Adverse Childhood Experiences. Dr Michael Smith, Associate Medical Director, Mental Health & Addictions, NHS Greater Glasgow & Clyde

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1 Adverse Childhood Experiences Dr Michael Smith, Associate Medical Director, Mental Health & Addictions, NHS Greater Glasgow & Clyde

2 A story of Childhood Adversity Some ACE science ACE reduction in practice

3 The science of ACEs

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5 % ACEs reported ACEs are common 60 ACES in England, 2013 (n=3885) to 3 4+ %

6 Odds Ratio ACEs are harmful 13 heart disease 11 liver disease COPD 9 lung cancer self-report alcohol problems women with >30 sexual partners psychotropic medicine use lifetime depression in women lifetime hallucinations lifetime attempted suicide Number of ACEs Linear (heart disease)

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9 Beebe et al, Attachment & Human Development

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14 Hoekzema, Nature Neuroscience (2016) doi: /nn.4458

15 Multiple adverse experiences and child cognitive development. Pediatric Research (2016) 79, doi: /pr

16 Childhood experiences shape Understanding and relating to other people Responses to crises and long-term stress

17 Understanding and relating to other people Mental health Sexual health Education Employability Parenting Violence, risk-taking, offending Responding to crises and long-term stress Diet Substance misuse Health behaviours Suicide 4x increased risk of Depression with 4 or more ACEs

18 Understanding and relating to other people Mental health Sexual health Education Employability Parenting Violence, risk-taking, offending Responding to crises and long-term stress Diet Substance misuse Health behaviours Suicide 32x increased risk of an STI with 4 or more ACEs

19 Understanding and relating to other people Mental health Sexual health Education Employability Parenting Violence, risk-taking, offending Responding to crises and long-term stress Diet Substance misuse Health behaviours Suicide 2.3x increased risk of unemployment with 4 or more ACEs

20 Understanding and relating to other people Mental health Sexual health Education Employability Parenting Violence, risk-taking, offending Responding to crises and long-term stress Diet Substance misuse Health behaviours Suicide 5x increased risk of Mother <18y with 4 or more ACEs

21 Understanding and relating to other people Mental health Sexual health Education Employability Parenting Violence, risk-taking, offending Responding to crises and long-term stress Diet Substance misuse Health behaviours Suicide 10x increased risk of hitting someone in last month with 4 or more ACEs

22 Understanding and relating to other people Mental health Sexual health Education Employability Parenting Violence, risk-taking, offending Responding to crises and long-term stress Diet Substance misuse Health behaviours Suicide 6x increased risk of using cocaine or heroin with 4 or more ACEs

23 Understanding and relating to other people Mental health Sexual health Education Employability Parenting Violence, risk-taking, offending Responding to crises and long-term stress Diet Substance misuse Health behaviours Suicide 3x increased risk of attending A&E in last year with 4 or more ACEs

24 Understanding and relating to other people Mental health Sexual health Education Employability Parenting Violence, risk-taking, offending Responding to crises and long-term stress Diet Substance misuse Health behaviours Suicide 12x increased risk of suicide with 4 or more ACEs

25 adjusted odds ratio Poverty and ACEs P=< ACE= 1 ACE= 2-3 ACE= 4+ 1 (least deprived (most deprived)

26 Poverty & inequality ACEs

27 Lifetime smoking reduces longevity by years 6+ ACEs reduces longevity by 20 years 4+ ACEs doubles risk of morbidity by age 70y 4+ ACEs doubles risk of mortality by age 70y

28 Colleagues assured us that patients would be furious when faced with these types of questions and they believed that patients would be unlikely to respond truthfully. Dr Vincent Felitti, Kaiser Permanente There was a sense of disbelief. People actually said, Rob, this can t be true. Because if this were really true, it would ve been studied and published. Dr. Robert Anda, CDC

29 ACEs in society a caution

30 In Scotland the age of criminal responsibility is 8 years old A child can be prosecuted at 12 years old Scotland imprisons an unusually high number of under-18s compared to European neighbours 30,000 children face parental imprisonment each year in Scotland

31 Destitution : people who cannot afford to buy the essentials to eat, stay warm and dry, and keep clean About 1,252,000 people, including 312,000 children, were destitute in the UK at some point during 2015

32 framing adversity in the UK

33 How do people frame adversity? What doesn t kill you makes you stronger Hard work and effort can overcome almost any obstacle Children need protection (but from physical threats) Lower-class families are innately less ambitious, competent and willing as parents Community decay (and nostalgia)

34 Pre-ACE ACE-informed What s wrong with you? What happened to you? Blame Shame Punishment Acceptance Curiosity Empathy

35 summary ACEs are similar to smoking in the strength of their effect ACEs are the leading cause of preventable harm in MH & addictions ACEs relate to poverty, but are not the same as poverty ACE-informed practice and policy can be highly effective Our slow response to ACEs reflects the need for a profound paradigm shift