Mental disorders are among the most prevalent, chronic and disabling health conditions; they touch the lives of most of us in some way. Although these disorders clearly have biological links, they are also substantially influenced by modifiable social, economic and environmental conditions that affect not only individuals, but whole communities, neighborhoods and populations.
At Mental Health America of Eastern Missouri, we believe that special consideration should be given to the social determinants of mental health, which are not necessarily distinct from the social determinants of physical health, but which have been neglected in our country. Underlying the concept of the social determinants of mental health is the importance of a population-based, public health approach in identifying and treating mental disorders. This approach, described in Mental Health: A Report of the Surgeon General, focuses on mental disorders from the perspective of the population rather than the individual patient. This public health approach also emphasizes the prevention of mental illnesses and the promotion of mental health.
Our nation’s mental health and burden of mental disorders are partly driven by policies pertaining to our basic rights and opportunities (ie, food, education, employment, and energy), our surroundings (ie, neighborhood characteristics and housing), and the nature of our social fabric (ie, social connectedness, access to health care, and equal opportunity for political voice). In examining the social determinants of mental health (Figure 1), it is important to consider those determinants experienced at the individual level (ie, adverse early life experiences; poor social support and lack of connectedness; and social exclusion based on race, ethnicity, sexual orientation, or disability) as well as social determinants deriving from the societal/political milieu (ie, poverty and income inequality, low education, unemployment, housing instability, food insecurity, and adverse features of the built environment).
Addressing the Social Determinants of Mental Health
Addressing the social determinants of mental health requires taking an approach distinct from the typical clinical interventions of psychiatrists and other mental health professionals in everyday practice. One-on-one interventions, such as counseling and education, can be employed, but doing so yields less overall population impact. On an individual patient basis, mental health clinicians can begin to address risk factors stemming from the social determinants of mental health by identifying the family/social network, economic, and environmental factors that influence illness and hinder positive patient outcomes.
The best way to make an impact on the social determinants of mental health is through action at the policy level. Mental health providers can advocate within the health care system, but also at the community, state, and federal levels, for policies that lead to a healthier society.
At Mental Health America of Eastern MO, we challenge mental health providers to increase their awareness of the social determinants of mental health, as a matter of mental health promotion and social justice.
This is a summary of a report written by Ruth Shim, MD, MPH; Carol Koplan, MD; Frederick J.P. Langheim, MD, PhD; Marc W. Manseau, MD, MPH; Rebecca A. Powers, MD, MPH; and Michael T. Compton, MD, MPH