Dear Cynthia,
I am a little behind in my lactnet reading, but your post stood out
because I am an infant mental health specialist.  Infant mental health
is a trans-disciplinary approach to "enhancing the social and emotional
competence of infants to master the primary physiologic, developmental
and psychological tasks of infancy without serious disruption caused by
harmful life events in their biological, relationship and cultural
contexts."    Infant caregiver relationships are the primary focus of
infant mental health assessments and intervention efforts.

An infant's mental health "evolves from multiple contexts: the
characteristics of the neonate, the relationship the infant has with
adults", the representations these adults have of the infant, themselves
and their relationship, and includes the effects of the settings where
these relationships take place.   "Early identification is necessary to
reduce the risk of serious developmental failure, relationship
disturbance," abuse and neglect.

I also work with lactation, (hesitant to say consultant as I am not
IBCLC).  Having given you the technical definition, I can tell you that
despite IMH describing itself as trans-disciplinary, it is not truly
even multi-disciplinary.  Lactation is barely recognized in the mental
health fields, likely because is poses some problems with basic
theoretical constructs and public policy.  For me, it was a delicate and
uphill matter to get my graduate school profs to open up to lactation as
compatible with their perspective, perhaps because they thought we were
radical weirdos, at first, or attachment freaks second, or just myopic.
Mutual respect was long time coming and was won only through the
strength of my relationship with them.  The mental health field will
continue to be slow because they themselves have been on the periphery
of the medical model, viewed as a "soft science" and therefore rather
defensive in their own right.

All this said, the only way to know who to refer to is to cultivate
personal relationships with your mental health providers.  Also know
that infant mental health practioners are few and far between, but we
are out here, usually in tangential jobs because we are newer to the
field, just now making our niche.  But working with a dyad is very
specific work and calls upon a skill set that, while it can and should
be shared among all of us in our field, is so new, that a specialist is
a plus.

Hope this shed some light,
Joanne

Zeanah,C. and Zeanah, P. (2001) Towards a definition of infant mental
health.  Zero to Three Vol. 22, No 1.
  Connecticut birth to three system service guideline #4. December 1998
www.birth23.org
  Zeanah,C. and Zeanah, P. (2001) Towards a definition of infant mental
health.  Zero to Three Vol. 22, No 1.
  Graham, M. (2001). Infusing infant mental health practices into care
giving. Infants and Young Children  14(1): 14-23 Aspen publishers
  Weatherson, D. (2000) The infant mental health specialist.  Zero to
Three Vol.21 , No 2.
  Als, H. and Gilkerson, L. (1995). Developmentally supportive care in
the neonatal intensive care unit.  Zero to Three. Vol. 15.  No.6

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