childcare, to infant feeding support and helplines.
Many parents feel unable to share their feelings honestly with those that they meet face-to-face. There are apps available for parents to provide information and offer support, such as Baby Buddy and Vroom. There is a new app called Circles, which is specifically designed to enable mums to share their experiences and to feel less lonely. Mums are matched with others at the same stage of parenthood, and can discuss relevant podcasts shared from peers and experts. Dr Hollins is involved in the development of this app.
Good quality childcare is crucial. Having a trusting relationship with a sensitive, responsive and available keyworker is what young children need. It is important to support parents to trust their instincts if they are concerned that their child isn't happy in the care of a particular childminder or nursery and help them to access local information about alternative options.
For other useful resources that you can offer to parents, please see Appendix 1.
C is for clinical interventions
Priory has recently started the parenthood, pregnancy and family (PPF) service at Priory Wellbeing Centre Harley Street.
This service will offer a comprehensive range of assessment and treatment interventions for each stage of a family's developmental timeline and is delivered by our expert consultant psychiatrists Dr Kathryn Hollins and Dr Lucinda Green.
- Comprehensive bio-psycho-social and relational assessment of parents and children
- Recommendations and psycho-education to strengthen and support health and development for parents and children
- Individualised information and advice about specific mental health problems that mothers may be at risk of developing in pregnancy and after birth
- Specialist advice to help parents to ‘weigh up’ the risks and benefits of using medication in pregnancy and breastfeeding, either to treat current mental health problems, or to reduce the risk of relapse in the perinatal period
- The opportunity to collaboratively develop a plan for pregnancy and postnatal care
- Assessment can include the involvement of partner, wider family and other professionals such as an obstetrician, a midwife or a health visitor
Treatments available can include:
- Parent-infant psychotherapy
- Couples and family therapy
- Cognitive behavioural therapy (CBT)
- Video interaction guidance -a brief collaborative process of change using video feedback
- Circle of security parenting
- Neonatal behavioural observation: a relationship building tool for new-borns and parents
- Mindfulness for pregnancy and parenthood
- Eye movement desensitisation and reprocessing (EMDR) for post-traumatic stress disorder (PTSD) after childbirth
Treatment as part of the PPF service is offered by a team of specialists focusing on the mother’s mental health, the parent-child relationship, the parental couple’s relationship, the whole family and intergenerational relationships.
Not all patients will be able to access Priory services. MABIM (mothers and babies in mind), part of the Maternal Mental Health Alliance, provides a free mapping tool on what should exist for both perinatal and infant mental health services and pathways. It is an interactive tool, which enables you to rate your local services and pathways.
For other useful resources, please see Appendix 2.
For more information, please view our GP section of the Priory website, which includes information on our outpatient therapy packages.
Courses for parents and GPs
- Circle of Security Parenting is an excellent programme, useful for all parents, which aims to increase understanding about children’s emotional needs and how to respond. Please click here for more information
- CPD for GPs – an interactive infant mental health online course
Websites with useful information for you and your patients
- Perinatal mental health – this comprehensive toolkit from the Royal College of GPs is an overview of available resources
- Infant feeding – the above toolkit gives useful advice, whether breast-feeding or bottle-feeding. Click here for a helpline which is available every day from 9.30am until 9.30pm
- Infant sleep – the well-researched infant sleep information source
- The Wave Trust report will also assist you in learning about best practice for supporting children, from conception to age two
- It may also be useful to explore the following example of an integrated parent infant mental health care pathway