Each July, National Minority Mental Health Awareness Month invites important conversations about access, stigma, treatment, and the inequities that shape mental health outcomes across communities. But too often, those conversations focus on older children, teens, or adults. We picture mental health as something that becomes relevant once a child can describe feeling anxious, withdrawn, overwhelmed, or sad. In reality, the roots of mental health disparities begin much earlier.
If we’re serious about children’s mental health equity, we have to start before kindergarten, with the earliest relationships, environments, and daily experiences that shape how young children learn to feel safe, connected, and understood. Mental health in the first five years doesn’t look like a child talking through their feelings. It’s whether a baby has a responsive caregiver who notices their cues or a toddler is soothed when they are distressed. Most notably, mental health in the early years is built through consistent routines, language-rich interactions, and moments of connection with the adults who love them. We often refer to these as safe, stable, nurturing relationships. They provide the foundation for healthy brain development, strong mental health, and lifelong physical, emotional, and social well-being.
Unfortunately, for many children, those early building blocks of healthy development are shaped by systems and stressors that are far from equal.
We know that children in marginalized communities are more likely to experience poverty, housing instability, food insecurity, exposure to racism and discrimination, and barriers to health care. We also know that caregiver stress has a profound impact on young children. When parents are stretched thin by economic pressure, unsafe neighborhoods, lack of paid leave, limited access to their own physical and mental health care, or the daily toll of systemic inequities, that stress does not stay neatly contained in adult life. It spills into the emotional climate young children are growing up in.
This doesn’t mean families are failing their children. Families bring tremendous strengths, deep commitment, and an unwavering desire to give their children the best possible start. At the same time, they are raising children within systems and circumstances that can place enormous strain on healthy development, especially during the earliest years.
The first five years are a period of extraordinary brain growth. A child’s brain is building the architecture for emotional regulation, stress response, language, learning, and relationships, and those skills do not develop in isolation.
Long before a child can even describe feeling anxious, overwhelmed, or withdrawn, they are learning whether the world feels safe, whether their needs will be met, and whether they can count on the adults around them for comfort and connection. It’s also why early relationships and shared reading belong in the mental health conversation.
Reading together is often framed as an academic activity, something that builds vocabulary, school readiness, and literacy skills. It absolutely does all of those things. But shared reading also supports mental health in ways that deserve far more attention.
When a caregiver and child curl up with a book together, they’re doing something deeply regulating. They’re slowing down. They’re making eye contact. They’re sharing physical closeness, language, and attention. For a young child, that kind of back-and-forth connection builds attachment and emotional security. Books can help children recognize facial expressions, understand routines, name feelings, and see that other people experience worry, frustration, joy, sadness, and pride too. For caregivers, reading can create a predictable ritual of connection even in the middle of a stressful day. Reading a book with a child may give the adult the small break in their day that allows them to slow down and remember how meaningful even brief moments of connection are for their relationship.
In other words, shared reading isn’t just good for literacy. It’s good for relationships that are the foundation of mental health.
That matters even more when we think about equity. Not every family has the same access to books, safe play spaces, high-quality early learning opportunities, pediatric guidance, or culturally responsive mental health support. Not every parent has the time or bandwidth to create calm routines after working multiple jobs, navigating transportation challenges, or carrying the emotional weight of discrimination and financial stress. If we want to reduce mental health disparities, we cannot put the burden entirely on families to “do more.” We have to make it easier for families to access the tools and support that help children thrive.
That includes programs like Reach Out and Read, which ensure families have books in the home and clinicians talk with parents not just about milestones and behavior, but about connection, routines, stress, and the simple power of reading together. It includes supporting programs that meet families where they are and honor their culture, language, and lived experience rather than assuming a one-size-fits-all model of child development. And it includes investing in policies that reduce the pressures that make it harder for caregivers to be emotionally available in the first place.
Culturally responsive support is especially important. Families are more likely to engage with services and guidance when they feel seen, respected, and understood. We must recognize the strengths families already bring to their children, including deep love and respect, storytelling traditions, multilingual households, intergenerational caregiving, community-based support systems, and a strong desire for their children to grow up to be healthy, capable, and compassionate adults. We must also acknowledge that conversations about mental health may look different across cultures, and that support should be built with those differences in mind, not in spite of them.
Relationships Essential Reads
Too often, we wait until children are struggling in school, acting out in a classroom, or showing signs of anxiety and depression before we ask what support they need. By then, we are often trying to intervene after years of accumulated stress. National Minority Mental Health Awareness Month should push us to think much earlier than that. It should remind us that mental health equity begins in infancy, in the day-to-day conditions of a child’s life, in communities that value all children and families regardless of race, ethnicity, or ability, and with the support they need to build strong, nurturing relationships from the start.
When we talk about children’s mental health equity, we have to start where children do: in relationships, in early childhood, and long before they ever have the words to tell us they are struggling.
