Early care makes substantial contributions to later adult psychiatric morbidities. ‘Hidden trauma’ refers to risk for behavioural and physiological dysregulation as a result of poor early care in infancy These experiences are likely to have an equal or greater impact on later morbidity than maltreatment which is easily observed.

There is an issue with a lack of trauma-informed services to refer people to who disclose a trauma exposure, according to Alicia Lieberman. Amongst mental health providers there is a lack training in trauma-informed therapeutic approaches. Screening is a necessary but not sufficient step in addressing the impact of trauma on health. Once a person is screened there is an onus to provide trauma-informed assessment and treatment. All trauma approaches seek to promotes physical and relational safety and affect regulation. Prenatal screening should include looking for current and past trauma.

Biological and interpersonal processes are involved in the intergenerational transmission of risk. ‘Foetal programming’ links prenatal stress to changes in foetal development and an increase in risk of developing psychiatric conditions later in life. Distress to pregnant women may influence foetal functioning by changes in placental gene DNA methylation. Parents childhoods and epigenetics are the first exposure in the intergenerational transmission of disadvantage. Maternal adversity, both before and during pregnancy, affect the respiratory sinus arrhythmia of the foetus – a marker of infant self-regulation which is linked to mental and physical health out comes throughout life. Higher ACE scores were linked with lower RSA. Maternal prenatal stress was found to be associated with the failure of the infant to recover following the stressor of the still-face experiment.

Interpersonal violence, especially violence experienced by children, is the largest single, preventable cause of mental illness. Early childhood violence is the equivalent for mental health to smoking for physical health. This indicates that it is important to make it a key focus of therapeutic intervention. There is a large amount of evidence that show the success of interventions that start in pregnancy and continue after birth.