Professor Kevin Nugent:

I will begin by responding to Deputies Keaveney and Ó Caoláin. My perspective is that everybody who comes into contact with the child - the dentist, the carer, the teacher or the occupational therapist - should be informed by mental health philosophy and understanding. We need an informed but compassionate understanding of the needs of children and families. I think it was Deputy Neville who spoke about the importance of parent education. It is really a question of supporting parents more than anything else. The issue of isolation is a key one in this context. This is also relevant to the last question I was asked. As far as I can see, our target is not to give parents brain-based programmes to make their children smarter or better. It is far from that. It is all about relationships. If the relationship is not there, nothing will happen. Learning cannot take place outside the context of a relationship in which the child feels safe, secure and loved. Only then will a child go into the world, explore it intrepidly and be ready to learn with a sense of openness. Regardless of whether we are talking about a school setting or a community setting, our feeling is that the key issue in the first three years is parent support. People who work with families need to be non-judgmental and culturally inclusive. As Deputy Ó Caoláin said, this is not happening in the school system. I want to pull out the cultural capital that exists within families, regardless of their cultural backgrounds, by giving them a chance to express themselves with their children. All parents want the best for their children.

I agree with the point that nurses have a key role from a cultural perspective. I was delivered by a midwife. These people have a marvellous role to play, and it is a role that has been attached to them for many years. All of us need to acknowledge that children can be helped. I will give an example. I saw a six week old baby with all the symptoms of depression. It was a remarkable case because when I met this baby on the first day of her life in a hospital not far from here, she was responsive and available. I said to the medic who was with me that the baby was having such a good start in life. She was bright as a button. She was tracking and looking around. She was ready for action. When I saw her again six weeks later as she was being placed for adoption, she was unrecognisable because of whatever had happened in the meantime. She had really lost her zest for life. She had poor tone and she was crying all the time. She was almost inconsolable. Of course this is absolutely reversible. The key thing for the child was to find a relationship with somebody who unconditionally loves her. That allowed the child to reclaim her initial zest for life and her biological expectation that her needs for food and love will be met.

It is certainly true that the earlier we can get there, the better. We feel that these interventions should involve supporting parents more than anything else. They should be family-centred and community-based. As many members have pointed out, the focus should not be on the individual parent. Isolation is really the enemy. Senator Burke asked whether there is any data in this regard. There is data all over the place. For example, a premature baby who is isolated is more likely to have all sorts of issues. Isolation is even more important than social class. The absence of support can be a problem. It has been mentioned that it is important for mothers to have other women to talk to. I really want to support that whole issue. My focus is on prevention. Ms Mitchell is dealing with critical things like young people self-harming. I am saying that we should be seeing the signs right at the beginning. We should look at whether there are mental health issues in the first three years. Luckily, people like Dr. D'Alton are looking at this. The Irish Association for Infant Mental Health is training professionals to be aware of this. One needs to have very good eyes to see that children are showing the signs of trauma, but it can be done. We do not want to believe that very young children notice what is going on. I used to say that they do not notice, but I know now that they notice everything. The six week old who was mentioned noticed that the world was not there for him. He was fed, but he already realised that his biological expectation and need to be cared for was not being met. By that time, he had internalised a model of the world as a world that is not there for him. Our goal is to support the development of trust and of the expectation that the world is going to be there for children and is going to support children.

I will conclude by summarising what I have said. I hope I can address all of the concerns of members by saying that this is an issue of prevention at an earlier stage. The human brain is at its most malleable in first three years. I remind the committee that this is a case of "use it or lose it". If a child gets positive reinforcement from his or her parents, all the architecture of his or her brain will be framed by that. By the time he or she goes into school, he or she will be ready to learn by virtue of what happened before his or her third birthday. If a child is secure, he or she will not have to prove anything and he or she will be ready to explore. By contrast, the anxious child who does not feel a sense of being valued and loved in the early years will have great difficulty in school. All I will say, following the work of Dr. D'Alton and others, is that we should be there at the very beginning. If we were to ensure all professionals are given mental health training when they enter the profession, we would deal with one of the key issues that presents itself.