Consultation Opportunity

In June 2024, the National Mental Health Commission invited feedback on its Draft National Guidelines for including mental health and wellbeing in Early Childhood Health Checks (ECHCs) for children aged 0–5 years. The draft Guidelines sought to embed mental health considerations into existing developmental checks, acknowledging the importance of the early years for lifelong wellbeing.

QAMH’s Submission

QAMH welcomed this consultation opportunity, noting that mental health concerns often begin in childhood and that early, recovery-focused interventions can transform outcomes. In our submission, we endorsed the trauma-informed and early-intervention frameworks, as well as the emphasis on building trusting relationships between practitioners, parents/carers, and children.

We also highlighted areas for improvement, including:

• Ensuring maternal and caregiver mental health is considered, given its direct impact on children.
• Addressing gaps in foundational service provision, particularly in rural and remote areas.
• Recognising the vital role of the community mental health and wellbeing sector in providing psychosocial supports.
• Improving the layout and usability of the Guidelines for practitioners.
• Acknowledging work such as the “thrive by five with culture alive” legacy led by SNAICC, the national voice for Aboriginal and Torres Strait Islander children.
• Developing co-designed training for practitioners to support implementation.
• Strengthening guidance for hard-to-reach communities, including those experiencing domestic and family violence or living in remote regions.
• Placing greater emphasis on proactive engagement to reduce barriers to care.

Understanding The Final National Guidelines

The Final National Guidelines, released in 2025, aim to help health practitioners, service providers, and governments consistently embed mental health and wellbeing into developmental checks for children aged 0–5. They support the early identification of children who may be struggling and help families access timely care and advice.

Rather than focusing on diagnosis, the Guidelines promote a holistic view of children’s wellbeing. They highlight the role of social, emotional, behavioural, and developmental needs, as well as the influence of caregiver wellbeing, cultural context, social determinants, and family connections. This ecological perspective always places the child within the context of their family unit (see Figure 1).

Figure 1: Conceptual model for including mental health and wellbeing in ECHCs

Final Guideline Changes And QAMH’s Influence

The final Guidelines retained the same overall structure as the draft but introduced a number of important refinements. Several of these directly reflect QAMH’s advocacy during consultation:

• Rights-based framing: Adoption of principles from the United Nations (UN) Convention on the Rights of the Child and the UN Declaration on the Rights of Indigenous Peoples.
• Cultural safety: Stronger emphasis on practitioners engaging in ongoing cultural learning and reflection, a theme QAMH strongly endorsed.
• Caregiver mental health: Explicit recognition that parents’ and carers’ mental health is foundational to child wellbeing, directly reflecting our call for this to be highlighted.
• Foundational needs: Clearer definitions, including a distinction between foundational needs and NDIS “foundational supports”, aligning with QAMH’s feedback.
• Proactive engagement: Greater focus on proactive outreach and follow-up, including closing referral loops and supporting families through transitions – another area influenced by our submission.
• Community venues: Expansion of delivery locations to include Aboriginal Community Controlled Organisations, cultural centres, immunisation clinics, and fathers’ groups, reinforcing QAMH’s view that checks should be accessible in everyday settings.

What Is Still Missing?

However, despite these gains, several priorities remain absent:

• The community mental health and wellbeing sector is not explicitly recognised as a referral partner or support provider, limiting visibility of the psychosocial supports families rely on.
• No reference is made to co-designed training with lived experience, despite its importance for workforce readiness.
• Hard-to-reach communities, particularly those experiencing domestic and family violence or living in rural/remote contexts, are acknowledged only broadly, with little tailored guidance.
• The Guidelines retain a technical format, without adopting our suggestions for improved layout and practitioner usability.

Why This Matters

Without explicit recognition of community-managed supports, or clear pathways for families in rural and high-risk contexts, the Guidelines risk identifying children and families in need without ensuring adequate services are available to help them. As QAMH has repeatedly stressed, guidelines are only as strong as the service system that underpins them. Strengthening psychosocial supports and embedding the community mental health sector as a core partner will be essential to realising the Guidelines’ intent.

QAMH will continue to champion the role of community mental health in building a system that keeps people well, connected, and thriving in their communities.