Re-Framing Children’s Mental Wellness

As a society, we are on the threshold of a new understanding of, and—one hopes—a new attitude toward, mental illness. A number of recent developments are responsible for this change:

• Advances in brain science, and particularly the role of early-experienced toxic stress;
• Reports of substantial, and incompletely understood, rises in the prevalence among children of , , and other emotional or behavioral difficulties.
• A new recognition of the magnitude of the issues surrounding our combat veterans (and their families) with post-traumatic stress disorder, traumatic brain injury, and other mental illness; and,
• Recent deadly attacks by individuals whose mental illness was at least one factor precipitating their behavior.

These events have helped call into question many of our prior assumptions about mental illness: its prevalence, its origins, and the ways we address it through both treatment and prevention.

Mental illness is common: half of us will experience a mental health concern at some point in our life. Most of these will first arise in childhood.

But, as common as it is, mental illness is under-acknowledged, under-treated, and under-resourced in our health care system. It still bears the heavy burden of stigma.

Child Trends recently conducted a wide-ranging review, for the Robert Wood Johnson Foundation, on the topic of children’s mental health and wellness. Out of that work, several key themes emerged:

For most purposes, the distinctions we have made between mental and physical health are unhelpful and inaccurate. Mind and body are inseparable, whether considered at the level of neuro-biology, or in how we appraise our own well-being. The conventional separation feeds the continuance of stigma. So, let’s talk about health, period—or, better yet, wellness.

Wellness is more than the absence of illness. We’re learning that many disorders exist on a continuum, rather than being simply a matter of having/not having. In addition, even when illness is present to a greater or lesser degree, individuals can experience more or less well-being—for instance, a sense of competence, purpose, and optimism. Conversely, illness-free individuals can struggle with the absence of these attributes of “flourishing.”

Wellness—which, we argue, is what individuals strive for—is a resource—one that is developed, nurtured, drawn-upon, and replenished throughout life. Developmentally, wellness is first built up from the nurturing relationships between children and their caregivers.  Wellness is also sustained through positive routines and practices that initially are imposed by caregivers—healthy habits around eating and sleeping, for instance, or expectations around physical activity and “screen time,” and about managing emotions—but that later become internalized.

A child whose wellness resources are adequate can face numerous challenges—stresses—and see few, if any, long-term ill effects. On the other hand, when either stresses are overwhelming, or wellness resources are low, children’s wellness can flag, or even be thrown seriously off-course.

The implications of such a model as we’ve proposed are not all fully developed. But they include a number of opportunities for positive roles that parents and other caregivers, teachers and schools, youth-serving programs and systems, and policymakers can play.

We think our children and youth deserve as much. Business-as-usual with regard to these issues isn’t working; we need to think—and act—in new and better ways.