Artwork by Monica Garwood for Anxy magazine

Imagine a world in which the bulk of our efforts are spent on preventing illness from ever occurring. Imagine all families have access to the support they need to promote healthy functioning, not only when something terrible happens in the family system, but at any time. All students have individualized education and support plans, not because they are struggling, but because we seek to bolster their success. All kids live in safe communities and have access to activities that support their physical, spiritual, and mental wellness. In this world, we have more wellness and resource centers than hospitals and jails. Imagine!

The human brain develops at a tremendous pace in the first five years of life; neural pathways needed for healthy psychological functioning are wired in these early years. Investing in healthy brain development and family wellness at this young age “produces positive returns over a child’s lifetime in the form of decreased medical and mental health costs, greater educational achievement, higher likelihood of employment, and lower likelihood of incarceration.”

Adolescence marks a pivotal moment in brain development. Importantly, it is also when early signs of mental illness begin to materialize: 50% of mental illness begins by age 14 and three-quarters by age 24. When symptoms are left unrecognized or untreated, children and communities suffer.

“Children & adolescents struggling with these disorders are at risk for academic failure, substance abuse & a clash with the juvenile justice system — all of which come at a tremendous cost to them, their families & the community.”

Harold Koplewicz, Child Mind Institute

 

But it is not just the onset of serious mental illness that is impacting our youth. Trauma and adversity are affecting millions of children and impacting their mental health and wellbeing. Trauma can be the result of witnessing or experiencing violence; social, racial, and economic inequities; or maltreatment. These adverse childhood experiences affect brain growth, development, and stress early in life and can result in high levels of hormones such as cortisol, which directly affects brain neurons. This greatly increases their risk of depression, anxiety, suicide, and post-traumatic stress disorder, as well as physical health problems in adulthood. 

But the good news is that early intervention to build resiliency, address trauma immediately, and facilitate rapid access to treatment when needed can change brain development and life’s trajectory for the better. 

If we treat mental health as preventative care and integrate services that respond to adversity, rather than just pathology, into schools, pediatrics, prenatal care and more, we can change the trajectory for many. This requires a shift in WHERE services are located and WHAT those services look like. 

Expanding support to a broader range of the population for preventative mental health care can also have the effect of destigmatizing mental health. We can normalize that most everyone needs help at various points in their life.

Some approaches that have proven effective or promising include strengthening families and integrating mental health and wellness into schools and routine healthcare visits.

Family Wellness. Families can be strengthened, in part, by teaching effective parenting skills, improving communication, and building relationship skills to help families deal with adversities such as substance use, divorce, illness, and poverty. From a systems perspective, strengthening families would mean shifting the focus toward supporting family units instead of removing kids from homes. Examples of these types of programs include:

• Supporting young, first-time pregnant women and mothers in need of extra support. The Nurse-Family Partnership is one model that establishes a trusted relationship between a public health nurse and a mother, who meet from pregnancy until the baby turns two years old. The model has been shown to reduce behavioral and intellectual problems, keep children safe and healthy, and even reduce involvement in the juvenile justice system later in life.
• Bolstering community-based Family Resource Centers. These centers provide culturally relevant programs and services right in their neighborhood. They may be located in churches, schools, community centers, or public housing. Examples of their services include parenting classes, home visits, violence prevention, mental health and family counseling, community building and wellness activities, respite care, and other critical services such as housing assistance.

School-based Services. Integration of mental health and wellness into schools can support children encountering adversity or trauma, develop students’ decision-making skills, and improve self-awareness. It also provides a platform to teach techniques for developing positive relationships, coping with violence, mitigating aggressive behavior, and preventing substance use. Some promising and proven models include:  

• School-based Health and Wellness Centers: These centers are located within or very near schools, and all students (and often families and surrounding communities) can access low- or no-cost services including primary healthcare and mental health services. Alameda County pioneered this model and it now exists in 277 schools across California. The centers have proven to benefit student health and academic performance and reduce healthcare costs overall.  
• Integrating wellness, mindfulness, stress reduction techniques, and mind-body education into classrooms.

Image from California School-based Health Alliance                        

There are other opportunities to meet people where they are to support mental wellness, develop resiliency, and intervene early when problems arise. Co-locating mental health professionals and pediatricians so they function as a team would allow routine visits to the pediatrician to include a mental health check-up for youth and parents. New tools to support the mental health and wellbeing of teenagers in the online places they are already accessing are also promising. By offering more universal prevention services at the places people are already gathering, we can intervene early and create an environment where a mental wellness checkup is as common as an annual physical, creating more positive life trajectories for young people.