The Environment Is Part of the Treatment: What New Mental Health Research Is Teaching Us About Behaviour

Understanding why lasting behavioural change often begins with the relationships, expectations and environments surrounding the individual. 

By Dr. Bob Carey

There is a question I have returned to many times throughout my career, particularly when working with children, adults with developmental disabilities, and families struggling with persistent behavioural or emotional difficulties. Why is it that an individual can function reasonably well in one environment, yet experience considerable difficulty in another, even though the person's diagnosis, abilities and personal characteristics have not changed?

A child who is cooperative and engaged with one teacher may become anxious, oppositional or withdrawn with another. A young person who manages the demands of school throughout the day may arrive home emotionally exhausted and become overwhelmed by what appear to be relatively minor expectations. An adult with a developmental disability may function successfully in one residential or community setting but experience frequent behavioural difficulties after a change in caregivers, routines or living arrangements.

We often respond to these situations by looking more closely at the individual. We consider whether symptoms have worsened, whether medication needs to be adjusted, whether behavioural consequences should be strengthened, or whether additional treatment is required. These may all be legitimate considerations, but there is another possibility that deserves equal attention. Perhaps something important has changed in the environment, or perhaps the environment has never been particularly well suited to the person's needs in the first place.

This is a question that has shaped much of my work with the Positive Systems Approach (PSA), and it is becoming increasingly relevant as new mental health research examines the influence of relationships, family environments, schools and broader social conditions on psychological wellbeing.

Several studies published in 2026 offer particularly interesting perspectives. Although they examine different populations and use different research methods, they share an important underlying theme: mental health and behaviour cannot be fully understood by examining the individual in isolation.

When the School Environment Becomes Part of Mental Health

One of the more compelling recent findings comes from an Australian longitudinal study published in September 2026 in npj Mental Health Research. Stevens and colleagues examined psychological distress and wellbeing among 1,548 adolescents attending 35 schools, considering a variety of school-, staff- and student-level factors.  The researchers found that several aspects of the school environment, including students' perceptions of school climate and connectedness, were associated with better wellbeing at the time of assessment. However, when they examined outcomes two years later, student-rated school connectedness was the only factor among those studied that remained associated with higher wellbeing.  The finding is important, although it requires careful interpretation. The study demonstrates an association rather than proving that increasing school connectedness will necessarily cause improvements in mental health. Nevertheless, it suggests that a young person's experience of belonging may be an important part of the environment in which psychological wellbeing develops.

Consider what this means for a student who is experiencing anxiety, attention difficulties, social isolation or disruptive behaviour. We may be inclined to identify the child's difficulties as the primary problem and direct our interventions toward improving emotional regulation, attention, coping skills or behavioural compliance. Yet the research encourages us to consider whether the student feels accepted, understood, supported and valued within the school community.

A student who anticipates criticism, rejection or failure may approach ordinary classroom expectations very differently from a student who feels secure in relationships with teachers and peers. The same academic task can represent an opportunity for success for one student and a source of considerable emotional distress for another.  From a PSA perspective, these differences are not incidental. They are part of the functional context in which behaviour occurs.

This understanding is strengthened by another 2026 study that is especially relevant to Canadian educators. Molyneux and colleagues examined school belonging among more than 23,000 students in Grades 6 through 8 across 365 British Columbia schools. Their findings indicated that belonging was associated not only with individual characteristics but also with relationships with adults and peers, experiences of victimization, and features of the school environment itself.  Of particular interest was the finding that school-level relational conditions mattered. Students' sense of belonging was not simply an individual attitude or personality characteristic; it was associated with the broader social climate in which they participated.  This is an important distinction because it changes the way we might approach intervention. Rather than focusing exclusively on helping a socially isolated or anxious student become more resilient, we can also examine whether the school is providing the relationships, opportunities and protections that make belonging possible.  For some students, individual counselling or skill development will be essential. For others, equally meaningful improvements may come from changes in classroom expectations, peer relationships, teacher responses, opportunities for participation, or the way the school responds to exclusion and conflict.  The objective is not to choose between helping the student and changing the school. It is to recognize that both may be necessary.

Parenting Is Also Shaped by the System

A similar theme emerges from a Perspective published in Nature Mental Health in September 2026 by Cuartas and colleagues. The authors reviewed evidence concerning parenting practices, early childhood development and mental health, emphasizing that parenting itself is shaped by socioeconomic circumstances, culture, social support, emotional wellbeing and environmental conditions.  They also examined the importance of engagement in play and learning activities, supportive relationships and nonviolent discipline, while discussing the developmental and mental-health risks associated with physical and psychological punishment.  What I find particularly relevant is their emphasis on ecological interventions and parenting-support programs rather than approaches that focus exclusively on changing the child.

This raises an important question about the way we sometimes respond to families experiencing behavioural difficulties. When a child is frequently oppositional, aggressive, anxious or emotionally dysregulated, we may recommend that parents become more consistent, establish clearer boundaries, use more effective reinforcement or respond differently to challenging behaviour. These recommendations can be valuable, but they may overlook the circumstances that make effective parenting difficult.  A parent who is exhausted, overwhelmed by financial pressures, managing personal mental-health concerns, or receiving little practical support may find it extremely difficult to maintain the calm, predictable and positive interactions that their child requires. A child who has difficulty with communication, sensory regulation, attention or emotional control may then respond to ordinary demands with distress or resistance, further increasing parental stress. Over time, the family can become caught in a pattern in which the child's behaviour increases adult frustration, adult frustration changes the way expectations are communicated, and the child's distress becomes more pronounced.  Eventually, everyone may begin to see the child as the problem, when the problem may actually be the interactional pattern that has developed.

This is one of the central principles of PSA. Behaviour is influenced by what happens before it, what happens after it, and the larger circumstances in which those interactions take place. Understanding those relationships allows us to move beyond simply reacting to behaviour and toward changing the conditions that contribute to it.  A family intervention might therefore include teaching the child communication or coping skills, but it might also involve simplifying routines, adjusting expectations, increasing positive interactions, coordinating caregivers, reducing unnecessary conflict and ensuring that parents have adequate support.  In many cases, improving the health of the family system becomes an important part of improving the child's mental health.

The Predictability of Everyday Life May Matter More Than We Realize

Another recent development adds an interesting dimension to this discussion. Research highlighted by the U.S. National Institutes of Health in 2026 examined the importance of unpredictable home environments in identifying children at risk for mental-health difficulties.

The researchers drew attention to experiences that may not always be captured by conventional measures of childhood adversity, including inconsistent household routines, unpredictable parental responses and instability within family relationships. Their findings suggested that these environmental experiences may provide useful information about children's vulnerability to depression and sleep difficulties.  This is particularly relevant because unpredictability is not necessarily dramatic or immediately recognizable as a serious problem. It can emerge gradually through ordinary family circumstances, particularly when caregivers are under considerable stress or when the household is repeatedly reorganized around a child's behavioural difficulties.

Consider a child who never knows whether an ordinary request will lead to encouragement, criticism, negotiation or an argument. Perhaps bedtime changes considerably from one evening to another, homework expectations depend on how tired the parents are, or a child's emotional outbursts repeatedly determine what happens next. Even when everyone involved is trying their best, the environment may become increasingly difficult for the child to anticipate and navigate.  For a child who already experiences anxiety, autism, ADHD or difficulties with emotional regulation, this unpredictability may be particularly challenging. The child may become increasingly vigilant, resistant to change or dependent upon rigid routines as a way of managing uncertainty. Adults may interpret those responses as stubbornness or defiance, leading to further attempts to impose control.

Within PSA, predictability has always been an important feature of a positive environment. Consistent expectations, understandable routines, clear communication and supportive relationships help people anticipate what will happen and what is expected of them. They can also reduce the number of situations in which an individual is repeatedly confronted with demands that exceed their current coping abilities.

The newer research provides another reason to take these ordinary environmental conditions seriously. It suggests that the organization and predictability of everyday family life may be relevant not only to immediate behaviour but also to longer-term emotional wellbeing.  We should be cautious about assuming that every association represents a direct causal relationship. Children with existing emotional or behavioural difficulties can themselves influence family routines and parental responses, and families differ considerably in their circumstances. Nevertheless, the findings reinforce the importance of examining environmental patterns as part of assessment and intervention.

What Happens When We Consider the Parent-Child Relationship as Part of Anxiety Treatment?

An additional 2026 article in Nature Mental Health offers a particularly interesting perspective on childhood anxiety. The authors examined how developmental neuroscience might help improve psychological treatment by paying closer attention to parental involvement in children's emotional experiences.  They focused on two processes: the ways parents influence or filter the environments their children encounter, and the ways parents help buffer children's fear responses.  This research is especially interesting because it takes the discussion beyond the general observation that parents influence their children. It suggests that understanding specific processes within the parent-child relationship may eventually help clinicians tailor interventions more effectively.

For example, a parent may respond to an anxious child by removing every situation that produces distress. Although this may provide immediate relief, consistently avoiding difficult situations can sometimes reduce opportunities for the child to develop confidence and coping skills. At the other extreme, a parent who repeatedly pushes a frightened child into situations without sufficient preparation or support may inadvertently increase anxiety.  The challenge is to create an environment in which the child feels sufficiently safe and supported to approach manageable difficulties while gradually developing greater independence.

This is very consistent with the balance we try to achieve within PSA. We do not want to remove every expectation or difficulty from an individual's life, nor do we want to rely upon repeated demands and consequences when the individual lacks the skills or emotional capacity to respond successfully. Instead, we try to modify the environment, teach useful skills, provide appropriate support and gradually increase expectations as competence develops.

An important qualification is that the Nature Mental Health article is a proposed neuroscience-informed approach rather than a clinical trial demonstrating the effectiveness of a new treatment. Its contribution lies in identifying processes that may help improve future interventions.  Even so, the underlying message is compelling. The relationship between the child and the caregiver is not merely the background against which treatment occurs. It may be one of the processes through which treatment becomes effective.

Moving Beyond the Individual Without Losing Sight of Individual Needs

Taken together, these studies offer an increasingly useful framework for understanding the relationship between behaviour, mental health and the environment. They also help explain why interventions that appear appropriate on paper sometimes produce disappointing results in everyday life.

A behavioural program may be carefully designed, but if the adults implementing it are exhausted, inconsistent or working at cross-purposes, its effectiveness may be limited. A student may receive excellent individual counselling, but if the classroom continues to be experienced as threatening or rejecting, progress may be difficult to sustain. A child may learn coping strategies during therapy, but if home routines remain unpredictable and opportunities to practise those skills are limited, those strategies may not become part of everyday functioning.  Similarly, an adult with a developmental disability may have received extensive behavioural intervention, yet continue to struggle because the residential or vocational environment has not been adapted to their communication abilities, sensory needs, emotional vulnerabilities or need for meaningful participation.

These examples do not mean that individual treatment is unnecessary. Mental-health conditions, developmental differences, cognitive limitations and personal histories are real and important. Some individuals require specialized psychological treatment, medication, educational accommodations or substantial ongoing support. A systems perspective should never become an excuse to minimize those needs.  Rather, the environment needs to be considered alongside the individual, because the interaction between the two often determines how successfully a person can function.

This is also why PSA has always emphasized the importance of examining both individual and system factors. We want to understand the person's strengths, limitations, communication abilities, emotional functioning and learned patterns of behaviour, but we also want to understand the relationships, routines, expectations, reinforcement practices, environmental conditions and support systems that influence everyday experience.  The practical implications are considerable.  When a child repeatedly struggles with a particular expectation, we can examine whether the demand is appropriate, whether the child understands what is required, whether the necessary skills have been taught and whether the environment provides enough opportunity for success. When parents become caught in repeated conflict with their child, we can examine how the family interaction has developed and what changes might reduce the likelihood of escalation. When a student experiences school refusal, we can investigate not only the student's anxiety but also their relationships, sense of belonging, experiences of success and perceptions of safety within the school.

In each situation, the objective is to understand why the behaviour is occurring and then to change the circumstances that make the behaviour more likely, while helping the individual develop more effective ways of responding.  This is not simply a more compassionate approach, although compassion is certainly important. It is also a more comprehensive approach to assessment and intervention.

The Growing Importance of Supporting the People Who Provide Support

One of the implications of this research that deserves greater attention is the wellbeing of the people who provide care and support.  Parents, teachers, residential support staff and other caregivers are often expected to maintain patience, consistency, optimism and emotional availability while responding to considerable demands. Yet their ability to provide effective support is influenced by their own circumstances, relationships, resources and emotional wellbeing.  This is particularly relevant to the PSA concept of team health. A support system that is chronically stressed, poorly coordinated or lacking in resources may struggle to provide the predictable and positive environment that an individual requires.

Recent research on universal parenting-support programs adds to this discussion by examining whether interventions directed toward caregivers can improve both children's emotional and behavioural outcomes and parental mental health. The importance of this work lies partly in recognizing that parents' wellbeing and children's wellbeing are interconnected, rather than treating them as entirely separate clinical concerns.  In practice, this means that supporting a parent may involve much more than teaching a particular behaviour-management technique. It may involve helping caregivers develop a shared understanding of the child's needs, reducing unnecessary demands, strengthening relationships, providing opportunities for respite or ensuring that families can access appropriate community services.

The same principle applies in schools and community agencies. A teacher who feels supported by colleagues and administrators may be better positioned to respond thoughtfully to a distressed student. A residential support team with consistent leadership, adequate training and shared expectations may be more capable of preventing challenging behaviour than a team that is repeatedly responding to crises without sufficient organizational support.  When we improve the conditions under which caregivers work, we may also improve the conditions experienced by the people they support.  That is a particularly important systems-level intervention because it recognizes that the wellbeing of the individual and the wellbeing of the support system are closely connected.

Where Does This Leave Us?

After many years of working with individuals who experience behavioural and mental-health difficulties, I have become increasingly convinced that one of the most important questions we can ask is not simply what is wrong with the person, but what is happening between the person and the environment.

The emerging research does not suggest that changing the environment will resolve every psychological or behavioural difficulty. Nor does it mean that relationships, routines or social support can replace appropriate clinical treatment. What it does suggest is that these factors deserve to be considered essential components of a comprehensive understanding of mental health.  A child's sense of belonging at school, the predictability of family life, the emotional wellbeing of parents, the quality of caregiver relationships and the broader conditions under which people live can all contribute to the circumstances in which psychological difficulties develop, persist or improve.

For me, these findings provide further support for the central proposition of the Positive Systems Approach: behaviour does not occur in isolation, and meaningful intervention requires an understanding of both the individual and the system surrounding that individual.  This has been a recurring theme throughout my recent articles, whether discussing school connectedness, parenting, emotional regulation, predictable routines or the importance of understanding what challenging behaviour may be communicating. Although the research continues to evolve, it is encouraging to see increasingly sophisticated studies examining questions that have long been important in practical behavioural intervention.  The real challenge, of course, is translating these findings into everyday practice. It is one thing to recognize that the environment matters and another to identify which environmental factors are most important for a particular individual, determine what can realistically be changed and coordinate the people responsible for making those changes.  That is precisely what PSA was developed to help accomplish.

These principles are explored in greater detail across my three books on the Positive Systems Approach, beginning with the foundational work written with Terry Kirkpatrick, Managing Disruptive Behaviours with a Positive Systems Approach, which describes how behavioural principles can be integrated with a broader understanding of individual and system factors. The parenting applications are developed further in What If It's Not Just the Behaviour? A New Way to Parent with a Positive Systems Approach, while What If It's Not Just the Behaviour? A Parent's Companion translates those ideas into 45 common situations that parents encounter in everyday family life.

Although the books address somewhat different audiences and circumstances, they share a central idea: when we understand behaviour within its larger context, we become better equipped to prevent difficulties, teach useful skills, strengthen relationships and create environments in which people have a greater opportunity to succeed.  Perhaps the most important lesson from this growing body of research is that effective mental-health intervention should not always begin and end with the individual receiving treatment. Sometimes the most meaningful changes emerge when we examine the expectations, relationships, routines and systems that shape the person's everyday experience.  And sometimes, by changing what is happening around a person, we create the conditions that allow something important to change within that person.

References

Cuartas, J., Lansford, J. E., Backhaus, S., et al. (2026). Supporting parenting in early childhood to foster human development and mental health. Nature Mental Health. https://doi.org/10.1038/s44220-026-00726-1

Molyneux, T. M., Ji, X. R., Shapka, J., Kassan, A., & Oberle, E. (2026). School belonging in early adolescence: A multilevel analysis of individual, relational, and organizational predictors among Canadian middle-grade students. Journal of Youth and Adolescence. https://doi.org/10.1177/02724316261485862

Stevens, S. K., Maston, K., Beames, J. R., et al. (2026). Longitudinal associations between school-, staff-, and student-level factors with student psychological distress and wellbeing. npj Mental Health Research. https://doi.org/10.1038/s44184-026-00244-z

National Institutes of Health. (2026). Childhood screen detects mental health risks. https://beta.nih.gov/our-science/nih-research-matters/childhood-screen-detects-mental-health-risks

Leveraging parental processes in the treatment of childhood anxiety disorders: Insights from developmental neuroscience. (2026). Nature Mental Health. https://doi.org/10.1038/s44220-026-00702-9

The effects of universal parental support programs: A systematic review and meta-analysis. (2026). BMC Public Health. https://doi.org/10.1186/s12889-026-28844-6