“To most effectively and efficiently address New York City’s mental health challenges, we must focus on our youngest residents and their caregivers.”

Perinatal health—physical care and support focused on pregnancy, birth, and infants—has been increasing in public visibility, with a new and urgent focus on mental health.

New York City has recently taken significant steps towards addressing a number of intervention and service issues for families with newborns. In March, Mayor Eric Adams announced a new agenda that specifically focused on improving family and child mental health. In April, the City Council unveiled its “Mental Health Roadmap,” which focuses on effective community-based models and addresses barriers to improved mental health in New York City.

These plans are a much-needed and welcome acknowledgement that mental health is just as important as physical. As the mayor said, “We must address the whole person.”

A critical—and perhaps the most critical—point to do so is in the early years of a child’s life. The mayor’s plan specifically acknowledges this, while stating that “few models of a holistic youth mental health system exist.” In fact, there are a number of models that we know have beneficial and long-lasting impact on children and families which the city can implement, if not expand, right now to create the foundations of a true youth-focused mental health system.

Research shows that 85 percent of brain development occurs before the age of 5 and that healthy social-emotional development in the first five years is a key foundation for later success. Intervening early, beginning in the prenatal period, helps keep children on track developmentally and prevents more severe social, emotional, and behavioral problems later in childhood, adolescence, and beyond.

We also know that infants, toddlers, and young children develop in the context of their relationships, being totally dependent on those who care for them. The quality and consistency of those early relationships impact young children’s learning, development, and lifelong health and mental health outcomes. We need to support the caregivers and the ways in which these relationships develop in order to support young children and their future selves.

At the most basic level early childhood mental health services need to be more widely available. The city is in the process of developing its capacity, especially within communities historically underserved by the mental health community. The NYC Early Childhood Mental Health Network, funded by the City’s Department of Health and Mental Hygiene, has created seven specialized mental health clinics across all five boroughs that provide licensed clinical mental health services for children, from birth to 5 years of age, and their families.

The authors oversee a technical assistance center that has trained over 12,000 early childhood professionals as part of this expansion. This initial investment has been critical. Continuing to expand the number of mental health practitioners with expertise in serving young children and their families is crucial, as is growing beyond the initial seven health clinics to ensure additional services flow to communities, families, and children in need.

Soon-to-be parents and infants can expect to receive primary health care services, making it one of the few universal perinatal settings. It provides a unique opportunity and space to bring mental health care providers on board the care team at the very beginning of a child’s life.

In New York City, co-location of mental health specialists for early identification and intervention is already taking place as part of the 3-2-1 IMPACT program. Funded through the Robin Hood Foundation, the Mayor’s Office for Economic Development, and NYC Health+Hospitals, 3-2-1 IMPACT integrates three disciplines–behavioral health, pediatrics, and women’s health–to deliver transformative primary care to mothers and children at the same time.

The New York State Office of Mental Health is expanding a similar program, Healthy Steps, on the state level to connect child- and family-development professionals with families during pediatric visits. Mental health and family care providers should increasingly be brought together, through government and other initiatives, to increase access to this holistic care model.

Similarly, ensuring mental health consultation in early childhood care and education provides another key touch point in the early life of a child. By bringing mental health information and best-practices to daycare operators, pre-school providers, and other caretakers and organizations, we can build the capacity and competency of those caring for young children, while supporting attuned and responsive caregiving.

Treatment centers within the NYC Early Childhood Mental Health Network partner mental health professionals with early childhood providers (such as staff and teachers) to build their capacity to support children’s social and emotional health and development. This model also helps ensure mental health providers can intervene quickly to maintain children in the most appropriate care and educational settings. The city’s health plan should help break down silos between education and mental health services, while establishing frameworks to better integrate mental health consultation into the broader public and private education framework.

New York City has taken a number of first steps towards creating a model mental health system focused on both parents and young children, and should be applauded for committing itself to doing more. However, to most effectively and efficiently address New York City’s mental health challenges, we must focus on our youngest residents and their caregivers. Through expanded and new programming, mental health support will be easier to find and take advantage of—so we can really begin to address the whole person, from the very beginning.

Evelyn Blanck, LCSW, is executive director of the New York Center for Child Development, executive vice president of the New York Center for Infants and Toddlers and director of the NYC Early Childhood Mental Health Training and Technical Assistance Center (TTAC).

Dr. Andrew Cleek is deputy executive director at the McSilver Institute for Poverty Policy and Research, where he oversees a portfolio of technical assistance centers that offer training, consultation, and educational resources serving all mental health, substance use disorder, and child welfare agencies in New York State, as well as infant and early childhood mental health providers throughout New York City.