The Social Determinants of Mental Health
Mental health is the combination of complexities between your genes and your environment. As a field and to better help individuals we work with, it is integral to evaluate the role that non genetic social and environmental factors play in contributing to poor mental health and in causing and worsening mental illnesses.
The biopsychosocial model has served as a structure, primarily for clinicians to help them formulate a course and treatment plan for individual patients. The model essentially recognizes the interplay and interactions between biological, psychological, and social factors and how these factors contribute and influence the onset and course of mental (and physical) illnesses. The role of each of these factors is incredibly significant. Let’s take a look at the social determinants of mental health and why this is important and so influential.
What are Social Determinants of Mental Health?
The World Health Organization (WHO) defines the social determinants of health as the conditions in which people “are born, grow, live, work, and age and the wider set of forces and systems shaping the conditions of daily life.”
Michael T. Compton, M.D., M.P.H., and Ruth S. Shim, M.D., M.P.H in their book The Social Determinants of Mental Health write that the major social determinants of mental health are effectively the same as for physical health and that the “ “core” social determinants of mental health are: racial discrimination and social exclusion; adverse early life experiences; poor education; unemployment, underemployment, and job insecurity; poverty, income inequality, and neighborhood deprivation; poor access to sufficient healthy food; poor housing quality and housing instability; adverse features of the built environment; and poor access to health care.” They further state, “there are other social determinants of mental health that could be articulated, including inadequate or unequal access to transportation, exposure to violence, conflict, and war in childhood or adulthood, mass incarceration and poor relations between law enforcement and communities, environmental air, water, or land pollution, climate change, sexism and other forms of non–race-based discrimination; and adverse or unsupportive features of the workplace.”
These determinants suggest that mental health is deeply influenced by policies made at the government level and affecting change within these systems require change through policy and programs, as well as, collective and individual decisions within society.
This is an incredibly layered and complex topic. I want to highlight and emphasize the reason for this post which is that I think these factors are not as discussed as much as they should be in the context of mental health. We are living in a time when the responsibility of taking care of ourselves is being solely put on the individual. That if we have poor health and poor mental health, we aren’t taking the time to take care of ourselves. Indeed, this misses the greater environmental and social context in which we all live and are affected by both consciously and unconsciously. In order to have a real conversation about what we can do to take care of our mental health as individuals, we have to consider these factors and the roles they play in our individual and collective lives.
Why this is important for our Mental Health
These social determinants predispose individuals and populations to poor health outcomes. For example, at the individual level, being affected by one or more social determinants can lead to “poor” choices. If you don’t make enough money to be able to purchase enough grocery items at the store for your family, one of the only other options you may have is access to fast food restaurants due to it’s affordability. This decision and other decisions that may negatively affect mental health, could occur simply because of a lack of healthy and affordable options, which in turn leads to known risk factors (e.g., poor diet, substance misuse) for poor physical and mental health. On top of which, exposure to adverse social conditions like inadequate housing or unemployment, leads to stress and known psychological and physiological stress responses that biologically create more vulnerability like increased HPA-axis activation (stress) and inflammation, both of which increase the risk of mental illness.
In this context, there are limited options for people to engage with with regards to taking care of their mental health. These are systemic issues that lead to poor mental health outcomes and to advise people on an individual level to modify their diet or to practice pop psychology “self care” by taking bubble baths and meditating when they are faced with such circumstances that dramatically affect their mental health, is unhelpful at best and offensive at worst. For example, to recommend someone to purchase organic “non-processed” foods when they work 50 hours a week to afford rent, have a sick family member to take care of, and have children of their own, is again, both dangerous and oblivious to the larger context that affects us as individuals.
In order to actually take care of our mental health, we need to have our basic needs met. We also need our stress levels to be manageable. Living in a pandemic has made that incredibly difficult for most people. We also need public health recommendations that make sense, are accurate and rooted in scientific practice and literature, and we need change at a societal and individual level.
What can you do?
Are there any lifestyle and behavioral factors that are in your control even if it is very little? Are you able to move your body for 15 minutes a couple of times a week? Are you able to connect to some kind of social support system? Do you have access to processed foods? Because processed foods are great. I’m sure you never read that in an article discussing mental health and nutrition, but it’s true. Packaged foods like oatmeal, oats, lentils, wholegrain pasta, canned vegetables and fruits, canned beans, canned seafood, frozen fruit and vegetables, pasta sauce, ready to heat microwaved rice, spices, are all excellent options that help support your mental health.
Practice real self care by taking care of your personal hygiene as best as you can. Are you able to get some help from a friend, neighbor, or family member to help make you a meal or give you an hour to rest? Budget your money and time. Try and prioritize your sleep. Do what you can when you can. And know that you are doing the best you are able to for you and your family. There are greater changes that need to be made at the societal level in order for public mental health outcomes to change at a large scale. You can’t eat your way our of depression and anxiety with the best Mediterranean style diet when you are living with the constant stress of being able to pay your bills, living with a partner who has chronic mental illness, or are experiencing racial discrimination and sexual harassment in the workplace. If the only thing you can afford to eat right now is McDonalds twice a week because it ensures that you are able to eat enough calories, please do it. Anyone shaming you for making those choices is ignorant to your life context and is speaking from a place of privilege which they likely are unaware of.
References
https://focus.psychiatryonline.org/doi/pdf/10.1176/appi.focus.20150017#:~:text=the%20main%20%E2%80%9Ccore%E2%80%9D%20social%20determinants,healthy%20food%3B%20poor%20housing%20quality
https://www.paho.org/en/topics/social-determinants-health
