What is Children’s Mental Health Care? An Expanded View

A recent Zoom call with a wide variety of local practitioners to address the topic “Building Mental Health Supports for Children and Families” included early childhood educators, home visitors, and early intervention specialists among others. One described an incident in which a colleague was called in the evening by a desperate mother whose 4-year-old son had “trashed the house.” Feeling completely at a loss regarding where to refer this distraught family, she suggested they call the police. Another participant with decades of experience spoke of the many times she has participated in efforts to create a “referral resource guide” only to find them collecting dust in boxes on an office floor. At a bi-weekly Community of Practice group sponsored by The Hello It’s Me Project including many of the same participants, a social worker in a general pediatrics practice described a sense of “heaviness” when she sees families struggling and she has nowhere to refer them. She described a kind of catch-22 where in order to get “services” a child must first have a diagnosis of a “mental health disorder,” but scarce availability of practitioners who can provide such a diagnosis makes this first step seem unreachable.

A sense of helplessness pervaded both meetings, with the “referral” offering a concrete action to combat that helplessness. A phrase I learned from a peer recovery coach with whom I co-facilitate a group for families in the grips of substance use- “find your power” – came to mind. I shared my experience with a pediatrician colleague in Brazil who is also trained in parent-infant mental health. She immediately got the idea when I borrowed the phrase to explain a wish to help pediatricians and others on the front lines with parents and young children “find their power.” She understood how practitioners often can’t see the power of the little moments of connection that when they are summed can change the life and developmental trajectory of a family. She recommended a pair of videos that capture the connection between mind and body and the vast array of possibility for bringing joy in moments of connection. They describe a program with a 10-year history that brings pregnant mothers together to dance that has adapted to the online setting during the pandemic.

I showed the videos during our next Community of Practice session. While YouTube offers an option to translate. I decided to show the films in the original Portuguese. My thought was to demonstrate how we can make meaning without words or language by listening to the music and watching the movement. In fact staying out of the thinking parts of the brain gives a better sense of how infants and young children make meaning of their world well before the capacity for language comes on line.

Two participants in our Community of Practice Group who work at a local mental health center had during a previous session described the time they spent with a client taking turns holding her baby during the home visits as they awaited the appointment with a “mental health professional” for an “evaluation.” After we watched the video, they added to their story, noting that each time they held the mother’s infant, following a time during which their client could calm down and regroup, they handed the baby back to her. I noticed how this story itself represented a kind of dance. Another participant described a program Girls on the Run that builds young girls confidence through physical activity in social interaction. The director of a home visiting program shared how so many of her meetings with parents are upsetting, with mothers and fathers are feeling weary, isolated, and heavy during this stressful time. She followed up with the story of her successful virtual groups for parents. In these Zoom meetings parents are given the chance to connect with one another and open up about the challenges they are facing while engaging in fun crafting activities.

My recent book The Power of Discord, co-authored with world renowned psychologist Ed Tronick, offers model of emotional wellbeing rooted in decades of research:

“Emotional well-being and emotional distress both grow out of variations in the repeated moment-to-moment exchanges that make each of us who we are. On one end of the spectrum, robust interactions lead a person to experience the world as safe and filled people who can be trusted. At the other extreme, fear and mistrust inform a person’s understanding of themselves and the world around them. The two extremes help us make sense of the more typical experiences that fall somewhere in between. Rather than being fixed, the meanings you make in your earliest experience are continually changing in new relationships in an ongoing process of making meaning of yourself and the world as you grow and change.”

Expanding the concept of “mental health care” as informed by contemporary developmental science can offer a way through these difficult times. Our sense of self in the world evolves in an ongoing process of meaning making in relationship with others. Each interaction we experience has the potential to create meanings of hope and belonging. Each one of the participants in these groups has the opportunity to share moments of connection with the many families they serve. Staying present without feeling overwhelmed with helplessness and a need to immediately “refer” can itself offer a solution. The robust participation in these community meetings shows the potential to provide what pediatrician D.W. Winnicott termed a “holding environment;” safe, secure caregiving relationships that facilitate healthy development. We just need to find our power.

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