The Social Determinants of Mental Health

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The Social Determinants of Mental Health

edited by Michael T. Compton, MD, MPH, and Ruth S. Shim, MD, MPH. American Psychiatric Publishing, Washington, DC, 2015, 270 pages, $58.00 (paper).

The development of mental illness in an individual is driven by a confluence of genetic and biologic factors, and researchers in psychiatry are actively pursuing a greater understanding of illness through their focus on these areas. The authors and editors of The Social Determinants of Mental Health effectively argue for the need to broaden the foundation of our understanding of the determinants of mental illness by including an examination of the social and the environmental context of individuals, their families, and their communities. In doing so, they remind us to consider the individual who is at risk for illness and enlighten us to the potential for population-based, public health approaches that might both prevent mental illness and promote mental well-being and resilience.

The editors include a wide range of social topics explored by experts in the fields. Chapters include a focus on discrimination, education, employment and housing, and economic inequality. In doing so, the authors portray a society in which these factors exist not in isolation but in a community where there may be diverse and overlapping stressors. The authors effectively bridge the gap for readers who may initially dismiss these topics as less relevant to understanding mental illness than the biologic factors that more commonly appear in professional journals. The authors dissect each topic area and consistently draw parallels between the determinants of physical health and mental health.

Lest the reader become overly disheartened while reading The Social Determinants of Mental Health, each chapter concludes with a section on the role for a mental health professional in promoting mental health. For example, the chapter on unemployment reminds readers of the role of supportive work in the treatment of psychiatric illness and, by extension, recovery from mental illness. The final chapter, cowritten by David Satcher, serves as a call to action for addressing the limitations and destructive aspects of the social environments that exist in many communities in America. While many of the recommendations focus on the advocacy role that psychiatrists can employ through their involvement in organized social and political efforts, the authors also provide specific recommendations that an individual psychiatrist or professional can follow. As the cover of the book reminds us with a photograph of blade of grass splitting a cracked asphalt path, there is always a place for hope and optimism.

When tackling a topic as broad as social determinants, it is not possible to cover every aspect, even in a wide-ranging text. One area that would have been useful to explore in greater detail is the widespread exposure to violence in certain communities. While the authors did mention this in a thorough discussion of adverse early life experiences, an entire chapter might have afforded them an opportunity to discuss communities dominated by violence associated with high incarceration rates and drug addiction. However, as the editors assert, it is not possible to review every topic, and their goal was to provide an extensive overview and a framework for exploring a number of social factors.

In a social climate where there is public outcry over criminal acts by a few individuals with severe mental illness and legislative bodies debate implementing additional restrictions upon those with mental illness, The Social Determinants of Mental Health serves as a fresh reminder that the mental health of individuals depends upon the overall viability and well-being of entire communities and that solutions require debate and political decisions on steps to address difficult community problems. Mental health professionals who have worked in the field for a number of years may find this a refreshing reminder of the community mental health movement and the optimism it instilled. Students and residents will find a public health perspective that inspires a sense of optimism that may be lacking in their everyday training.

Jeffrey Stovall, MD

[email protected]

Author affiliation: Vanderbilt University School of Medicine, Nashville, Tennessee.

Potential conflicts of interest: None reported.

J Clin Psychiatry 2016;77(5):e602

dx.doi.org/10.4088/JCP.16bk10753

© Copyright 2016 Physicians Postgraduate Press, Inc.