Prevention and early intervention in the life of a child, or the life of a vulnerability or difficulty, are vital elements in improving infant and child mental health. They help to prevent the development of mental illness as the child journeys into adolescence and adulthood. Wellbeing in childhood is also associated with a range of positive outcomes, including higher academic achievement, economic security and improved social relationships (VicHealth, 2015).
Research shows over 13% of 4–11-year-olds in Australia experienced a diagnosable mental health condition in a 12-month period (Lawrence et al., 2015). Poor mental health in infancy and early childhood has been linked to physical and mental illnesses in adulthood (Hughes et al., 2017; Zeanah Jr & Zeanah, 2019). Yet infants and children (aged 0–12 years) experiencing mental health problems have the lowest access to and use of specialist mental health services in Australia (Emerging Minds, 2019). This means a significant number of Australian children currently aren’t getting the help they need, when they need it.
Prevention and early intervention are part of the spectrum of mental health interventions, which also includes mental health promotion, treatment and continuing care. The image below outlines a core set of mental health services needed to decrease the incidence, duration and severity of mental health conditions, along with premature mortality rates (Mrazek & Haggerty, 1994).
Preventing mental health problems involves intervening before a condition develops (Mrazek & Haggerty, 1994). These types of interventions aim to identify and modify factors and environments that are associated with mental health difficulties. These may include perinatal influences; relationships with family, friends and other adults; schools and workplaces; sports, social and cultural activities; media influences; and the physical health of individuals and communities.
An early intervention approach aims to identify the early signs and symptoms of a mental health condition and prevent it from progressing into a diagnosable illness. This includes supporting children experiencing the first episode of a mental health condition. Early intervention supports aim to reduce the impact of mental illness and adversity in terms of duration and damage, and foster hope for future wellbeing.
Considering all the elements of the child’s ecology can help you to find opportunities for early intervention and prevention. In the following podcast excerpt (1 min 27 sec), Brad Morgan, Director of Emerging Minds shares some prevention and early intervention examples.
Child mental health difficulties do not look the same as adult mental health concerns. Young children cannot process emotions, worries or stresses in the same way as adults. This means child mental health difficulties will often present as behaviours, relationship problems or traits.
In many cases, parents or adults will describe a worrying behaviour, or a series of behaviours, while expressing concern for their child’s emotional wellbeing. These behaviours are often given a label (e.g. ‘naughty’, ‘attention-seeking’) without any thought as to the underlying issues the child may be experiencing. This can result in the child’s emotional difficulties being overlooked.
A child’s behaviours also need to be considered in the context of child development, bearing in mind that not all children develop at the same pace. As children grow, their ability to communicate their thoughts and feelings will change. If behaviours fall outside the realm of what is expected for a particular developmental stage, they may be a sign of mental health difficulties. You can find more information on child development in our ‘ages and stages’ fact sheets at the end of this resource.
Parents and extended family members are instrumental to the mental health and wellbeing of infants and children. The factors that have an impact on mental health in childhood often arise from, or are influenced by, the child’s family. Therefore, addressing strengths and vulnerabilities in parents’ lives will also benefit children’s social and emotional wellbeing. Strategies that enhance nurturing relationships and support family, kin and community connections can provide positive mental health outcomes for children as they grow.
You may be familiar with the saying, ‘It takes a village to raise a child.’ In the case of prevention and early intervention, services outside of the mental health sector have a critical role to play. These services include not only health, family and community services, but also sectors such as sports, arts, business, education, labour, justice, transport, environment and housing (World Health Organisation, 2018).
General practitioners and educators are particularly well-placed to support children’s mental health through prevention and early intervention approaches. The regular contact they have with children and families enables them to recognise changes in a child’s behaviour and temperament that parents may miss. And the trusting, ongoing relationships that exist between professionals, parents and children can make it easier to talk about how adult issues might be impacting on the child’s mental health and wellbeing.
Inter-sectoral strategies are also key to effective prevention and early intervention support. These include strategies aimed at the socio-economic empowerment of women, violence prevention and poverty reduction, as well as coordinated responses between infant, child, adolescent, adult and aged service providers and systems (World Health Organisation, 2018).
Prevention and early intervention strategies can significantly reduce the impact of adverse childhood experiences (ACEs) such as family and domestic violence and parental substance use (Bellis et al., 2019; Jones, Merrick, & Houry, 2019). A focus on preventing or intervening early in mental health conditions not only benefits infants and children – it creates a solid foundation for health outcomes later in life, making it a long-term investment in Australia’s future.
Bellis, M. A., Hughes, K., Ford, K., Ramos Rodriguez, G., Sethi, D., & Passmore, J. (2019). Life course health consequences and associated annual costs of adverse childhood experiences across Europe and North America: A systematic review and meta-analysis. The Lancet Public Health, 4, e517-e528.
Emerging Minds. (2019). Keeping child mental health in mind: A workforce development framework for supporting infants, children and parents. Adelaide: Emerging Minds.
Jones, C. M., Merrick, M. T., & Houry, D. E. (2019). Identifying and preventing adverse childhood experiences: Implications for clinical practice. JAMA, 323(1), 25–26.
Lawrence, D., Johnson, S., Hafekost, J., Boterhoven De Haan, K., Sawyer, M., Ainley, J., & Zubrick, S. R. (2015). The mental health of children and adolescents. Report on the second Australian Child and Adolescent Survey of Mental Health and Wellbeing. Canberra: Department of Health.
Mrazek, P. J., & Haggerty, R. J. (1994). Reducing risks for mental disorders: Frontiers for preventive intervention research. Washington DC: National Academy Press.
VicHealth. (2015). Epidemiological evidence relating to resilience and young people: A literature review. Melbourne: Victorian Health Promotion Foundation.
World Health Organisation. (2018). Mental health: Strengthening our response (fact sheet).
Zeanah Jr, C. H., & Zeanah, P. D. (2019). Infant mental health: The clinical science of early experience In C. H. Zeanah Jr (Ed.), Handbook of infant mental health (4th ed., pp. 5–24). New York: The Guilford Press.