Friday 30 September 2016

Suicide prevention plan misses out on crucial early years

Dr Paul D'Alton

Published 26/06/2015 | 02:30

Irish Prime Minister Enda Kenny arrives to attend a Eurozone emergency summit on Greece in Brussels, Belgium (REUTERS/Charles Platiau)
Irish Prime Minister Enda Kenny arrives to attend a Eurozone emergency summit on Greece in Brussels, Belgium (REUTERS/Charles Platiau)
Dr Paul D'Alton

'Connecting for Life', the new Suicide Prevention Strategy launched by An Taoiseach Enda Kenny and Minister for Primary and Social Care Kathleen Lynch, misses one essential point: preventing suicide begins in infancy.

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'Connecting for life' begins in infancy and whilst the new strategy is to be welcomed, failing to include the early years of infancy results in a very significant oversight. Such an oversight seems to replicate many national health intervention strategies that overlook early intervention and prevention.

Over the last century, the importance of the early years (zero to three years) has been established. We have a reliable scientific evidence base that testifies to the importance of the early years in laying the psychological foundation for later life.

A host of well-conducted, longitudinal studies demonstrate that the risk of health difficulties, such as heart disease and diabetes, and a whole raft of psychological difficulties, such as depression, anxiety and alcoholism, are related to aversive early life experiences.

The early years are when babies learn to crawl, to smile, to play, to rhyme, to give and receive love and to establish trust. This is the period of development when the brain is at its most formative. The brain has its greatest period of plasticity, of being shaped and moulded for later life, during the first three years.

This period of development presents tremendous opportunity but also tremendous vulnerability. These years of early brain development lay the foundation for later emotional well-being - or not.

Our genes serve as the blueprint for neurological development, the brain networks established are reinforced by repeated use.

Experts in the field refer to this as a 'serve and return' interaction between the baby and their caregivers. In the absence of good-enough responsive caregiving, the brain architecture forms in such a way so as to create a vulnerability to psychological difficulties across the trajectory of the human journey.

We also understand that this process is greatly influenced by social and economic status and therefore one can see how brain architecture is significantly shaped by social and economic conditions.

Michael Marmot, the world renowned epidemiologist, identifies the 'social gradient' affecting the quality and length of our lives according to where we are on the economic pecking order and urges governments to develop policies concerning early child development.

He stresses the need for government policies to be constructed through the lens of equity as a means of counterbalancing the social determinants of health outcomes, and urges governments to tackle the ever-increasing health inequality because of the ethical issues involved.

The recognition of the social and economic factors contributing to suicide and as targets for action in the new national strategy is a very welcome and encouraging addition.

As a nation, we have made great advances in the physical care of children with national immunisation programmes, dental care and universal child welfare payment.

There are huge gaps in these services and well-documented inequalities.

However, the absence of policy and subsequent provision to support the social and emotional development of children under three years of age is a gap of tremendous significance and reach.

This gap is glaringly reflected in the new suicide prevention national strategy.

Over the past 50 years, infant mental health has emerged as a significant approach to the promotion of social and emotional well-being in infancy, as well as a preventive-intervention approach to treatment when significant risks to the infant or young child, the parent, and the relationship are identified.

Ireland is lagging decades behind many of its European neighbours in the provision of perinatal and infant mental health services.

In doing so, we are failing to care for some of our most vulnerable citizens.

In doing so, we are failing to target early intervention and prevention and such a significant gap is regrettably mirrored in an otherwise worthy national suicide prevention strategy.

Dr Paul D'Alton is a clinical psychologist and president of the Psychological Society of Ireland. He writes here in a personal capacity.

Irish Independent

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