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  • Writer's pictureDr. Paul D'Alton

Social injustice and inequality play a pivotal role in mental health of citizens

It is abundantly clear that the chronic stress inherent in disadvantaged communities has significant impact on their mental health.

Man on a psychologist's couch, with his head in his hands.

On March 18, 1968, three months before he was assassinated, Robert Kennedy said: "Yet the gross national product does not allow for the health of our children, the quality of their education, or the joy of their play. It does not include the beauty of our poetry or the strength of our marriages; the intelligence of our public debate or the integrity of our public officials. It measures neither our wit nor our courage; neither our wisdom nor our learning; neither our compassion nor our devotion to our country; it measures everything, in short, except that which makes life worthwhile."

I think the same can be said about our approach to well-being and mental health. We seem to disregard the things that make life worthwhile - the beauty of poetry, the strength of our relationships, the intelligence of public debate. We seem to forget the central role that compassion and wisdom play in shaping a society where individuals can live good lives. We seem to forget that the health of our children, the quality of their education and the joy of their play lay the very foundations for later well-being and mental health. Until we approach mental health from this perspective nothing is going to change.

Over the last three decades there is growing evidence that we need to work with whole systems if we are to improve health and well-being. I firmly believe that if we continue to think in siloed terms about mental health and well-being we are going nowhere quickly.

We know intuitively that the alarming increase in self-harm and consistently high rate of suicide in this country is a whole-society issue. It is tragic that the annual figures for the number of people who end their lives by suicide in this country is unchanged over the last decade or more. In 2001, for example, there were 519 suicides, and in 2012 there were 507 suicides.

This national tragedy, made up of life-shattering loss for those left behind, needs a whole-society response. As long as we continue to seek a solution in one particular department or in one particular service the HSE provides, such as the mental health services, we are destined to repeat the annual national tragedy of more than 500 lives lost to suicide. We cannot continue to abdicate the entire responsibility for well-being and mental health to specialist mental health services or to the minister with responsibility for mental health. Well-being and mental health are whole-government responsibilities and we have to stop thinking in segments, in artificial departmental divides.

I am very pleased to say this Government's recent suicide prevention strategy, Connecting for Life (2015), is a good example of a whole-government approach. But we need to start much earlier than at the point of suicide prevention. We need to adopt a proactive whole-government approach to well-being as foundations of mental health. If we fail to adopt a whole-system approach to well-being and positive mental health, to put it simply - we are at the wrong end of the pitch.

To do this we have to recognise the well-established determinants of health - the social, economic, political, cultural and environmental factors that determine health. If we are serious about the mental health of our nation we have to radically embrace a multi-factorial approach to well-being and mental health.

Too often decisions taken by our governments are made without consideration for the social determinants of mental health or, as Kennedy said, things "that make life worthwhile".

The well-being of our citizens will never be advanced if we simply see ourselves as an economy and continue to measure our success only by advances in GDP and loose sight of ourselves as a society, as an interdependent collective.

We need to move away from the understanding that well-being is simply the result of some magical internal psychological process. We need to be very cautious of an insidious mentality that places excessive responsibility for well-being and mental health in the hands of the individual.

We are a collective and an interdependent species. We need to fully credit the power of deprivation and inequality to erode the capacity of the individual at an emotional, spiritual, psychological and intellectual level. There are of course other factors at play, but social injustice and inequality play a pivotal role - we know these from decades of research in the field.

As a psychologist and educator for almost 20 years, I remain convinced of one thing - equality is the best form of therapy.

It is abundantly clear that the chronic stress inherent in disadvantaged communities has significant impact on their mental health.

An extensive body of research confirms the relationship between social inequalities, general health and poor mental health. The well-being that we seek as a nation will not be achieved until our policymakers and leaders address these inequalities.

We need to radically reorient our approach in the evidenced-based knowledge that social and economic development are two sides of the same coin, and that a sustainable flourishing economy is only built on a flourishing population.

There isn't a citizen in the country who doesn't want radical change to the well-being and mental health of the people of this country. How do we do this?

We have to determine prospectively the potential implications of governmental action upon the social determinants of mental health.

Just as we are now accustomed to making an environmental impact assessment of proposed projects, we need to adopt a mental well-being impact assessment.

This can be done by legislating for the provision of mental-health-proofing all future government actions. There are a number of well-recognised tools available and used in other jurisdictions, such as the Mental Wellbeing Impact Assessment (MWIA) tool.

The MWIA assesses the impact policies, programmes and services have on mental well-being at individual, community and structural levels. It focuses on the social determinants of health and protective factors which are associated with mental well-being including control, resilience, community assets, participation and inclusion.

Originally published in The Irish Independent 26/01/16.


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