Notable child & adolescent psychiatrist sends letter to global citizens on World Mental Health Day 2021

Endowed Yale Professor joins with mental health practitioners from around the globe to call an end to violence against children

Street boy (India) alongside a green ribbon, symbol of mental health awareness. Photo 23755205 / © Ziprashantzi |
Street boy (India) alongside a green ribbon, symbol of mental health awareness. Photo 23755205 / © Ziprashantzi |

Letter by James F. Leckman, M.D., Ph.D., Neison Harris Professor at the Yale Child Study Center, on behalf of the Early Childhood Peace Consortium (ECPC)

Dear citizens of the world,

Thanks to the World Health Organization (WHO), World Mental Health Day is observed each year on the 10th of October. We all know that so much more needs to be done on behalf of children and families to ensure that they have access to adequate and affordable treatment and care. The Early Childhood Peace Consortium joins the WHO and the End Violence Against Children network to highlight the importance of this need, especially for young children and their families.

Science teaches us that the early years of life are formative and set the stage for a child’s cognitive and social-emotional development [1]. Parental engagement is key and nature of the parent-child bonding can have a positive or negative impact from one generation to the next and can serve as a foundation for more peaceful and social equitable communities [2]. Parents and caregivers need to provide ‘nurturing care’ to their infants and young children. Nurturing care can be supported by a range of interventions delivered pre-pregnancy, during gestation, the newborn period, infancy, and early childhood [1]. Many of these interventions have shown to have lifelong benefits including improved health and well-being, and increased ability to learn and earn as well as reductions in morbidity, mortality, disability, and injury.

More specifically, nurturing care refers to five interrelated components:

  1. security and safety,
  2. adequate nutrition,
  3. access to adequate health services,
  4. responsive care-giving, and
  5. early learning opportunities.

It is manifested through behaviors and knowledge about:

  1. care-giving (e.g., health, hygiene care and feeding),
  2. stimulation (e.g., talking, singing and playing),
  3. responsiveness (e.g., early bonding, secure attachment, trust and sensitive communication), and
  4. safety (e.g., routines, protection from violence, abuse, neglect, harm and environmental pollution),

…all of which are constrained by structural conditions affecting the life chances and life choices of a given family.

Citizen holding sign, “I want to feel safe.” (March for Our Lives Event, Los Angeles, CA, USA)Photo 113199559 / Child And © Sheila Fitzgerald |
Citizen holding sign, “I want to feel safe.” (March for Our Lives Event, Los Angeles, CA, USA). Photo 113199559 / Child And © Sheila Fitzgerald |

Unfortunately, many children in our world do not receive adequate nurturing care [3]. Multiple factors such as socioeconomic stresses underpin the well-being and mental health of caregivers, which may increase the risk of their not providing adequate care to their children [4] [5]. Sadly, every year, hundreds of millions of children are exposed to domestic violence and harsh parenting, often from an early age [6]. Globally, one out of two children 2–17 years of age suffer some form of violence each year [7] and one in ten children are sexually abused before the age of 18 years. There is also an urgent need to address the inequities linked to gender and racial discrimination. Other challenges include the presence of parental psychopathology and the use of addictive substances by parents. As a result, hundreds of millions of children fail to reach their full developmental potential.

A challenging reality in today’s world that has had a negative impact on the mental health and well-being of children and families across the globe is the ongoing SARS-CoV-2 (COVID-19) pandemic. As recently highlighted on the Early Childhood Peace Consortium website, children and families in fragile and conflict-affected settings are especially vulnerable. Children are, in many ways, the hidden victims of the pandemic.

Students learning the dangers and the good uses of the internet and social networks. Photo 103165314 / Child And © Claraaa |
Students learning the dangers and the good uses of the internet and social networks. Photo 103165314 / Child And © Claraaa |

Another critically important issue to the field of child rights and protection is regulating internet use given the proliferation of digital devices and electronic games with graphic violent content, with potential consequences on brain development, behavior, and risks of child abuse or exploitation online (for example, see the United Nations Broadband Commission for Sustainable Development “Child Online Safety Report” (U.N. Broadband Commission for Sustainable Development “Child Online Safety Report”).

Fortunately, efforts to improve the mental health of parents’ health and to reduce parenting-related stress have demonstrated potential to improve children’s developmental outcomes in light of adverse experiences [8], particularly among families living in conflict and refugee settings [9] (United Nations Children’s Fund).

It is crucial that the global community of educators and humanitarian practitioners join with WHO, End Violence Against Children, and the Early Childhood Peace Consortium to address these recent and ongoing unfortunate realities. Working together we can have a positive impact of the next generation and generations to come [10].

In solidarity,

James F. Leckman, MD, PhD
Neison Harris Professor, the Yale Child Study Center and the Departments of Psychiatry, Pediatrics and Psychology, Yale University

[Visit Dr. Leckman at the Yale Child Study Center.]

[Visit Dr. Leckman at the Early Childhood Peace Consortium (ECPC).]


[1] Britto, P.R., Lye, S.J., Proulx K., Yousafzai A.K. et al. Nurturing care: Promoting early childhood development. Lancet, 389(10064) (2017) 91–102.

[2] Leckman, J.F., Panter-Brick, C., & Salah, R. (Eds.), Pathways to Peace: The Transformative Power of Children and Families. MIT Press, 2014.

[3] Clark, H., Coll-Seck, A.M., Banerjee, A., Peterson, S. et al. A future for the world’s children? A WHO-UNICEF-Lancet Commission, Lancet, 395(10224) (2020) 605–658.

[4] Shonkoff, J.P. & Garner, A.S. The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1) (2012) e232–246.

[5] Miller, K.E. & Rasmussen, A. The mental health of civilians displaced by armed conflict: An ecological model of refugee distress. Epidemiol Psychiatr Sci. 26(2) (2017) 129–138.

[6] Hillis, S.D., Mercy, J.A., & Saul, J.R. The enduring impact of violence against children. Psychol Health Med, 22(4) (2017) 393–405.

[7] World Health Organization, UNICEF, UNESCO, UNSRSG/VAC, & End Violence Against Children. Global status report on preventing violence against children, 2020. Are governments taking the necessary steps to end violence against children? (accessed 01 April 2021).

[8] Tol, W.A., Song, S. & Jordans, M.J., Annual Research Review: Resilience and mental health in children and adolescents living in areas of armed conflict — A systematic review of findings in low- and middle-income countries. J Child Psychol Psychiatry, 54(4) (2013) 445–460.

[9] Panter-Brick, C., Grimon, M.P. & Eggerman, M. Caregiver-child mental health: A prospective study in conflict and refugee settings. J Child Psychol Psychiatry. 55(4) (2014) 313–327.

[10] Leckman J.F., Ponguta, L.A., Pavarini,G., Hein, S.D. et al., Love and peace across generations: Biobehavioral systems and global partnerships. Comprehensive Psychoneuroendocrinology, 2021, in press.

More information

  1. BBC News. World Mental Health Day. What’s it all about? (05 October 2021).
  2. UNICEF (2021). The State of the World’s Children 2021. On My Mind: Promoting, protecting and caring for children’s mental health (flagship report).
  3. UN Special Representative of the Secretary-General on Violence Against Children (2021). Hidden scars: how violence harms the mental health of children.
  4. World Health Organization (WHO). Mental well-being: resources for the public.
  5. World Health Organization (WHO). WHO report highlights global shortfall in investment in mental health (08 October 2021).
  6. Yale Global Mental Health Program.

About the ECPC

The Early Childhood Peace Consortium (ECPC) is a global movement of United Nations agencies, Non-Governmental Organizations, academia, practitioners, and the private sector focused on sharing scientific and practice-based evidence on how investment in early childhood development (ECD) can contribute to sustainable peace, social cohesion and social justice. We recognize that investing in ECD is a powerful and cost-effective strategy for reducing violence, poverty, and exclusion and for building peaceful societies.

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Early Childhood Peace Consortium (ECPC)

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