In the wake of the #MeToo movement, the issue of consent rolled off the tongues of many a campaigner when discussing the interpersonal sexual relations, usually between men and women, and the worry that men (and women) did not know enough about consent: how to give consent, how to ask for it, and how and when to know that one had obtained consent.
Consent is applicable to the myriad of possible permutations of sexual and other relationships. In addition, there was a call by many for the implementation of consent classes or educational material related to consent to be obligatory in the workplace, universities and schools, to inform adults (and even children some argued) about consent in sexual and relationship matters.
Consent is an important matter. However, in light of such concern for consent discussed in the context of two adults negotiating a sexual relationship or not, one would think the importance of consent generally (not in a sexual or necessarily in the relationship sense) would be accorded to our most vulnerable in society: children. It seems that such an idea is not considered important when it comes to the proponents of the latest fashion (specifically in Scotland but growing in the rest of the UK) in public health and social policy initiatives: Adverse Childhood Experiences (ACEs) and related 'mental health' psycho-education infiltrating school curricula in the UK.
From the NHS Scotland Health website, ACEs are stressful events. They list them as:
• domestic violence
• parental abandonment through separation or divorce
• a parent with a mental health condition
• being the victim of abuse (physical, sexual and/or emotional)
• being the victim of neglect (physical and emotional)
• a member of the household being in prison
• growing up in a household in which there are adults experiencing alcohol and drug use problems.
NHS Scotland go on to say:
ACEs have been found to have lifelong impacts on health and behaviour and they are relevant to all sectors and involve all of us in society. We all have a part to play in preventing adversity and raising awareness of ACEs. Resilient communities have an important role in action on ACEs. An ACE survey with adults in Wales found that compared to people with no ACEs, those with four or more ACEs are more likely to:
• have been in prison
• develop heart disease
• frequently visit the GP
• develop type 2 diabetes
• have committed violence in the last 12 months
• have health-harming behaviours (high-risk drinking, smoking, drug use).
However, evidence concerning the existence of and cure or prevention of ACEs is not near to being resolved and is a still highly contested area of study. The idea of causality versus correlation of ACEs with adult physical health and 'mental health', the role of stress, biology, and trauma, and the nature of screening (not least the controversy of scoring ACEs) is a long way from being adequate to dictate public health policy.
Nobody would dispute that childhood, adversity and development are important when it comes to adult 'mental health' and physical health, especially in people who present with issues in adulthood, but the evidence on ACEs does not support a 'risk preventative' psycho-social public health policy that targets everybody, especially children who are 'well'.
There is not enough space here to discuss in detail the criticisms of ACEs here, but despite the poor evidence to support it, there have been calls for the implementation of 'routine enquiry' or screening of people and children in various settings (including schools) to assess for the presence of ACEs on the basis that this would be a valuable 'risk preventative' strategy. What rarely, if ever, gets discussed by any pro-ACE advocate is the idea of consent if any 'routine enquiry' was to take place.
Under normal guidelines of ethics and asking people, especially young children, one would have to obtain consent from the person or parent(s)/guardian(s) of the child – this issue does not seem to factor into any discussions of ACE inspired public health policy/intervention. This is quite incredible considering many involved in the ACE 'movement' are involved in public health, social work, psychology and academic research. Any psychologist or health professional knows full well that to conduct any kind of research or perform an intervention upon individuals, one has to obtain informed consent; otherwise, one cannot conduct the research/intervention.
One also has to provide information and details of what happens to any data collected and how it will be securely stored. Even psychology undergraduate experiments, involving adult students tapping keys on a computer keyboard in response to pictures of teddy bears need to give informed consent.
If this is the case, why is the importance of consent not being accorded to children in discussions of ACE screening? It seems that cognitive dissonance over ethics is taking place. There is also a growing narrative where some pro-ACE advocates seem to imply that the state's 'dominance' in the hierarchy trumps the authority of parents to intervene on the basis of the state-inspired ACE ideology. It is at this point that things are becoming quite sinister. The Scottish Government have been here before; their failed Named Person Scheme proposal was deemed by the courts to be unnecessarily intrusive, destructive of family life and highly totalitarian. With ACEs, who some critics believe is the Named Person Plan B, we are again getting into totalitarian lands.
On a recent trip to Lithuania, I discussed the ACEs movement and ideology with various psychiatrists, psychologists, and psychotherapists who had lived under the USSR. My eastern European colleagues responded to my descriptions of state involvement and ACE ideology as sounding very much like totalitarian communism. It seems some may be ignoring (perhaps deliberately) the lessons of history at our peril.
I think people, parents and professionals need to be aware of this creeping totalitarianism, seeping into the lives of families and their children. The tentacles of the state do not just turn up overnight; they grow via faux compassion and fake evidence – 'The ACEs movement is about love and hugs', some have been seen to tweet on social media. Indeed, presently in Scotland (and England too), primary school children are subjected to 'resilience' training or promoting health and emotional well-being, which derives from ACE ideology and focuses on well-being, psycho-social health and relationships.
These lessons are in effect psycho-social educational interventions based upon a narrow and reductive idea of 'mental health'. Children as young as a five are asked to reflect upon relationships, emotions and their families. Psychological projection tools are used which encourage such reflection and yield much information (i.e., qualitative data) on children's families, lifestyles, struggles, problems and difficulties.
Anecdotal reports are suggesting that younger children are becoming confused and distressed with this aspect of the school curriculum (an ACE in itself?). And these 'lessons' are conducted without informed consent or consultation with parents. There have been reports of parents asking teachers if any data is being taken or recorded from these lessons. They have been told that no data is being taken or recorded, yet posters designed by children, guided by teachers, adorn the walls of schools (worryingly non-anonymised) describing the emotional states, worries, trials and traumas of children and their parents. It seems that the General Data Protection Regulations (GDPR) mean little in this ACE inspired world.
This is an instance of the school being turned into a 'mental health' centre. These curricular developments are wholly inappropriate; the school is not a place where you meddle with the 'mental health' of a child, or extract information from them on issues pertaining to 'mental health' and well-being. There are specialist services and professionals to work with children if they need help. They are called Child and Adolescent Mental Health Services (CAMHS). But CAMHS and NHS psychological services are overstretched and some are at breaking point. What exactly do ACE advocates want to do once they have identified all the ACE 'victims'? Where will ACE advocates send children and what treatments will they receive when at present there are limited resources on offer?
The ACE movement need to address the issue of consent and GDPR, as do the Scottish Government who equally seems to be in a love in with the ideology of ACEs. This is ironic as the Scottish Government are very keen on promoting consent; only in certain contexts it seems (i.e., sexual relationships). An even more sinister link to the ACE movement has been discussed by American blogger Alison McDowell. She writes:
ACEs are getting tremendous media exposure of late. While I believe this to be a crucial public health concern, my fear is that ACE prevention and mitigation interventions will become vehicles for 'innovative' finance and will expand profiling of vulnerable populations.
McDowell's article describes, in harrowing detail how the targeting of populations for financial purposes and data collection, are carried out by commercial enterprises supported by governments. This is not carried out with the aim of addressing the structural inequalities that give rise to poverty and misery in society (eg, variables which exist outside the family home and control of families and impede people to lead happy lives), but rather to find, harness, and control a population 'identified' as victims and to herd them into perpetual victimhood, allowing the state to be able to intervene into the lives of families and children.
If the ACE movement does not address the consent issue and the more sinister links to the ACEs/resilience/well-being movement and its ambition of data collection, more and more people and parents will start to question what exactly is being developed supposedly to 'treat' their children. No amount of hype or celebrity endorsement can hide the fact forever that the ACE emperor has no clothes. The bottom line is: children and their parents have the right to consent or not when it comes to ACE ideology. Let me be clear: if the need for consent is overridden by the state, we are entering into totalitarianism.
Dr Bruce Scott is a psychologist, psychoanalyst and parent