Infant Mental Health Policies Critical for Long-Term Well-Being

October 06, 2023 | Maria Gabriela Ruiz

Infant mental health encompasses the social, emotional, and cognitive well-being of children aged zero to three. Secure attachments, emotional regulation, and healthy relationships shape brain development and lay the foundation for lifelong mental health. However, a 2006 study estimated that approximately 9.5% – 14.2% of children aged zero to five experience mental health issues that manifest as emotional, behavioral, or eating disturbances. Infant and early childhood mental health issues often go unrecognized because of how differently they present in infants compared to children and adults.

During the first three years of life, an infant's brain undergoes significant growth and development, forming neural connections that influence their cognitive, emotional, and social capacities. This is the fastest development the brain will ever undergo. Infant mental health is closely linked to early childhood development, as factors that promote positive infant mental health also have a direct influence on the child's developing brain and emotional capacities. Negative mental health in infancy can lead to long-term implications including impaired cognitive development, physical and emotional health issues, and interpersonal challenges. In contrast, infants who receive consistent, responsive care are more likely to develop positive mental health outcomes, which fosters resilience, socioemotional well-being, and cognitive abilities.

Infant mental health is influenced by factors such as community environment, caregiver's mental health, socioeconomic status, access to healthcare, early childhood education, and social support systems. Poverty, limited resources, discrimination and racism, trauma, and adverse childhood experiences (ACEs) can increase infant mental health challenges. Supportive environments mitigate the impact of chronic stress and adverse experiences for infants and their families. Federal and state legislation can play a role in promoting positive infant mental health by providing funding and policies that support early intervention, caregiver assistance, and the creation of nurturing environments conducive to their emotional well-being.

Federal Efforts

Supportive policies and federal investments have a significant impact on the mental well-being of infants. States can use these levers to drive early intervention and create supportive environments for emotional development.

The Infant Early Childhood Mental Health (IECMH) Grant Program is authorized under the 21st Century Cures Act and provides funding to states to sustain and support children and infants at risk of mental illness or emotional disturbances. These funds are aimed at serving professionals who work with children and infants through prevention, early intervention, and treatment. From 2019-2022, more than 80,000 children were screened, referred to mental health services, and provided mental health care through interventions supported by this grant program.

State Legislative Efforts

In 2022, Maryland enacted HB 513, which established the Infant and Early Childhood Mental Health Support Services Program, administered by the State Department of Education. The program's objective is to promote positive mental and behavioral health practices in young children by offering referrals and services and requires the governor to include an annual $3 million appropriation for the program each year.

Also in 2022, Rhode Island enacted RI HB 7801, establishing a task force to develop plans improving the screening, assessment, diagnosis, and treatment of mental health for children from birth to age five who are covered by Medicaid. The task force released their plan on June 20, 2023.

In 2023, Alaska enacted HB 41, their mental health budget bill, which makes appropriations for the annual expenses of the state's integrated comprehensive mental health programs, including Strengthening the System: Alaska’s Comprehensive Integrated Mental Health Program Plan. This plan will ensure Alaskans can access preventive measures, treatment, and comprehensive support across the lifespan with an emphasis on supporting infants born with fetal alcohol spectrum disorders and neonatal abstinence syndrome, and their caregivers.

The Hawaii legislature is considering SB 1351 to address the growing mental healthcare needs of children under five. This bill would establish an infant and early childhood mental health program within the Department of Health to organize and provide mental health support services specifically for children aged five and under. The program will implement adaptable approaches to service delivery and professional training, including in early childcare, home visitations, and early interventions.

Recommendations for Improving Infant Mental Health

State and federal programs and policies around infant mental health can lead to improved health outcomes throughout the life course. The following are recommendations to strengthen legislative efforts.

• Educate legislators on the benefits of infant mental health programs. This includes discussing enhanced access to mental health services, improved screening and assessment protocols, and other early intervention programs. Additionally, provide information to policymakers as they craft legislation supporting infant mental health.
• Support comprehensive screening and assessment protocols and improve data collection systems related to infant mental health. Implementing standardized screening and assessment tools to identify and address early signs of mental health concerns in infants and young children can help ensure timely intervention and support for infants who need it most.
• Promote cross-sector collaboration to facilitate a coordinated approach to infant mental health. Invite healthcare providers, policymakers, early childhood professionals, social service agencies, community members, and other relevant stakeholders to facilitate partnerships and information sharing. Establish a comprehensive approach that includes community-based programs and interventions to address some of the basic needs of infants and their families.
• Promote consumer and provider education and awareness to ensure the provision of culturally competent, evidence-informed solutions. State and territorial health departments can lead efforts in this space by informing providers and patients about existing programs and policies to support infant mental health, promoting the usage of beneficial programs, expanding the public’s understanding of available resources, and ensuring continued funding of critical resources. By increasing awareness and education about early intervention, families, physicians, and the entire infant care team can better understand how to support infant mental well-being.

States' efforts in this area, including policies that increase funding, personnel, education, awareness, and support, are crucial to laying the foundation for future work that promotes positive infant mental health. It is imperative that these efforts are sustained and intensified to ensure the long-term mental and developmental well-being of infants. ASTHO will continue to monitor and report on this important issue.