We live in a world where risk taking is commonplace and often encouraged. A common saying is “play now and pay later”. Most individuals count on the fact that there is always a fix for those situations where something goes wrong. Many children nowadays spend a great amount of time on their tablets playing exciting video games for hours that provide an explosion of stimuli and entertainment. Oftentimes, this limits participation in other activities that enhance other important life skills, which are needed to be able to adapt and be resilient in life.
Psychiatry is relentlessly seeking better treatment options and cures for many conditions for those that are suffering severe psychiatric disorders. We are confident that new discoveries and research insights in biotechnology and genetics will lead to successful and safer treatments in the future. In the meantime, we need to do better with preventive measures.
Most mental illness begin in childhood and late adolescence. It is estimated that around 50% of mental health conditions start before the age of 15 and about 75% begin before the age of 25. This is significant because there are many things that we can do early on to prevent or mitigate the difficult course of mental illness in later years.
Psychiatry has fallen behind other areas of medicine when implementing preventive approaches that improve mental health and wellbeing. When I ask medical students and psychiatric trainees questions such as what percentage of their training is dedicated to preventive psychiatry, most admit that preventive psychiatry should be an essential component in their education but they acknowledge that this is not a significant component of their training.
So, how can we implement preventive measures throughout children’s development? Let’s start with the youngest group and focus on children, ages 0-3, where we have significant evidence that enhancing attachment behaviors in mother-infant bonding helps prevent significant anxiety and other early disruptive behaviors in children. Identifying adverse childhood experiences(such as trauma, neglect, or personal losses) and addressing them early on will significantly mitigate the psychological impact of these painful experiences in their lives. On the other hand, adverse childhood experiences can become significant risk factors for severe mental illness later in life if they are not addressed early on in life.
During preschool and school age years, it is essential that parents develop effective parenting skills that emphasize warm, firm, and supportive approaches to parenting. Developing effective parenting skills will help prepare children for the world beyond the home and improve self-esteem and confidence.
Many essential skills can be taught and fomented in children which can safeguard them against life’s challenges, stressors, or traumatic events. Here, I want to highlight the importance of resilience. Many believe that people are born resilient and that this is an aspect of our temperament. There is evidence that certain factors which improve resilience in individuals can be taught or learned, these include: effective parenting, positive self-concept, self-regulation, social competency, cognitive flexibility, adaptability to new situations, and problem-solving skills.
Let me emphasize that these factors or skills must be practiced consistently and over time. Children should be encouraged to participate in different social settings and activities where they can learn, incorporate, and practice these skills.
It is important to teach children that experiencing a whole range of emotions is part of our humanity. Children should be mindful of their internal “signal lights” associated with emotions, and respond to situations congruently. At the same time, intense emotions that elicit aggressive, violent or impulsive behaviors can be mitigated with self -regulation, an essential skill that we can develop. Most importantly, adults need to model self-regulation for children. It is “not what I say, but what I do” that will most likely impact children’s skills.
During adolescence and young adulthood, youth are experiencing a new wave of brain development that continues over years, including emotional regulation and the development of cognitive executive skills that are essential for insight and judgement, and have a huge impact in life. During medical training, young doctors are encouraged to use a cautious approach when starting patients on new medications—“start low and go slow”. I think this can also be applied to young people when helping them to make other important decisions in life.
Children, adolescents, and young adults can improve mental wellness by improving sleep hygiene, eating healthy meals, and developing regular exercise routines that help our physical and mental health. We should promote leisure time and down time to balance our stressful work and life schedules. We can promote companionships with our loved ones, friends, and others that can help us with empathy and mutual support. We all need to enhance our sense of belonging in our homes, work, and community.
Safety issues, suicidality, and non -lethal suicide behaviors are prevalent in youth. Suicide and death by firearms are the leading cause of death in this age group; thus, it is imperative that we get better at assessing these situations and inquire about risk factors, including substance use disorders and access to weapons and provide appropriate counseling and safety measures for lethal means.
Let’s promote preventive measures that enhance our mental wellbeing and encourage our kids to develop resilience and readiness to adapt to life’s challenges. Remember that “an ounce of prevention is worth a pound of cure”.
Daniel Gutierrez MD
Daniel is a Board-Certified in Psychiatry as well as, Child and Adolescent Psychiatry. Currently, Dr. Gutierrez is Chief Medical Officer at Tropical Texas Behavioral Health, where he’s practiced child and adolescent psychiatry for the last 25 years. He holds a position as Clinical Professor of Psychiatry at UT – Rio Grande Valley’s School of Medicine. Dr. Gutierrez is also a co-founder of the Shrink Box podcast.