When it comes to your mental health, zip code matters

The Adler School of Professional Psychology’s Institute on Social Exclusion (ISE) hosted a conference in September 2012 on “The Social Determinants of Urban Mental Health: Paving the Way Forward, ” to increase public awareness on how social conditions affect the mental health and well being of urban residents.

Around 200 health professionals and community stakeholders joined in conversations about ways to encourage action to address the social determinants of mental health.

Conference presenters, including globally recognized epidemiologist Sir Michael G. Marmot, Ph.D., Director of the University College London Institute of Health Equity (Marmot Institute), and Kwame McKenzie, M.D., Medical Director of the Centre for Addiction and Mental Health in Toronto, conveyed powerful ideas about how to build advocacy, spread knowledge and share insights in an effort to work toward the common goal of health equity. Sir Marmot highlighted several points in his presentation that examined the conditions in which people live, work, and age that are linked with particular social and economic features of society. He reported that combined negative conditions such as lack of access to medical care, disadvantages from genetic makeup, unfair employment opportunities, lack of education, and other factors may enable struggles with emotional maturity, physical health and wellbeing, social competence, and life expectancy.

ISE Executive Director Dr. Lynn Todman and the ISE team also integrated a workshop within the conference regarding their Mental Health Impact Assessment (MHIA). The MHIA is an 18-month assessment tool designed to evaluate the impact of public decisions on population mental health. The ISE team is focusing the use of the MHIA to Chicago’s Englewood residents due to changes in federal guidance about employer use of arrest records. Englewood is a low income, predominantly African American community on Chicago’s southwest side. The community suffers from many issues such as crime, violence, unemployment, poor housing, ad overall lack of services to its residents. As one of the most highly marginalized and impoverished Chicago neighborhoods whose crime rate ranks among the highest in the United States, the MHIA constitutes efforts to integrate mental health considerations.

Results of the MHIA will be used to evaluate policy guidance on the US Equal Opportunity Commission to prevent employers from utilizing an applicant’s arrest records to make employment decisions. This piece of legislation has important implications for communities similar to Englewood, and will be reported to various stakeholders including Englewood residents, public officials, and legislators to advocate for improving community mental health.

Dr. Bechara Choucair, Commissioner of the Chicago Department of Public Health, also spoke in support of health equity and recognized explicit social and environmental influences on population health.

“Socioeconomic factors must be a core focus….guiding principles involve looking at multiple complex interrelated factors that contribute to social inequity and engage diverse populations… to alleviate health disparities,” said Dr. Choucair. Priorities to address included improving the quality of healthcare that is provided to communities, promoting healthy prenatal care, campaigning against teen pregnancy, and expanding access to healthy and affordable food.

Common threads throughout presentations addressed similar key tools for change, including preventative measures and pro-active frameworks to improve mental health and wellbeing. Many strategies reflected on realistic methods to advocate for social change such as pursuing policy development, continuing research in the interest of systems management, and increasing individual efforts to promote awareness around environmental conditions.

Presenters, including Marice Ashe, J.D., M.P.H., Founder and CEO of ChangeLab Solutions in Oakland California, revealed that within under-resourced communities in California a range of individual factors might contribute to the manifestation of a behavioral health concern—a mental health or substance use disorder—in a particular individual.In her discussion, Ashe focused on how laws and policies create social structures in which health behavior occurs. She noted that laws that affect the social determinants of health directly affect the mental health of such neighborhoods. For example, many underserved communities are high in convenience stores limited to fast food or snacks, lack zoning policies to support walking and bicycling, and have loose standards for foods provided in such communities. By improving health requirements for communities who lack these opportunities, those residents may achieve access to more resources.

To prevent such disparities, solutions included long-term protection, ongoing care, and population-wide interventions, such as:

·        Continuing partnership development

·        Increasing public action vis-à-vis government policies

·        Advocating for public health improvements, such as cleaner water, safer roads and immunizations

·        Exploring physical risk factors, such as smoking, obesity, alcoholism to promote comprehensive preventative services

·        Improving basic societal foundations through poverty reduction, economic opportunities, healthcare, justice, transportation and education

Countless communities locally and globally are affected by limited access to services; high rates of poverty and joblessness; or by discrimination, violence and marginalization. The psychological outcomes perpetuated by social problems warrant exploration;the object of which is teasing out the risk and protective factors of mental health inequity.  These findings could then be used to work toward fundamental changes in the ways that communities are planned, and closer attention to monitoring and adjustment of the environmental factors that affect the behavioral and physical health of all who live in society. 

To learn more about the ISE, visit www.adler.edu/ise.

Stacey Willard, MA, is currently a doctoral student at the Adler School of Professional Psychology in Chicago.