Adverse Childhood Experiences Dr Michael Smith, Associate Medical Director, Mental Health & Substance Misuse Services, NHS GG&C Prevention in MH

2

ACEs… are common

ACEs… are common are harmful Lifetime smoking reduces longevity by 10-12 years 6+ ACEs reduces longevity by 20 years

hitting someone in last month attending A&E in last year ACEs… 4x increased risk of Depression with 4 or more ACEs 32x increased risk of an STI with 4 or more ACEs 2.3x increased risk of unemployment with 4 or more ACEs 5x increased risk of Mother <18y with 4 or more ACEs are common are harmful 10x increased risk of hitting someone in last month with 4 or more ACEs 3x increased risk of attending A&E in last year with 4 or more ACEs 12x increased risk of suicide with 4 or more ACEs

ACEs… are common are harmful are not the same as poverty Poverty & inequality ACEs

ACEs… are common are harmful are not the same as poverty extend beyond the household Bereavement Bullying Discrimination Witnessing violence Neighbourhood safety Frequent money problems Food insecurity Homelessness Prolonged parental absence Parents always arguing No good friends

ACEs… are common are harmful are not the same as poverty extend beyond the household can be overcome

Beebe et al, Attachment & Human Development 2010 3-141

Systems find attachment very difficult Beebe et al, Attachment & Human Development 2010 3-141

for individuals Pre-ACE ACE-informed “What’s wrong with you?” Blame Shame Punishment ACE-informed “What happened to you?” Acceptance Curiosity Empathy

for services Pre-ACE ACE-informed User perspective assumed Provider interest dominates Exclusion Inflexibility ACE-informed Choice and voice Inclusion and trust

summary ACEs are similar to smoking in the strength of their effect ACEs relate to poverty, but are not the same as poverty ACE-informed practice and policy can be highly effective ACE-responsive services needs change from practitioners