Transcript for
How can a national workforce approach support children’s social and emotional wellbeing?
Narrator [00:00:02] Welcome to the Emerging Minds podcast.
Sophie Guy [00:00:08] You’re with Sophie Guy, and today I’m joined by the director of the National Workforce Centre for Child Mental Health, Brad Morgan, to discuss how the Workforce Centre is supporting the mental health of infants and children. Brad has a background in occupational therapy and brings a wealth of knowledge and experience to the National Workforce Centre having previously led the children of parents with a mental illness or cut me initiative. Well, thank you very much, Brad, and welcome. Thank you for joining me for a conversation today.
Brad Morgan [00:00:34] Thank you.
Sophie Guy [00:00:36] So the first question I want to ask you is why is it important to be looking at the mental health of infants and children?
Brad Morgan [00:00:42] Infant child mental health just like physical health is a really important resource that we need to do our everyday life. So for infants and children, they’ve got a really important role in learning, too and engaging with others in relationships, of engaging in play and education. And so mental health provides the tools or resources that they need to do those things. On the other hand, if there’s poor mental health that really disrupts their relationships, their engagement in learning and play. And over time that can really have a long term impact on their outcomes in general, in their health and development, but also in their education and as adults into their employment. So mental health in infants and children is really that important for them in the now what their everyday role as children is. But also in the long term, it’s really important for them as they grow into adults for supporting the best outcomes we can.
Sophie Guy [00:01:36] And so it’s something that needs to be sort of consciously built and developed. Is that what you’re saying?
Brad Morgan [00:01:44] Yeah, yeah, definitely. I think when we think of mental health, we often think mostly about teenagers and adults. We don’t tend to think of children having their own mental health. And in particular, I think infants and young children, people don’t tend to think of them having mental health. And I think when we talk about mental health, I think of it in the positive sense of social emotional well-being, positive mental health. What that means for infants and children is we often haven’t had our attention on it. And it’s often been quite ignored by a lot of the community. I think we just don’t have good, I guess, what you call good literacy about children’s mental health. And so the consequence of it is we don’t tend to understand that. We don’t tend to know how we can support it. We also don’t know how we can respond to what it looks like when there might be difficulties that might emerge. And so that’s really important for us to do, knowing that in the short and long term what that means for children’s daily lives in relation to education and relationships with other.
Sophie Guy [00:02:40] And you talked about good mental health and poor mental health. Can you talk a bit more about what this might look like in infants and children?
Brad Morgan [00:02:48] Good mental health? I really would think of as what you’d notice about children’s behaviour. So when you’ve got good mental health, what things would hope to see is children and infants experiencing a whole range of emotions. So we want them to be happy. We want them to be getting angry. We want them to be feeling sad about things. And we want them to have a full spectrum of those emotions, because that’s what’s really important for people in their everyday interaction. And so feelings and emotions help us to manage the different ups and downs of life and get through. And so for infants and children, things that you would notice about good mental health is that you’d see them engaging with others and interacting with others. And for infants you can sort of see that as soon as they’re born that they’re engaging and gazing at their adult caregivers or their parents or others around them. And sort of you’ll notice that and that sort of gets more as they get older and older. And so have a good mental health you’d want to be seeing that type of interaction happening. You’d want to see a whole range of emotions. And then I think the thing, the difference probably between good mental health and poor mental health is that those emotions and feelings don’t disrupt significantly over time children’s participation in relationships and in their play and learning.
[00:04:03] Poor mental health is the things that you might see on the other end of that spectrum is when they might not be engaging with others or the nature of that engagement is quite difficult for them. You might also notice that they’re not engaging in play or learning as readily, and I think you’ll also see some emotions dominating more than others. So of see the persistence of feelings, of anxiousness or sadness sort of going across over time, but also a whole range of areas like we all sort of tend to react to the environment and sometimes the environment makes us happy in our relationships, make us happy. But sometimes they make us. sad. But what you would see is the difference is those patterns of feelings becoming the dominant part of how they’re feeling. So most things make them worry or most things make them feel sad or. And so that’s sort of the pattern you’ll notice. And that can happen in infants where you’d sort of see them not as engaging or interacting as much or they might be crying a lot more. And infants cry, a lot. Infants who might be struggling might be really difficult to settle or hard to settle when that’s similar in toddlers and children is it might take them a long time to settle down and that might be signs of things getting a bit difficult.
Sophie Guy [00:05:18] So you saying like a toddler having a lot of tantrums or, you know, disagreeing a lot, sort of saying, no, a lot to their parents and that’s being what parents might think of is defined or something. Is that a sign of poor mental health do you think?
Brad Morgan [00:05:33] It can be. And that’s one of the real challenges around infant child. Mental health is those things are also what we expect of infants and children. And so I think the dominating feature and I think probably a helpful way to think about mental health in infants and children is on the continuum that on one end we sort of have positive mental health. And when we mean positive mental health is that I do experience the whole range of emotions, but they learn to manage and cope with those emotions. So it doesn’t cause significant disruptions that doesn’t persist and impact on all their other activities. Where you sort of move across that continuum is when you start to see things like you were sort of mentioning those defined behaviours or that anxiety or sadness persisting over a long time and it becoming almost a pattern of how they interact with others or how they engage in everyday activities. So that can get to a point where what we call a diagnosable mental health condition in infants and children. And that’s when those patterns are really quite severe and persistent and quite pervasive across a whole range of things that children and infants might engage with in their life as well.
Sophie Guy [00:06:41] And it sounds as though this is an important point. The idea that good mental health does include things like expressions of anger, expressions of sadness, frustration. And I think it’s really easy to get sort of in that trap of oh it is happy all the time. Could you talk a little bit more about that in relation to child and child development?
Brad Morgan [00:07:05] So I think from a happiness perspective, that is a desirable outcome we all want for our children. In my mind, I think it’s thinking of happiness as being the predominant feeling we have about our lives, that we feel hopeful when happy. But it’s actually important for us to feel anger and sadness because their emotions that help us respond to what’s happening around us. So when we experience grief, if we’ve lost our pet or a family member, that’s really important for us to be sad about that. That’s what we do and we need to feel those feelings. But it’s when those feelings dominate and that we lose hope or we lose a sense of positivity about our future, I think that that’s when it becomes problematic, because when you’re not feeling hopeful about the future, it does impact on how you might interact with other people, how you engage in your learning and play. So I think that’s sort of for us as we do tend to want to view children just as happy and adults just as happy. But I guess for us, the full suite of emotions is a really important part of being human and part of how we live our lives. And I think in the context of stress and things like that as well, that stress is good because it helps us to be activated to do things and respond to things. But when that stress becomes so severe and chronic that it starts to dominate all our experiences. That’s when we start to experience sort of poor mental health problems as well.
Sophie Guy [00:08:27] Okay. And now we talk a little bit about what do we know about children’s mental health in Australia? Can you talk a little bit about how children are doing?
Brad Morgan [00:08:35] We know a little bit, but I don’t think we know enough. We don’t collect probably enough information about children as a population, the whole population of children. What we do know is we know a bit of detail about children who aren’t well at the moment. So some of the data we do know is that around one in seven children under twelve experience a mental health condition or diagnosable mental health condition every year. So that’s quite a big statistic. And if you’re looking at sort of health problems in childhood, it’s a really important one for us to be paying more attention to. We also know within that, that probably only one in six of those children experiencing a mental health condition get the help they need. I guess what that means is that there’s a lot of children struggling without getting the support they need. And we do have quite good evidence about mental health interventions in childhood that can change or manage the impact of those difficulties on children’s lives. And they’re quite effective. But what it means is that children not getting access to that.
Sophie Guy [00:09:36] Only one in six accessing mental health services. Can you talk a bit about why is that the case? Why are so many children missing out?
Brad Morgan [00:09:44] I think there’s a whole range of issues. And like I was saying before, we don’t tend to have high levels of what we call child mental health literacy in the communities. So what that means is we don’t know what it looks like when children might be showing signs or experiencing difficulties. And as a consequence, we don’t then seek help for it. And so for that reason, we do have quite low rates of help seeking in families. Because they just don’t know the difference between sort of normal development and behaviour versus what might actually be quite a significant mental health problem. And then the other part of that I think is we do have quite a lot of hesitancy to label mental health difficulties in childhood, because when we think of mental health, we tend to think of it in an adult mental health or mental illness lens, which means we’re sort of thinking of presentations we’re used to seeing an adult’s where in childhood they’re quite different. And so it’s quite a different lens we have around that. So I think people sort of assume that we’re talking about the same things that adults experience and just applying that onto children, which isn’t the case generally in infant child mental health.
Brad Morgan [00:10:47] The other thing is what we’re finding is there is low access to mental health services and supports for infants and children.
Sophie Guy [00:10:54] There isn’t enough services?
Brad Morgan [00:10:56] Yeah. Yeah. So part of it is not knowing when to seek help for getting access to services. But the other part is we also know there are less services available for infants and children experiencing mental health difficulties compared with, say, adolescents or adults when they might experience difficulties. I think some of that evidence demonstrated almost the younger you are, the less likely you are to get some help when you are experiencing quite significant mental health difficulties. And I think the nature of that is coming also to some of those presentations that services are often designed to respond to threshold when people meet certain thresholds of presentation in the mental health.
Sophie Guy [00:11:38] So what does that mean certain thresholds?
Brad Morgan [00:11:41] So when you sort of look at mental health presentations, so the symptoms, the severity of symptoms that people might experience when they’re experiencing a mental health condition is a lot of services tend to be designed to respond to the most severe presentations. And so the presentations that we see in adulthood and in teenagers or young people are, I guess, meeting people’s thresholds much more than what a young child’s thresholds would be. So ike a severe presentation in an infant or a young child is going to be, I guess in general, less severe than what we would notice in a teenager or an adult. And so we don’t tend to respond with the same level of intensity as what’s needed within that group as well.
Sophie Guy [00:12:26] Is that, do you think, some normalising that goes on? Of what is maybe sort of a child in distress and perhaps needing support but we sort of normalise it as, oh, you know, they are just being a three-year-old or a terrible twos or that kind of thing?
Brad Morgan [00:12:39] Yeah, definitely. I think we do normalise. I think that tends to be more of the tendency rather than not. And I think that’s why that work around helping people to understand the differences between sort of what’s the normal range of emotions and behaviours and development at different ages and stages that we would expect, but then to have a lens on when should we be a bit more worried and when should we be activating support? And I think by nature we do tend to, as you sort of said, normalise what could be a quite significant issue for an infant or a child. And as a consequence, we sort of just accept that as part of their personality or their everyday functioning as opposed to going, this is something we could address now and support.
Sophie Guy [00:13:29] And what is sort of the first place that parents can go to where people can go to, is it GP?
Brad Morgan [00:13:36] I think that’s one of the challenges as well in this space is that there are so many different gateways for support that people go to for responding to children’s mental health. And part of that’s got to do with how that behaviour or it’s explained. Some people might explain it as if really struggling with a behaviour at the moment and so seek the support of someone to manage their behaviour. Others might go to actually know they’re experiencing tummy aches and headaches a lot of the time. And so they might go get support for that, but not realise that underlying that might be what we call sort of symptoms that might be physical symptoms, but might be underlying that, you know, when we’re anxious or things like that, we get tension in our tell me or that we get headaches when we’re stressed. And so not necessarily noticing it for what it is. And I think within that where people tend to go, where people notice, I think is probably where is where people will activate the support.
[00:14:29] So often people will talk to their teachers or their schools about what’s happening for their children. And teachers also observe and notice. So schools might be a place where people go for support. GPs to be the first place where families go. And I think GPs tend to be that place because that’s often where families will go for a whole range of issues over the life course. It can be things like immunization that can occur when children are getting sick. And as part of those conversations GPs are able to sort of understand the family as a whole and over the life course. And so there’s some important opportunities to sort of think about how we support j.p.’s to. And families to talk with their GPs about when they might be worried about children’s behaviour or emotions or mental health.
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Narrator [00:15:14] You’re listening to an Emerging Minds podcast.
Sophie Guy [00:15:20] As a national organisation, how are you working towards strengthening support for children’s mental health?
Brad Morgan [00:15:26] So we’re really looking at how we support the professionals that come in contact with either children or families or parents during that, in particular that first 12 years of life. And what we’re really looking at is two areas of work. We sort of described as sort of early intervention, early in life. So helping professionals understand how important childhood is for social emotional development, for lifelong mental health, and helping them with some of the tools that they need that they can use in their everyday practice to promote and support positive mental health or social emotional well-being. And the other part of our work is helping professionals and a whole range of professionals, because we know that there isn’t sort of a necessarily one place where families go. They got to lots of places that helping all those different places that families go to have a better understanding of what it might look like when infants or children are experiencing mental health difficulties and helping them understand that a bit more and then helping them understand what types of support they could offer. So whether that’s more information that helps families understand more about mental health or mental health difficulties, it might be knowing where they can get access to support. It might be also for some professionals what more they can do within their role. So what are some of the interventions that they can offer? So if they’re working as mental health professionals with children, what are some of the evidence we know about the types of practices of interventions that can support children when they start to experience mental health difficulties as well?
Sophie Guy [00:17:00] And so are you talking about social workers, psychologists, occupational therapists, speech pathologist? You’re talking about just sort of those groups or is it broader?
Brad Morgan [00:17:12] Much broader. In my mind, I sort of tend to prioritise, I guess, the services that are most likely to have the most impact on children’s daily life. And so I sort of think about how often services who have the most contact with children or most likely to have the most impact on a family’s daily life. So we are looking at some of those groups you mentioned. So where people are seeking support for developmental health difficulties is where they go, tends to be health services where they employ psychologists, social workers and nurses, GPs, medical professionals. But we’re also really looking at a lot of the services in the community that come in contact regularly with children or families or could be playgroups, and they’ve got volunteers or support playgroup workers. It could be local government and how they might respond to community concerns and trauma and providing them with some of the tools around how they can support children’s mental health in the context of those sort of difficulties. And within that, it’s also just thinking about the environments in which children learn and play and how that can be designed and supported to foster good relationships and nurturing relationships with children in the community as well.
Sophie Guy [00:18:21] So I can imagine that you mentioned playgroups, local government, that there’d be people in there who really wouldn’t see it as their role, that they’re there to sort of understand child mental health and support mental health. Can you talk about that a little bit yet?
Brad Morgan [00:18:38] So the reason we’re targeted, some of those other groups that might not necessarily be health services is we know the children’s mental health in a positive sense is influenced by the communities that they live in and make connections within the community, their relationships with others. And that’s much broader than health services, health services that provide support when children might be struggling. So on the other end, we sort of need to be looking at those organisations that, whether they know it or not, are having a positive influence or can have a positive influence on children’s mental health. And so I think that’s why we’re still looking at those groups. Its looking at, I guess, that early intervention, early in life is looking at how do we create healthy communities and healthy places for children to live that nurture mental health and their social emotional development. But alongside of that was the other group which are services that are available to respond and support children when they are experiencing difficulties.
Sophie Guy [00:19:34] What are the main strategies that the National Workforce Centre is engaging in to to educate and support professionals and organisations around child mental health?
Brad Morgan [00:19:45] Well, I think for us we’re really looking at probably three key areas of work. And one of those is strengthening child mental health literacy. So what I was mentioning before around how we improve across the workforce, I guess a better shared understanding of what do we mean when we talk about children’s mental health and what nurtures and supports it, but also what it looks like when it’s disrupted or when there might be difficulties that are emerging. So that’s sort of one body of work to do that. So we’re looking at improving our understanding across a whole range of workforce groups about children’s mental health. The other bit of work that we’re really looking at is we know from when we’ve spoken with professionals and with families is that talking about children’s mental health and the things that influence isn’t a natural part of the conversation that families have when they’re engaging with services and professionals that have felt the same as well, that it isn’t part of their normal conversations. And so for us, we’re really looking at how do we create a safe place for that conversation to happen. And so we were looking at how professionals become aware of how sensitive this is. It can be to talk about this, but to give them some tools or the types of language they use, the way they relate and might start the conversation with families and getting feedback from families about that as well. The goal is that we talk about children, social, emotional well-being. So we’re talking between professionals and families about how do we make this a normal natural part of our engagements and discussions that we have in a whole range of services, that it’s not something that sort of isn’t talked about or who must not be named sort of idea that that’s sort of what children of mental health can be in a lot of engagements.
Sophie Guy [00:21:23] How do you think, how do you create more comfort or safety around talking about these kinds of things?
Brad Morgan [00:21:32] What we’re really learning, I think, from families about that. A lot of families have engaged with services around some really tricky things and learning from them about what has been positive experiences, where they have had a fairly robust discussion which went positively about the challenges impacting on their family and their children and their children’s mental health and learning from those experiences from families there. And what was it about that engagement in the way that that conversation happened that felt comfortable and safe for you. And also for professionals to reflect on that as well, about when they have felt comfortable to have a tricky conversation with families about some of these things, what happened for them and what was supporting them to do that well. So for that type of work, we are really looking at, I guess, the experience that professionals and families have had and learning from that. But also families and professionals can also comment on what doesn’t go so well and what that looks like and why they think that didn’t go so well. So learning from those experiences as well.
[00:22:33] So the other part of the work is we’re really looking at the interventions. I guess the interventions are types of practices that we know when children do experience difficulties or when they might be at risk of experiencing difficulties or types of practices and interventions that support and have good evidence. And so a lot of our role is looking at because they aren’t necessarily as available as widely as we’d like them to be, is to work with different workforce groups who are engaging with children around mental health or working with parents who might be experiencing difficulties around how do we provide you with some of the tools and work with you to sort of integrate some of those practices that we know have good evidence into their everyday work. Some of that work might be prevention intervention. So working with families, particularly in the adult service sector, when we know that children might be a bit more at risk. And so interventions that really strength and resilience. We are also looking at sort of when they might be the first signs of difficulty or when children are starting to experience more persistent feelings or behaviours that might be indicative that they’re heading towards experiencing mental health conditions. So knowing what to do and the intensity and type of support that can address those issues earlier. But also when children do experience mental health conditions, is providing some other interventions and practices and tools that we know can be offered to families to, I guess, get them back into into their learning and education and play in their relationships and minimise the impact of those symptoms and manage those symptoms impacts on children.
Sophie Guy [00:24:06] So I’ll finish up by asking you to talk a little bit about how the National Workforce Centre is delivering this work?
Brad Morgan [00:24:14] It’s quite a big challenge to have a national focus on how we change the behaviour of a national workforce to support children’s mental health. So what we’re really looking at is things that can be offered across the country nationally. And so we have a national website and within that website, professionals can access education and training on how they can support children’s mental health. They also can get access to lots of tools that they can and information resources that they can bring into their engagements and practice with families. So when they’re sitting down, there’s actually things that they can do with families that we provide online as part of that practice or that they can share with families as the things that families can use in their home or in between their work. So a lot of that work is provided via our website and that’s all accessible freely and really, being a resource hub, I think that professionals can use to better their understanding of the evidence, but also the tools and practices that I can apply in everyday practice.
[00:25:17] The other bit of work we’re doing is a lot of awareness raising. So we have a communication strategy that provides a lot of engagement via media, social media in publications that professionals are accessing on websites around helping people be aware of the resources available to them, but also to help them understand children’s mental health a bit more. And then the other work we’re providing is for organisation managers in particular. Organisations around, because we know children’s mental health isn’t the core business necessarily of a lot of organisations or even on the on the agenda or business of a lot of organisations is we know that we need to work with a lot of managers and organisations at that level to think about how they can bring in children’s mental health into their core business. But then what are the structures and resources and supports that they can put in place as an organisation to support their staff to provide the support to children’s mental health in their everyday engagements with families.
Sophie Guy [00:26:17] Okay, and how’s that going?
Brad Morgan [00:26:17] Well for us as a whole. One of the big challenges we have is there are so many workforce groups that we’re targeting. So I think a way we’re really looking at it is we know this is going to take a lot of time. Just in general, we have to raise awareness of children’s mental health and raised the mental health literacy around children in the workforce groups. So that in itself it’s going to take some time. But we also know there’s a lot of organisations that are doing this really well. And so what we’re looking at is how do we provide them with additional resources to take them further, but also to learn from a lot of the organisations. And I think that’s one of the positive things about Australia is that we do have lots of examples of really world leading practice in this area of work. And so part of our challenge is to find those pockets of really important world leading work so that we can capture that story and then share that with other organisations that benefit from that. I think that’s a challenge, but it’s also the exciting part of our work as well, that there’s so much good stuff happening. We’ve got so much that we can learn and share with other people. Once we can capture that story and our challenge is to share the resources and tell the story in a way that others can learn from and apply in their settings.
Sophie Guy [00:27:28] Okay. Well, we’ll leave it there today. Thank you very much, Brad for coming and talking to me today.
Brad Morgan [00:27:34] Thank you.
Narrator [00:27:36] Visit our website at www.emergingminds.com.au to access a range of resources to assist your practice. Brought to you by the National Workforce Centre for Child Mental Health, led by Emerging Minds. The National Workforce Centre for Child Mental Health is funded by the Australian Government Department of Health under the National Support for Child and Youth Mental Health Program.