COMMENT:The Government's Mental Health and Addiction Inquiry has done a great job in raising many issues important to New Zealand. One area that I see as needing further attention is that of earlier intervention for our children and families.
Earlier intervention across government, not just in health.
As the Ministry of Health itself notes, "The science is clear: What happens before conception and birth and within the first three years of postnatal life has a major effect on the subsequent development of the child, through adolescence and into adulthood."
The "adverse childhood experiences" (ACEs) research was originally conducted in the US 20 years ago. This research found that if a child came from a background where a high number of adverse events had occurred (ie. abuse: physical, emotional or sexual; neglect: physical or emotional; or household dysfunction: mental illness, family violence, divorce, addiction or a parent in prison) that child was more likely to have poor physical and mental health outcomes.
For example, an individual with four or more ACEs is 4.2 times more likely (than those with fewer) to have a teenage pregnancy, 4.4 times more likely to experience depression, 5.6 times more likely to use illicit drugs and 10 times more likely to have problematic drug use; and, importantly, be 30 times more likely to attempt suicide.
The US has taken the results of this research very seriously. It has had national policy around trauma for nearly 20 years. The Substance Abuse and Mental Health Services Administration notes, "Trauma has no boundaries with regard to age, gender, socioeconomic status, race, ethnicity, or sexual orientation. Trauma is a common experience for adults and children in American communities, and it is especially common in the lives of people with mental and substance use disorders".
A high incidence in indigenous communities is also found. For these reasons, the need to address trauma is increasingly seen as an important part of effective health, mental health and addiction care.
Public Health Wales found similar results in a population-based study, and both Scotland and England estimate that the prevalence of adversities in their populations would be equally as high.
Scotland has taken this work further than any other country. It has committed to addressing all types of childhood adversity and this is anchored in their national approach of "getting it right for every child".
This means a four-pronged approach: first, providing inter-generational support for parents, families and children to prevent ACEs; second, reducing the negative impact of ACEs for children and young people; third, developing adversity and trauma-informed workforce and services; and fourth, increasing societal awareness and supporting action across communities.
In New Zealand we have the Treaty of Waitangi to consider. We must take into account the effects of historical, cumulative, intergenerational and situational trauma for Māori.
Pasifika communities also speak of negative processes such as poverty and racism, which compound ACEs.
Prevention of adversity in New Zealand needs strong action now.
The Prime Minister's child and youth wellbeing work is an important element in this work.
The Prime Minister's chief science advisers have also contributed by stating what ACEs work means for health, social development and justice.
I do believe the time is right in New Zealand for a new, national strategy which aims to decrease the prevalence of early adversity and thereby strengthen the adults of the future.
This would not need be another organisation, but rather an effective, across government strategy which also include strengthening agencies already working in this area at the coalface.
Examples are: Maori and Pasifika agencies, LGBTQI+ groups, Whanau Ora, public health, mental health and addiction agencies, NGOs, community groups, school counsellors, and primary care among others.
It is an area in which we all need to take responsibility in order to enable people to flourish.
• Janet Peters is a registered psychologist in Tauranga and New Zealand liaison for the International Initiative for Mental Health Leadership.
WHERE TO GET HELP:
If you are worried about your or someone else's mental health, the best place to get help is your GP or local mental health provider. However, if you or someone else is in danger or endangering others, call 111.
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