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Understanding the brain's capacity to adapt and recover – what this means for mental health

By Dr. Steven Miller, Head of Neurology and Senior Scientist in Neurosciences & Mental Health at SickKids

This week on sickkidscmh.ca, we are celebrating Children’s Mental Health Week. For our second instalment of this five-part series, Dr. Steven Miller, Head of Neurology and Senior Scientist in Neurosciences & Mental Health at SickKids, explains the connections between brain health and mental health, and the relatively new understanding of the brain’s capacity to adapt and recover.

Mental health issues are bringing children, youth and families to hospitals in record numbers. Over the last decade, there has been a staggering 66 per cent increase in the number of child and youth emergency department visits for mental health issues, coupled with a 55 per cent increase in hospitalizations. In part these increases speak to the success of reducing stigma and we should continue to encourage help-seeking behaviour. But they should also inspire us to act—individually as clinicians, researchers, and educators, and collectively as a society to transform the way we prevent, diagnose, and treat mental illness.

From a neuroscience perspective, we focus on the brain—its 200 billion neurons, making more than one hundred trillion connections. We’ve known for a long time that a healthy brain is foundational to our mental health. But we know far less about how our environment and experiences influence the development of the neural mechanisms that support optimal mental health. Without this knowledge, we are limited in our ability to develop more effective mental health interventions.

Thankfully, emerging findings in the field of neuroscience are beginning to shed light on the intricate connections between brain, environment and experience, revealing new targets for therapies and new ways of thinking about prevention and treatment of mental illness altogether. Just today, based on collaborative research between SickKids and The University of British Columbia, we published an article an article online in JAMA Network Open, demonstrating that the impact of a neonatal brain injury on cognitive outcomes is virtually eliminated in babies born to mothers of higher socioeconomic status. Why is this so exciting? Because it suggests we are on our way to finding an answer to the question: how can we heal the brain?

The question itself is relatively recent. For centuries, scientists considered the brain unchanging and non-regenerative. Once lost, it was thought, brain cells were gone forever, and with them the movements, words, and memories they make possible. Brain injury at any age was a tragedy, but particularly so for infants—beginning life with a life sentence: permanent brain damage. We now know better. The late twentieth-century discovery of brain plasticity has revolutionized our understanding of the brain’s capacity to adapt and recover. The challenge has become: how do we promote it?

Somewhere in the environment and range of experiences common to babies born to women of high socioeconomic status is one answer. And with that answer comes the possibility of better mental health outcomes for all children, not just those born into high-income families. But what is it? Is it better nutrition? Is it less exposure to stress? Is it more exposure to reading and rich language environments? We don’t know yet, but we have some clues and the field is ripe for discovery.

Just last year a team of researchers at Harvard delivered some of the first evidence of the neural activation patterns underlying the relation between children’s early language exposure and verbal skills. They found it was not just exposure to language, but specifically the number of conversational turns they experienced that had the greatest impact, and both were highly correlated with socioeconomic status.

For us here at SickKids, this emerging evidence suggests we need to think beyond the walls of our hospital in preventing and treating mental illness. What neighbourhoods do our patients come from and what home environments are they returning to? How can we support them and their families in closing the gaps created by social inequities? It’s a call to action for all of us.

We are unique in that we have a strong connection in the community, through SickKids Centre for Community Mental Health, where early intervention programs for families and babies are already underway. From neurons to neighbourhoods – at SickKids our future contributions to child and youth mental health are boundless.