Adults who had difficult childhoods are not receiving sufficient mental health care, finds California study

While 20% of California adults said they had four or more adverse childhood experiences, nearly 40% of that group reported an unmet mental health need in the last year, according to a new study by the UCLA Center for Health Policy Research.

Adverse childhood experiences referred to physical or emotional neglect; physical, sexual and emotional abuse; and household challenges, including intimate partner violence, divorce or parental separation—or living with anyone involved in the criminal justice system or who was struggling with mental illness and/or substance use disorder.

The study, which uses data from the 2022 California Health Interview Survey, notes that adverse childhood experiences, or ACEs, can disrupt healthy brain development and alter how the body responds to future stressful experiences. Preventing ACEs can reduce a broad range of serious conditions (e.g., depression and cardiovascular disease), socioeconomic challenges (e.g., unemployment) and behaviors like heavy drinking and smoking in adulthood.

"This study helps us more clearly understand how our childhoods shape the adults we become, in particular our mental well-being," said Sean Tan, senior public administration analyst at the UCLA Center for Health Policy Research and lead author of the study. "If we get better at screening for these adverse childhood experiences as part of people's routine health care visits, the potential benefits may go beyond better physical and mental health."

Isolating the findings by smaller demographic groups, researchers found:

• Younger adults in California (ages 18–35) are twice as likely as adults 65 and older to have had four or more adverse childhood experiences.
• Among adults who had at least one adverse childhood experience, 47.9% of those ages 18–35 reported an unmet need for mental health services in the past year compared to 21.4% of adults 65 and older.
• Of Native Hawaiian or Pacific Islander adults, 70% reported having had one to three adverse childhood experiences, the greatest proportion of all racial or ethnic groups.
• Larger proportions of adults who identified as American Indian or Alaska Native (36.8%), multiracial—two or more races (27.3%), Black or African American (25.9%) or Latino (24.2%) reported having had four or more ACEs when compared to all adults (20.1%).

Positive childhood experiences can serve as counterbalances

Positive childhood experiences, which refer to advantageous experiences before the age of 18, can protect against the harmful effects of adverse experiences, the report said. Positive experiences include feeling safe and protected at home as children, feeling that their family stood by them during difficult times, and feeling a sense of belonging in high school.

Similarly to how younger adults had more adverse childhood experiences than older adults in California, they also had fewer positive childhood experiences.

Nearly two-thirds of adults 65 and older reported having four or more positive childhood experiences compared to 52.6% of adults ages 18–35 and 54.5% of adults ages 36–49. And 10.8% of adults said they had no positive childhood experiences.

Recommendations to curtail the effects of adverse childhood experiences

A 2021 California law mandated health insurance providers to reimburse hospitals for adverse childhood experience screenings of children and adults. The report recommends expanding ACEs screening training requirements not just for providers seeking Medi-Cal reimbursements but for all insurance payers. Tan said this would promote widespread adoption and sustained implementation of ACEs screenings and intervention protocols.

In addition, the report recommends the state develop new awareness campaigns to increase screenings for adverse childhood experiences, especially for populations insured by Medi-Cal. The percentage of Medi-Cal recipients who had an ACEs screening by county ranged from 0.2% (Colusa County) to 39.6% (Orange County) among children and young adults up to age 20, according to the report.

"Given that Medi-Cal serves low-income households in California, the state needs to ensure that the neediest Californians have access to these difference-making types of care," Tan said. "It's about health equity."

The report lauded the ACEs Aware Initiative, which strives to raise awareness of the impacts of adverse childhood experiences and toxic stress on long-term health.

On May 3, the state announced its new Live Beyond campaign, which aims to increase knowledge about the science behind the potential impacts of ACEs on people's everyday lives, build skills with accessible tools and resources that provide steps to heal and manage stress, and prevent adverse childhood experiences from cycling into future generations.

"As society has made progress in destigmatizing discussions about mental health and including mental health care in our definition of 'health care,' our study shows that we still have a long way to go in terms of providing services and treatment," Tan said.