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

2. 2

3. ACEs…
are common

4. ACEs… are common are harmful
Lifetime smoking reduces longevity by years
6+ ACEs reduces longevity by 20 years

5. 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

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

7. 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

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

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

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

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

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

14. 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