Good mental health needs a good start in life
Dr. Trevor Hancock
25 September 2017
Not only is poor mental health very costly to manage, it also represents a large burden of human suffering and loss of human potential and – to the extent it is preventable – a tragic societal failure. So it is good to see that – finally – we are beginning to pay some attention to improving the mental wellbeing of the population.
The evidence is clear that good mental health begins in infancy and childhood; a good start in life can create more positive and resilient young people, better able to handle adversity when it occurs.This evidence must be used to inform and guide the work of the new Ministry of Mental Health and Addictions, the health care system, the government as a whole and indeed the whole of society.
There are in essence two key approaches: First, creating supportive environments that protect people from known risk factors and provide a positive, mentally healthy situation. Second, providing resources and programs that enable people – especially children – to become resilient, with the skills they need to manage life’s ups and downs. In practice, these two approaches interact and need to complement each other.
One of the key strategies, as with health in general, is to reduce the level of poverty in our society. A 2010 Statistics Canada report noted that Canadians in the lowest income group are 3 to 4 times more likely than those in the highest income group to report low levels (poor to fair) of mental health. Living in poverty is a very stressful situation, and so not surprisingly is associated with higher levels of anxiety and depression, among other things. The effects of poverty are compounded in Indigenous and some other communities by the legacies of colonialism, racism and discrimination, making these important upstream mental health risk factors to combat.
In a 2007 background document, the Ontario Division of the Canadian Mental Health Association (CMHA) noted “losing stabilizing resources, such as income, employment, and housing, for an extended period of time can increase the risk factors for mental illness”, especially for those who may already be pre-disposed to mental health problems. Because of the importance of poverty reduction, CMHA Ontario “has been calling for poverty reduction strategies that increase access to economic and community supports for vulnerable populations”. CMHA BC has also recently welcomed the poverty reduction measures brought in by the new BC government.
Infants and children are particularly vulnerable to the adverse effects of poverty and colonialism on the family and community environments in which they develop. A 2016 report from the UK’s Faculty of Public Health noted that poverty in the early years leads to poor cognitive performance, while in adolescence “it increases risks of depression, substance abuse, and early sexual and criminal activity”. It is not hard to see how these impacts can lead to the perpetuation of the cycle of poverty.
Efforts to buffer the effects of poverty and colonialism, even while working to reduce them, begin in infancy, indeed, even before birth. High-risk or vulnerable parents (e.g young, poor and single mothers, or parents with mental health or addiction problems) should be identified and provided with supportive services, both to improve their health in pregnancy and to help them develop better parenting and coping skills. A study from the University of Ireland found that “high quality early childhood enrichment provided through preschool results in enduring gains in children’s social and emotional wellbeing, cognitive skills, problem behaviours and school readiness”, especially among more disadvantaged children.
But while it might seem intuitive that high-risk families are the ones who need to be reached, it is well-established in public health that the majority of cases for most conditions do not occur in the high-risk population but in the far more numerous moderate and low risk populations. So all families need to be reached, assessed and offered services, with those found to be at risk provided with more focused, intensive and tailored support, proportionate to their need, an approach known in the UK as proportionate universalism.
So any government that is genuinely interested in ensuring the long-term mental wellbeing of our society needs to invest in poverty reduction, support for parents, especially the most vulnerable, and early child development.
© Trevor Hancock, 2017