The Intersection of Maternal Mental Health and Infant & Early Childhood Mental Health: A Conversation with Lee Johnson III, PhD

Conversation with Lee Johnson III, PhD

As part of Early Childhood Mental Health Awareness Month, we asked Lee Johnson III, PhD, MMHLA’s Board Chair and an expert on infant and early childhood mental health, to share some thoughts.

Dr. Johnson is Vice President of Policy at the National Black Child Development Institute (NBCDI) He is thrilled to have recently joined NBCDI (after several years at ZERO TO THREE) as he was one of NBCDI’s inaugural policy fellows in 2019.  Dr. Johnson has spent his career focusing on the social-emotional wellbeing of children, and counts Mr. Fred Rogers as one of his heroes.

Why is infant and early childhood mental health so important?

As early as 3 months, before babies utter their first words. they are experiencing a whole range of emotions.  The first years of a child’s life are critical for brain development and for building the foundation for all future learning, social and relationship skills, physical development, and health.

Safe, stable, nurturing relationships – along with environments where relationships serve as the active ingredients of the environment’s influence – are ideal conditions for a healthy brain and overall human development. In other words, human relationships are essential in all living.

Fortunately, when babies do not have what they need to thrive, parent-child therapies can help set a child toward healthy development.

What motivates you in your work?

My lived experience – as an early childhood educator, as state MIECHV (Maternal, Infant, and Early Childhood Home Visiting) director in Alabama, and most recently as a policy director at ZERO TO THREE – all contribute to my interest in promoting the mental health of children.

Childhood is not an adventure that we choose, but is chosen by adults, both those familiar and forever unknown, through the experiences they create for us.  The unfamiliar people who impact us early in life reveal that we are not exempt from experiences that can impede something deeply critical and connected to our development: our mental health.

Mental health is complicated:  Some days it is joyful.  Some days it is just hard.

Every step we take in caring for ourselves and others matters, whether big or small.  Taking care of each other is protective.  And so is community.  The more we build each other up – whether through policies that respond to the unique needs and strengths of young families, or the kind of support we give in our relationships – the stronger our ability to recover from hardship can become, and ultimately the safer we are to ourselves and to others.

In this country, we have not always talked about mental health, how we feel, what strategies to use, what help to seek, and how normal it is that every single one of us has a mind that we inhabit all day every day that deserves as much as love and attention and care as every single other part of our bodies. Health for the mind is not something we just arrive at; it is work.

“As the gusty winds blow and shake our lives, if we know that people care about us, we may bend with the wind, but we won’t break.”

-Fred Rogers

What keeps you up at night?

What keeps me up at night are all the gusty winds, wonders, and challenges that await our youngest, our mothers, our birthing people, our future.  I worry whether a mental health safety is available and accessible for all babies, children, and families.  It would be ideal to have a world with a dynamic, culturally-sensitive mental health safety net and a continuum of developmentally-appropriate mental health services that includes promotion, prevention, assessment, diagnosis, and treatment. Yet this is not a reality for most families.

Young children who experience high levels of stress due to trauma, natural disaster, parent loss, or who have family members who live with substance use disorder or mental illness, are at heightened risk of developing mental health issues.  These challenges will almost assuredly impact their mental health.

We have all heard about the impact of the pandemic on mental health. What about the impact on our nation’s youngest children?

In April 2020, the University of Oregon launched a survey to gather data on how families with children under age 5 were faring during the pandemic.  The data show that material hardship and social isolation during the pandemic increased emotional distress among parents and their young children.  This reflects 5-year trends in children’s wellbeing, which show an increase in both childhood anxiety and depression since 2016. Despite these increases in children’s mental health needs, there has been no significant improvement in children receiving mental health treatment over the past five years. In fact, children in the United States with at least one mental health disorder are not receiving adequate treatment from a mental health professional.

This mental health crisis that families face is not medicinal but societal.  Thus, we need a societal commitment to expand prevention programs, improve mental health in the earliest years, connect across a variety of settings, and prioritize the birthing experience and mental health of our nation’s childbearing people. When systems act to promote well-being at early developmental stages, our youngest, our neighbor’s youngest, our neighbors, and our society can reap the mental and emotional benefits for years to come.

“Each day is an opportunity for policymakers to advance racial equity, eliminate disparities in education,
and prioritize the health and wellbeing of our children, our neighbor’s children, of us all.”

– Dr. Johnson

What is the impact of maternal mental health on the infant?

We have a mental health crisis in our country.  We hear all the time that parents should safeguard their children’s mental health.  Yet when mothers and other birthing people do not get the support that they need to thrive, they are compromised in their ability to explore, access, and retrieve information and resources that might be important for both themselves and their babies.

We must recognize not just children’s mental health, but their mothers’ mental health.  Babies are here as a result of their mother bringing them into the world.  If we are not considering the investments that are needed to expand access to mothers and birthing people in the same way that we are considering investments to expand access for assessing and diagnosing mental health needs for infants and toddlers, then we are doing a grave disservice to the whole family.

“Children who live in a home where there are mental health conditions are themselves more likely to require psychiatric care at some point in their lives.  They are at higher risk for experiencing cognitive, emotional, or behavioral challenges.”

- Dr. Johnson

What can we do to ensure children are getting the mental health care they need?

One thing we can do is to talk about positive childhood experiences, and to talk about these experiences from a strengths-based perspective.  Just as adverse experiences in childhood can have lifelong effects on health and well-being, so too can positive experiences.

I’d like to share a couple of important resources:

The first is the Child and Adolescent Health Measurement Initiative, which focuses on creating family-centered measurement, data, tools, and research focused on helping all children and families thrive.

The second is The National Child Traumatic Stress Network, which was created by Congress in 2000, and whose mission is to raise the standard of care and improve access to services for traumatized children, their families, and communities.   The NCTSN has trained over two million professionals in trauma-informed interventions and works to integrate trauma-informed services into all child-serving systems, including child protective services, health and mental health programs, child welfare, education, juvenile justice, and programs serving military and veteran families.