What do we think about when we think about public services? Perhaps what comes to our mind in the UK is the Education and the National Health Services. Some people may also think about Social Services, the Prison Service, the Police Service, the Ambulance Service or the Fire Brigade. They are the services that we rely on, even without realising it, to help us when we are in crisis or vulnerable. At these times how we are treated really matters, it can make the difference between us recovering easily from a difficut situation or to finding it hard or impossible to recover.
Adverse Childhood Experiences
In recent years science has been learning a great deal about how our early lives can have an impact upon us across our life span. Between 1994 and 1997 an American Study asked 17,000 middle class people to fill in a questionniare when they had a physical examination. These people were adults and they were asked to report on their experiences as children. This allowed the researchers to link physical and mental health outcomes for adults to Adverse Childhood Experiences (ACEs) . Adverse Childhood Experiences is an umbrella term- a way of describing all sorts of difficult experiences, such as abuse (physical, sexual, emotional), household challenges (divorce, parental mental health, domestic violence etc.) and neglect (physical and emotional). There were several important findings:
- 2/3 of repondants report at least one ACE
- Most people who reported at least one ACE reported more than one
- ACEs were related to behaviour- lack of physical activity, smoking, alchoholism, drug use and missed work
- ACEs were related to a range of physical and mental health outcomes- severe obseity, diabetes, depression, suicide attempts, STIs, heart disease, cancer, stroke, broken bones
- ACE’s are related to the leading causes of death
- People with 6 or more ACE’s die 20 years earlier than people with no ACE’s
This study helped us to understand that difficult childhood experiences are very widespread and that some people have multiple vulnerablities. Importantly, we now know that these experiences are strongly related to long term physical and mental health outcomes in adults. This study has been replicated more recently in different parts of the USA.
This graphic is from the Centre for Disease Control and Prevention (CDC) website. It is a way of explaining how ACEs are related to a range of negative outcomes and to early death. Research has lead to greater knowledge of how the quality of attachment experiences (the relationships that a child has with caregivers) affects brain development. Brain development can also be called neuro-development. Research is helping us to understand more and more about how traumatic experiences can affect the brain. If we feel very sacred, because we are being hurt (emotionally or physically), or are seeing others hurt, or perhaps even fear someone might die, our brains try to protect us. Most people know about the fight/ flight response- when children are frightened or lack support this is the response that is triggered. It is an automatic response. As a human being, we have no choice over it. The chemicals that are involved in this response can be very toxic to the brain, especially the developing brain. In a way it can be seen as a injury, certainly the way the brain develps structurally and how it works can be changed. These changes in the brain lead to changes in social, emotional and cognitive development, which in turn affect behaviour, which in turn affects our health. We are learning more and more about the ways that attachment experiences and trauma affect the way the brain develops and functions. We are also learning more and more about what can support and protect brain development and therfore emotinal wellbeing. More information on attachment and trauma can be found in the links on the top of the page.
What do ACEs have to do with Public Services?
Logically, it shows us that in order to improve public health, we need to address violence and abuse of children. The CDC suggest that we can intervene actively to reduce ACEs. They suggest specific targeted interventions to support parenting and young families as well as mental health and substance abuse treatment. This are all very good ideas. In the short term this reduces harm and in the long term addressing childhood wellbeing could also reduce the demand for a range of adult services.
However, if 2/3 of people have at least one ACE, workers, service users, managers and policy makers are all likely to be affected. It could be useful to see violence, neglect, abuse of children as epidemic. If we take this view public services generally need to become attachment aware and trauma informed. This would require them to re-organise their service delivery, as, alongside their original purpose, their role needs to be one of primary prevention. In addition, public services already exist and can contribute to feeling better, or worse at critical times in our lives. Workers in these services are also at risk from being exposed to traumatic events and being harmed by the work they do if the organisation they work for is not trauma informed. It makes sense to ensure that public services can use the knowledge from scientific research to do the most effective job possible. This could reduce immediate harm and increase the wellbeing of our society. Furthermore, research into attachment and trauma can give us some specific ideas about how services can be more sensitive and helpful.