Lecture 10 - Contemporary and Societal Issues in Mental Health Flashcards
Why is equity important?
Individuals receive the same level of support, regardless of their demographics or clinical characteristics
What are social determinants of mental health?
- Social determinants shape health outcomes through living and working conditions.
- Linked to global health inequalities like reduced life expectancy and increased child mortality.
What is social gradient?
- Relationships between health risks and life expectancy linked with social status.
- Effects accumulating effects over time
What is resource distribution?
Disparities stem from unequal resource allocation
What are the impacts of social determinants?
Upstream and downstream?
What are the upstream impacts of social determinants?
Fundamental causes such as economic opportunities, educational attainment, and systemic inequities create conditions that influence mental health risks across the lifespan.
What are the downstream impacts social determinants?
These upstream factors manifest as poor living conditions, chronic stress, and limited access to quality mental health services, exacerbating mental health disparities.
What are key interventions?
- Housing First, IPS, and community-based initiatives improve mental health outcomes.
- Linking patients to cultural and social activities shows potential.
- Universal healthcare and poverty reduction address systemic inequities (the role of integrated care).
What are research recommendations?
- Longitudinal and linked data, along with mixed methods and whole system approaches.
- Promote meaningful partnerships with policymakers, researchers, and affected populations.
- Think systemic inequalities and not individual vulnerabilities.
What is the prevalence of male mental health?
- Data up to June 2024
- Male suicide rate was 15.7 per 100,000 compared to a female suicide rates of 3.8 per 100,000
- Men accounted for 74.9% of suspected suicides
What are the barriers related to male mental health issues?
- These norms associated with higher risk of suicide risk
- Lower rates of reporting depression
- Promotes emotional suppression and anger
- Externalising behaviours: Self-reliance, anger, violence, risk-taking (e.g., competitiveness, financial risk taking, alcohol and drug use)
- Instability, lack of support, markers from younger years (e.g., expulsion)
What is the stigma around help seeking for men?
- Men with mental illness face self-stigma influenced by societal attitudes from others This is prevalent even after attempting suicide (Cleary, 2017; Taylor et al., 2009)
- Young men especially fear social consequences (e.g., bullying, labelling as “weak”) for seeking help, causing isolation and reluctance to engage with mental health services.
- Help seeking is complex and not binary (engaged vs disengaged; Oliffe et al., 2020)
- Inconsistent/stigmatising – misalignment with masculine norms of self-reliance – reinforcing guilt and shame
- Male-dominated environments can lead to concealment
What is the isolation of men’s mental health?
- Men are particularly at risk of social isolation leading to mental health challenges and suicide
- Isolation – stepping away – a consequence of being self-reliant
- Lack of sense of belonging and feeling like a burden
- Importance of support for vulnerable groups an integration with mental health services
How can we destigmatise men’s mental health and masculinity norms?
- Research public campaigns and community programs to normalise mental health discussions for men and embed this across generations (move beyond the ‘speaking up’ narrative)
- Co-design, test, and implement school-based interventions to reshape perceptions of masculinity, promoting emotional openness and healthy help-seeking behaviours in young men
- Consider systemic issues and involvement in such activities (e.g., whole school involvement
Is there a gendered diagnosis bias for women?
- Overdiagnoses of anxiety and depression.
- Underdiagnosed for conditions like ADHD and autism due to gendered stereotypes.
- Mental health challenges misattributed to hormonal or emotional factors rather than underlying clinical causes.
Is there an over reliance of medication for women?
- High prescription rates of SSRIs for anxiety and depression in women.
- Hormonal treatments for conditions such as Premenstrual Dysphoric Disorder (PMDD) are not individualised.
Are the gendered disparities in access to care?
- Barriers due to caregiving responsibilities and economic inequities, impacting access to treatment.
- Marginalisation of disorders like postnatal depression and trauma-related conditions.
- More focus on women and not just the infant in perinatal mental health.
What is the female psychological approach according to Silvero, 2021?
- Diagnosis and care improvements
- Medication practices
- Equitable access
- Policy and training
What is diagnosis and care improvements in Silvero’s female psychology approach?
- Implement enhanced screening protocols for underdiagnosed conditions like PTSD and ADHD in women, addressing biases.
- Integrate trauma-informed and evidence-based therapeutic approaches.
What are medical practices in Silvero’s female psychology approach?
Reassess the reliance on SSRIs and hormonal treatments for anxiety, depression, and reproductive-related disorders.
What is the equitable access in Silvero’s female psychology approach?
- Increase resources to address specific needs (e.g., postnatal depression, trauma, eating disorders, menstrual- and menopause-related conditions).
- Introduce flexible, community-based approaches to increase accessibility.
What is policy and training is Silvero’s policy and training?
- Advocate for gender-sensitive public health policies and training to reduce implicit biases.
- Increase incentives to study women’s mental health across the life course and incorporate lived experience.
What is cultural competence?
- Cultural competence includes awareness of one’s own cultural worldview, knowledge of different cultural practices, and cross-cultural skills.
- Understanding cultural nuances allows for more accurate diagnosis and effective treatment.
- It ensures treatment is respectful of and responsive to the cultural needs of the patient.
- Promoting cultural competence reduces disparities in mental health care and improves outcomes.
What are the disproportionate effects during covid-19?
- Increased hospitalisation and mortality rates among ethnic minority groups.
- Socio-economic disadvantages – intersectionality.
What were the mental and physical health challenged during covid-19?
- Social determinants disproportionately impacted ethnic minority mental health.
- Stigma and discrimination related to ethnicity.
What was the unequal access to care during covid-19?
- Barriers to accessing mental health services, including digital exclusion.
- Experiences of racism and fear of inequity discouraged help-seeking.
What were the broader implication of covid-19?
The pandemic intensified pre-existing inequalities.
What were the key findings of Vahdaninia et al, 2020 study on ethnic minorities?
- Mental health services tailored for ethnic minority groups, including refugees and asylum seekers, reported positive outcomes across all studies.
- Culturally adapted approaches improved acceptability and accessibility for BAME groups.
What challenges were identified in Vahdaninia et al, 2020 ethnic minorities’ study?
- Barriers to accessing services include lack of awareness, stigma, and perceived discrimination.
- Systemic and cultural issues, such as limited clinician cultural competence.
- Diverse intervention types and small study sizes limited the ability to generalise findings.
What are the mental health challenges to the LGBTQIA communities?
- Depression, anxiety, self-harm, and substance abuse.
- Suicidal thoughts, with higher risks among trans individuals and young people.
- These challenges are linked to external factors like discrimination
social isolation and rejection.
- Intersectionality (low SES, ethnic minorities).
- Hate Crimes – increased risk of hate crimes, particularly:
- Gay men, young people, and ethnic minority groups within the community.
- Are we considering maybe hidden hate crimes (e.g., psychological).
What access to healthcare do LGBTQIA+ communities receive?
- 1 in 8 LGBTIQ+ people report unequal treatment by healthcare staff.
- 1 in 7 avoid help-seeking due to fear of discrimination.
What are the positive aspects of being LGBTQIA+?
- Confidence, self-acceptance, and a sense of belonging.
- Improved relationships with friends and family.
What systematic barriers are there for those who are LGBTQIA+?
- Stigma, discrimination, and embedded heterosexism in healthcare systems.
- Lack of understanding and education among health professionals regarding LGBTIQ+ health needs.
What strategies for improvement are there for the LGBTQIA+ communities?
- Promote equity and inclusion
- Tailored interventions
- Policy and awareness
How common is self harm?
12-month prevalence - ‘current’ self harm
- 13% for adolescents
- 4-10% in emerging adults
- 30-50% in university students (Magner-Parsons et al.; Lindquist et al., in prep)
- Adults (30+ years of age) is unknown.
What increases risk of self harm?
- LGBTQIA
- Age
- Gender
Are there structural risk factors to self harm?
Traditionally Studied
- Adverse Childhood Experiences (ACE’s)
- Adverse Life Events (ALE’s)
Emerging area of interest in NSSI
- Socioeconomic status (SES)
- General experiential adversity (Magner-Parsons & Hogarth, in review)
How do you treat self harm?
- Individual therapy, tailored therapeutic approaches, pharmaceuticals.
- Structural reform and system change. Trauma informed care.
- Patient autonomy - ‘stopping’ self harm is not necessarily a therapeutic goal for people
What are restrictive practices?
Actions used to manage behaviour that poses a risk to safety to themselves or others.
What are the types of restrictive practices?
- Seclusion
- Physical restraint
- Mechanical restraint
- Chemical restraint
- Enhanced observations
What is seclusion?
Isolating a person in a locked space
What is physical restraint?
Holding or immobilising a person
What is mechanical restraint?
using devices to restrict movement e.g. straps and belts
What is chemical restraint?
Using medication to control behaviour
What is enhances observations?
Observing all movements of a patient 24/7 within line or sight or within arm’s length
What are patient perspectives on their experience?
- Patients reported fear, powerlessness, and humiliation during restraint or seclusion.
- Retraumatisation for those with trauma histories.
What are patient’s perspectives on psychological impact?
- Restrictive practices conflict with the therapeutic goals.
- Emotional distress often persists long after the event;
- Impacting therapeutic relationships.
What are patient’s perspective on perceived neglect?
- Patients felt ignored and unsupported during and after the event.
- Lack of explanation from staff left patients confused and frustrated.
What are nursing perpectives?
Key findings
- Emotional toll on nurses includes fear, distress, and moral injury.
- Staff report limited resources, environmental constraints.
- Lack of adequate debriefing after incidents.
- Practices influenced by organisational culture, experience.
- Situational demands and stretched services.
Nurses’ perspectives
- Recognise the need for restrictive practices in some cases
- BUT emphasise their negative personal and professional impacts.
What are the principles of recovery-oriented practice?
- Hope and optimism
- Person-centred approach
- Empowerment
- Strength-based approach
- Holistic care
- Respect and dignity
- Collaboration and partnership
- Cultural sensitivity
- Social inclusion and connectedness
- Continuous improvement
What are the principles of trauma-informed care?
- Safety
- Trustworthiness and transparency
- Peer support
- Collaboration and mutuality
- Empowerment and choice
- Cultural, historical, and gender sensitivity
- Strength-based and resilience-focused
- Reducing retraumatisation risk
What are the advantages of digital solution and AI?
- Increased accessibility
- Cost-effectiveness
- Personalisation
- Stigma reduction
What are the disadvantages of the role of digital solutions and AI?
- Lack of human connection
- Data privacy and security
- Digital exclusion
- Over-reliance
- Hallucinations and biases
