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One Duchess, #5BigQuestions, 730 thousand births and 3.9 million children:

How to build the healthiest generation in history.

The first time that I met HRH the Duchess of Cambridge, it had just been announced that she was pregnant with her third child.

In fact, she had to delay our initial meeting for a few weeks, because of the severe morning sickness that she suffered at the beginning of her pregnancies.

I knew at that time that she had always been interested in the mental health of mothers and children, and in the fact that — in the words of a recent document by the Royal Foundation — “what we experience in the earliest years, from in the womb to the age of five, is instrumental in shaping our future lives”.

But little I had known at that time that her activities in this field would have been so momentous.

Today’s launch of the #5BigQuestions on the importance of the early years (more about these questions further down) is her greatest public initiative so far in this area.


We first met at the end of 2017, at Kensington Palace, together with my friend, and consultant perinatal psychiatrist, Dr Trudi Seneviratne.

We talked about how common mental health problems are in pregnancy, with one in four pregnant women experiencing problems such as depression, anxiety disorders and post-traumatic stress disorder.

We talked about how these mental health problems can be transmitted across generations, with our own research showing that the children of women with perinatal mental health problems are twice as likely to develop mental health problems themselves when adolescents or young adults.

Trudi and I were really impressed by her keen interest in maternal mental health and her knowledge on the field.

Two months went by, and the Duchess (as The Sun said, showing off her growing baby bump while sporting a baby blue overcoat), came to visit my University, King’s College London, and the Mother and Baby Unit at the Royal Bethlem Hospital, South London and Maudsley NHS Foundation Trust, the clinical unit led by Dr Seneviratne, which specialises in the treatment of antenatal and postnatal mental health illnesses, including postnatal depression and post-partum psychosis.

The Duchess of Cambridge arriving at King’s College Lonon (

She wanted to meet experts in the fields of maternal mental health, as well as clinicians and patients.

She wanted to know more about the consequences of maternal mental problems on children, and about the science that underpins this evidence.

How the hormonal environment in utero is influenced by mental health problems, leading to measurable changes in the development of the infants and in their ability to cope with stress as early as in the first year of life.

How mothers who develop postpartum psychosis, the most severe perinatal mental health problem, have some brain regions that are smaller when studied with brain imaging.

How infants born prematurely, a condition of very high stress for both mother and child, have abnormal developments in the brain that continue into adult life and are associated with mental health problems in adulthood.

How we can develop psychological interventions for women with depression or anxiety in the perinatal period.

How new treatments offered at the Mother and Baby Unit, such as filming mothers and infants playing together to optimise their interaction, and baby massage, can help mothers with mental health problems.

The Duchess speaks to academics working in perinatal research ( I am the first from the right!) (Jack Hill/The Times/PA)

How, in the UK, perinatal mental health problems cost society £8.1 billion per year, or £10,000 for every single birth in the country — and how three-quarters of these costs relate to adverse impacts on the child rather than the mother.

How treating perinatal mental health problems successfully by building specialist perinatal mental health services in the whole country would only cost £400 for every single birth.

And there are approximately 730 thousand births per year in the UK — yes, this is in the title — and a quarter of these will be touched by maternal mental health problems.

That she “sympathised with the mental plight faced by many mothers”.

That she said that “new mothers were supposed to feel super-happy after birth, but one in four was not”.

For me, the best bit was seeing her interacting with the women with mental health problems that were staying in the Mother and Baby Unit — how she just transformed this official visit, with staff, police and photographers all around, into a private, intimate occasion.

The Duchess of Cambridge at the Mother and Baby Unit (Reuters)

My third encounter with Duchess, was at the Royal Society of Medicine, after yet another couple of months, when she launched, through the Royal Foundation, the gathering of a group of experts to develop, in her own words, “the thinking in this critical area”.

Not that she had not done some thinking herself before — you can watch her speech here:

(21 Mar 2018) THE DUCHESS OF CAMBRIDGE MAKES SPEECH AT THE ROYAL SOCIETY OF MEDICINE The Duchess of Cambridge says mental health support should be available in primary schools "before the biological changes and academic pressures of adolescence kick in."

Some of the solutions she proposed in her speech echo with what many of us in the field see as the top priorities:

Mental health support in primary schools, before the biological changes and academic pressures of adolescence kick in.

Parenting and family support, so that parents feel able to get their children school ready and are confident that they themselves can cope with the mental and emotional needs of their own children.

Support to mothers, potentially before they even give birth, so that they are aware of how vulnerable they might be and critically know where they can find help for themselves as well as for their babies and toddlers.

Teaching parenting and relationship skills to teenagers to get the next generation of parents child ready well before they have to put these skills into practice.

But she did not mention the #5BigQuestions. So, what are the #5BigQuestions?

There are approximately 3.9 million children under the age of 5 in the UK — yes, this is also in the title — and these questions are about them.

Go to the website and check it out! It’s a quick UK-wide survey about the under 5s that anyone can answer. The Royal Foundation information sheet explains this very well: The Duchess has spent time meeting with families across the country and hearing about the issues they deal with day-to-day, in addition to speaking with academics, experts, organisations and practitioners.

Now it is the time to listen to the country as a whole, to hear what they have to say and start a national conversation on the under-fives.

OK, here are the questions — sorry you can only read them here, you have to go to the website to answer them:

The findings should provide a vital source of information for the early years sector, helping it to better understand public perceptions of the importance of the early years, and the first-hand experiences of parents, families and carers.

To me, as a scientist, it will be fascinating to know what people think.

I will not tell you my answers — yes, I did the survey already, last night — but I can tell I only knew exactly what to answer for two questions. For the other two, I had to think about it. For a fifth one, I could not really decide.

And I am supposed to be the expert!

So, now it is time for you to do what I did — go to the website, and answer the #5BigQuestions.

Feel, like me, that these are pivotal questions that dig into what makes us humans and members of a society.

Struggle with finding the right answer, then follow your heart and choose the best one.

Not the right one, but the best one.

It will only take a minute.

As the Royal Foundation says, by taking a minute to answer these questions, you can help them build the healthiest generation in history by giving every child the best start in life.

And I like that.


Header image credit

Hannah McKay/PA


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