The Preventive Psychiatry Act: An Act to “Addiction Proof” American Children
Executive Summary:
Presented by Dr. Amy Chai, MD, MS, board certified in Addiction Medicine, Internal Medicine, Fellowship trained in care of the complex patient and MS in Epidemiology. Currently Medical Director at a methadone MAT program.
Disorders of mental health prevent behaviors that lead to physical health. In fact, in my experience as a physician specialist in complex patient care and addiction medicine, patients with moderate to severe mental health problems are often unable to manage even simple health positive goals. The sense of “overwhelm” experienced by my patients is compounded by a medical system that demonizes them for “non-compliance” with medical instructions and a society that blames them for moral failure when they have problems like addiction and obesity.
In my clinical experience, health negative behaviors are most commonly a symptom of disease, not a cause. The underlying disease is disordered mental health. For example, it is not possible to “meal prep clean foods” or “go for a jog before work” when “getting out of bed and putting clothing on” is a task of Herculean proportions—as it is for millions of patients with depression and anxiety.
It is extremely hard to treat mental illness. It is even harder to treat addiction. Almost all severely addicted patients are “dual diagnosis,” patients with mental health diagnoses. As a physician, I often have to be satisfied to discover that “nobody overdosed this week” or “there are no autopsy reports for me to review today.” The philosophy we currently use in the addiction community is called, “harm reduction.” The goal of harm reduction is simply to keep more people alive for longer. It is not about seeing genuine human flourishing, health, or true recovery. That goal is too often elusive–perhaps in our current culture, it is even impossible.
Because addiction is a pediatric disease.
Addiction is a pediatric disease. Children who experience traumas, learning disabilities, concentrated poverty, rejection, social anxiety, and exposure to addictive substances are at high risk of mental illness and addiction. The trauma and mental health issues come first. With the exponential growth of mental health problems in our children all across America over the past 10-20 years, I foresee a massive tsunami of death and ruined lives from addiction as this generation comes of age. With our primary social institutions (family, faith, community) crumbling due to ideological and economic pressures, our next generation will be incredibly vulnerable to becoming “invisible people” beset by addiction, homelessness, and victimization. We do not have the capacity to stop this tsunami or to treat its victims. But we can work to prevent it.
The development of mental health disorders is often explained with something we call the “two-hit hypothesis.” This hypothesis is all about the combination of genes and environment. What this means is that some people have a genetic predisposition to an illness. But not everyone with the genetic predisposition will get the disease. It often requires a second “hit” from the environment to manifest itself.
We already know many things in the environment that cause that second hit. Childhood trauma, exposure to any addictive substance, family dysfunction, lack of social connection, child molestation, sexual exploitation, disruption of the natural family, peer rejection, and many other “hits” have been associated with the development of mental illnesses in at-risk children.
We have learned so much about the causes of psychiatric disorders.
Why don’t we apply what we know about the cause of psychiatric disorders and apply it to the prevention of psychiatric disorders? If traumas cause mental illness, why don’t we work with families to prevent traumas? If inflammation triggers mental illness, why don’t we work towards an anti-inflammatory diet? If sexual exploitation causes mental illness, why don’t we stop sexualizing children? I envision an entirely new discipline of “preventive psychiatry” to be funded by the NIH and supported with new RFAs (Request for Applications). Evidence-based policies to support mental illness prevention can then be implemented and outcomes measured. I predict that this will serve as the best way to “addiction proof” the next generation.
My hypothesis is that aggressive research and policy positions designed to implement this new discipline of preventive psychiatry can reverse the growing trend of problems with mental health and addiction that we currently see overwhelming our social services, emergency rooms, police departments, and morgues.
A healthy mind is the first step towards healthy behaviors. It is the only way forward if we hope to “addiction proof” the next generation of children. Not all mental health and addiction problems can be prevented. But I am confident that many can be. If the environment can cause mental health disorders, then changes in the environment can prevent mental health disorders.
The Preventive Psychiatry Act has four main funding areas:
1-Neuroplasticity in the fourth trimester:
The “fourth” trimester is birth to 90 days. Brain growth and development is incredibly rapid during this period. Creating a healthy mother-child dyad during maximum brain growth is absolutely critical to emotional health, empathy, and even IQ. And yet we do not have paid leave for mothers. Even professionals like myself were forced to return to work at 2 to 6 weeks post-partum. My fourth trimester plan would ensure that new mothers are aggressively supported, given adequate and fully paid 90-day maternity leave, given a fourth trimester “doula” consultant who would provide information and support for best practices, and referrals to community or faith groups locally. A mother who is not alone, exhausted, desperate, afraid, isolated, and depressed will work wonders on little developing brains. Our knowledge of this subject is already well established and initial policies can be implemented immediately. Best practices can continue to evolve over time as outcomes are measured in real-world applications.
2-Social supports for the natural family:
An increasing number of children are being raised in high stress environments by single parents. Financial stressors and absence of a nuclear family is difficult to navigate for the parent, and the overwhelm is transmitted to the child. Fatherless children are more likely to be vulnerable to predatory sexual abuse by adults and risky behaviors with peers. My social support plan would systematically evaluate policies that undermine the natural family and seek to change those policies to incentivize the normalization and support of the natural family. It would need to include parenting resources and re-entry job training for incarcerated fathers. It would also include education for parents about how to understand generational trauma and how to stop the cycle, providing best practice information and tools for healthy emotional engagement with children.
3-Outcomes for public school SEL programs:
All educators are aware of childhood development and identity formation. However, current SEL programs are not evidence-based and may require non-medical personnel to engage in activities that are not appropriate for deployment to the general public-school population. As a physician, I would never consider a blanket psychotherapy program for everyone in my practice. That would be malpractice, obviously. The roll-out of “social” and “emotional” development program for an entire grade level in an entire state—performed by untrained, non-medical practitioners–is also malpractice. It is time to call it what it is. Children are individuals, with different psychological, social, and emotional needs. Their maturity levels at any given age differ dramatically. Bad psychotherapy can be incredibly harmful. Let’s take a step back from SEL goals. Let’s focus on behavioral expectations and basic educational goals, with recommendation for psychological referrals as needed. Hand-in-hand with this is the “emotional lesson” that comes from punitive and zero tolerance policies. Schools must not rely on ideology, but rather on evidence. Children are being subject to experimentation without consent. School is a major driver of mental health problems in children. This must change.
4-Research into addictive activities and foods:
Exposure to any addictive substance prior to the age of 18 dramatically increases the risk of addiction. This exposure includes substances that seem less concerning, such as cigarettes and vapes. Increasingly, it is becoming apparent that there are certain (purposefully) addictive elements in games, technologies, and foods marketed towards children. Addictive behaviors are known to cause depression. Therefore, we must not allow corporations to market addictive activities and foods to children. This will require active research by the pediatric psychiatry community in order to formulate best practices for any legislation. I would recommend working with ASAM and the APA to create RFAs for NIH funded grants in this area.
This is an executive summary of the policy areas that would be funded by this Act. The goal of this Act would be to prevent the increase of mental health disorders by reducing known environmental triggers. Preventing mental health disorders from emerging in children and young people will enable them to engage in health positive behaviors. It is my observation that childhood traumas and mental health problems are a major driver of poor health, inflammation, and addictive behaviors that persist and are increasingly difficult to treat.
I believe that an ounce of prevention is worth a pound of cure.
I believe that in order to “Make America Healthy Again,” we must aggressively pursue policies that encourage mental health and human flourishing. These policies must be evidence-based and supported by RFAs being sent out by the NIH. Because without mental health, health positive behaviors are not possible. There is no physical health without mental health.