The roots of psychopathology and other illnesses lie in early developmental experiences. How might we intervene to prevent the development of mental illness in the early years? Given the scope of the problem, as demonstrated by the ACE’s research, it would seem that current psychotherapeutic models and practice are insufficient to turn the tide on early adversity. Action at a community and societal level is required.
There is a need for a ‘revolution’ in mental health care (OCHR, 2017). There exists a crisis of power imbalances which requires shifting to a rights-based approach. Treatment for people with mental health disorders has long been underfunded and undervalued. Three-quarters of people with mental health disorders fall into the ‘treatment gap’, where they are not receiving treatment. If we neglect to provide treatment for those who are manifesting mental disorders, it does not bode well for the likelihood that governments will invest in prevention.
Community psychology seems well placed to step up to the task of early intervention and prevention. Community psychology is concerned with the relationship between individuals, communities and societies and seeks to enhance the quality of life for individuals and communities. The field aims to prevent problems rather than treating them as they arise and strives to create ‘second order change’ which alters structural problems within society. The focus is on neighbourhood, community and societal levels and the field seeks to engage in policy research and advocacy to inform decision-makers about the best course of action. Focusing on altering the social-ecological systems in which we live would seem to hold far more promise for facing the epidemic of early adversity. Changing things at a policy level holds the greatest hope for turning the tide on this problem.
According to Sue Gerhardt, successful solutions already exist. One approach is to provide more health visitors to homes to provide guidance and encouragement with parenting. Another is parenting programmes. These solutions are easy to establish and have been effective wherever they have been tried.
The researcher David Olds has developed the nurse-family partnership programme in which nurses support vulnerable mothers to develop good relationships with their infants. ‘Watch, wait and wonder’. ‘Video interaction guidance’, and ‘circle of security’ are other programmes that have a similar aim. What is most important is that the professional helper develop a positive, supportive relationship with the family and encourage caregivers to reflect on what the baby is feeling and how to support the baby’s development.
There is evidence that these interventions lead to massive long-term savings in the social costs of crime, of putting children into care and of managing the consequences of poor emotional regulation. Interventions that enhance the mental health, executive functioning and regulation skills of vulnerable mothers which begin as early as pregnancy suggest promising ways to protect the developing brains of children. Allan Schore notes that there is a lot of evidence to show that we can maximise the short and long-term effects of interventions by concentrating on the period of the brain growth spurt (from the last trimester of pregnancy of through to the second year). The question is, are governments willing to fund this?