Building a prevention pathway for early mental health problems

在英国，十分之一的儿童受到心理健康问题的影响，给他们和他们的家人带来了巨大的痛苦。在这些问题持续存在的地方，它们可能会阻碍儿童在学校和工作场所发挥他们的潜力，并阻碍他们在成年后体验良好的身心健康。在财政上，英国每年因精神疾病而造成的个人成本为418亿英镑。考虑到儿童、家庭和社会的这种负担，迫切需要一种能够尽早预防心理健康问题的途径。我们现在知道，许多形成心理健康问题的风险和韧性的因素都源于生命的第一年。开始时更脆弱的儿童可能会继续发展为最初的困难，然后可能会发展为更成熟的问题。开发更好的方法来确定哪些儿童和家庭可能从支持中受益，这将有助于专业人员与家庭合作，以便在早期采取积极主动的方法。通过支持家庭提供反应迅速、始终如一的护理，我们可以帮助为心理健康奠定坚实的基础。在生命的头几年，当儿童的发展对他们早期的经历、关系和环境特别敏感时，这样做可以释放巨大的潜力，塑造儿童长期心理健康的过程。研究还表明，早期投资在经济上是有意义的，因为儿童在以后的生活中不太可能需要更密集的支持。这种对生命良好开端的承诺使儿童最初的1001天成为全球健康优先事项，这一点反映在最近世界卫生组织关于儿童早期发展的“养育关怀”框架中。然而，我们从数十年的儿童发展研究中获得的见解并没有转化为我们在英国促进早期心理健康所需的公共卫生战略。这一差距背后有两个关键因素。首先，我们缺乏一种快速、有效并为家庭和专业人员所接受的方法来确定幼儿心理健康问题的早期风险和弹性。其次，在对照研究中进行测试时，在预防问题方面表现出希望的儿童早期项目，在现实服务中交付时，通常不会显示出同样的成功。尽管这些方案都是精心制定的，但它们往往过于复杂和昂贵，难以大规模实施。该奖学金将使用流行病学和数据科学中的尖端技术来开发一种工具，以确定非常年幼儿童的早期心理健康需求，并为更个性化的支持提供途径。它将汇集以前对早期干预的研究提供的最佳证据，以便我们能够确定这些方案中的哪些做法和战略往往是最有效的。将这些方案剥离到它们最重要的组成部分，将使我们能够与家庭和专业人员合作，重新设计它们的交付方式，以便它们更好地适应家庭生活，回应家庭的需求和优先事项，并具有可行性和实用性。这将通过快速测试不同的方法来完成，找出哪些有效，哪些无效，并基于此学习调整方法。我们将在英国这样做，并在南非进行初步试点，以确保我们制定的原则和方法是灵活的，可以适当地适应不同的资源和文化背景。这项研究的最终目标是共同为早期精神健康问题开发一种灵活的预防途径，与家庭和社区面临的挑战相关，并回应家庭生活和提供服务的需求。这项研究有可能为改变儿童心理健康的进程提供所需的突破性影响。

One in ten children in the UK are affected by a mental health problem, causing significant distress to them and their families. Where these problems endure, they can hold children back from reaching their potential in school and the workplace, and from experiencing good physical and mental health into adulthood. Financially, the personal cost of mental illness is £41.8 billion per year in England. In light of this burden to children, families, and society, there is a pressing need for a pathway that can prevent mental health problems as early as possible.We now know that many of the factors that shape risk and resilience to mental health problems have their roots in the first years of life. Children who start off more vulnerable can go on to develop initial difficulties, which can then progress into more established problems. Developing better ways to identify which children and families are likely to benefit from support would help professionals to work with families to take a proactive approach early on. By supporting families to provide responsive, consistent care, we can help to build a strong foundation for mental health. Doing this in the first years of life, when children's development is especially responsive to their early experiences, relationships, and environment, could unlock huge potential to shape the course of children's long-term mental health. Research also suggests that investing early makes economic sense as children are less likely to need more intensive supports later on in life.This promise of a strong start in life has made children's first 1001 days a global health priority, as reflected in the recent World Health Organisation 'Nurturing Care' framework for early childhood development. Yet the insights we have from decades of research in child development have not translated into the public health strategies we need to promote early mental health in the UK. There are two critical factors underlying this gap. Firstly, we lack a way to identify early risk and resilience for mental health problems in very young children that is quick, effective and acceptable to families and professionals. Secondly, early childhood programmes that show promise in preventing problems when they are tested in controlled research studies typically fail to show the same success when they are delivered in real-world services. Although these programmes have been carefully developed they are often too complicated and expensive to deliver at scale. This fellowship will use cutting-edge techniques in epidemiology and data science to develop a tool to identify early mental health needs in very young children and a pathway for more personalised supports. It will bring together the best evidence available from previous studies of early interventions so we can identify which practices and strategies in these programmes tend to be most effective. Stripping these programmes back to their most important building blocks will allow us to work together with families and professionals to redesign how they are delivered so they fit better into family life, respond to families' needs and priorities, and are feasible and practical to deliver. This will be done by testing different approaches out quickly, figuring out what does and doesn't work, and adapting the approach based on this learning. We will do this in the UK as well as undertaking initial piloting in South Africa to ensure the principles and approaches we develop are flexible and can be adapted appropriately to different resource and cultural contexts.The ultimate goal of this research is to co-develop a flexible prevention pathway for early mental health problems that is relevant to the challenges facing families and communities and is responsive to the needs of family life and the services in which they are delivered. This research has the potential to provide the breakthrough impacts needed to change the course of children's mental health.