Steering Committee Feature Column
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Our Steering Committee Feature Column is updated regularly with information written by and about SAMHSA ADS Center Steering Committee members and their organizations. The SAMHSA ADS Center helps to promote acceptance and social inclusion for people with behavioral health problems and helps to counter the negative beliefs, harmful attitudes, and discrimination experienced by those with behavioral health problems.
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Please note that the views expressed in this column do not necessarily represent the views, policies, and positions of the Center for Mental Health Services, the Substance Abuse and Mental Health Services Administration, or the U.S. Department of Health and Human Services.
The Social Determinants of Mental Health: From Awareness to Action
On June 3–4, 2010, the Institute on Social Exclusion (ISE) at the Adler School of Professional Psychology hosted a conference titled “The Social Determinants of Mental Health: From Awareness to Action.” The conference served two purposes: (1) to highlight the ways in which social conditions, such as inequality, poverty, homelessness, violence, physical isolation and racism impact mental health and (2) to set the stage for concrete action on the social conditions that determine mental health. The conference was the first of its kind in the United States to explicitly apply the Social Determinants of Health framework developed by the World Health Organization (WHO) to the field of mental health. It was attended by more than 230 people, who traveled to Chicago from all over the United States and Canada, as well as Bermuda, Peru, Portugal, the United Kingdom and Thailand.
Pictured at the event from left to right: David Satcher, Lynn Todman, and Raymond Crossman
The keynote speaker was David Satcher, the 16th Surgeon General of the United States, a former Director of the Centers for Disease Control and Prevention (CDC), a member of the WHO Commission on the Social Determinants of Health, and a longtime advocate for mental health. In his remarks, Dr. Satcher called for a “global movement” to eliminate health disparities by addressing the social determinants of health. He noted, “We need a movement that places fair health, fairer distribution of health and better overall population health at the head and heart of governance.” He went on to ask, “Is health–including mental health–about personal responsibility? Yes and no. Communities have to have places to be safely active, and to buy good foods. We must focus on personal responsibility and social responsibility, and integrate both.”
Dr. Satcher was followed by a panel that included Gail C. Christopher, Vice President for Programs, Food, Health and Well-Being at W.K. Kellogg Foundation; Aida Giachello, Director of the Midwest Latino Health Research, Training and Policy Center at the University of Illinois at Chicago; Terry Mason, Chief Medical Officer at Cook County Health System (Metropolitan Chicago); and Aaron Wernham, Project Director of the Health Impact Project for Pew Health Group of The Pew Charitable Trusts. The panel was moderated by Marian McDonald, Associate Director for Minority and Women's Health within the Division of Emerging Infections and Surveillance Services at the CDC National Center for Emerging and Zoonotic Infectious Diseases.
During the panel, Dr. Christopher commented about the impact of structural racism, which she described as a not-often-cited but nevertheless significant social determinant of mental health that does great harm to the emotional well-being of communities of color in the United States.
Dr. Mason described how prisons and jails are full of people with mental illnesses that have their origins in the social environment–unsafe housing, dangerous neighborhoods and poverty. He also noted that healthcare systems need to get out of the business of disease control and management, and into the business of real prevention. Dr. Wernham spoke about Health Impact Assessment (HIA) as a method for identifying and addressing the social determinants of mental health. And, Dr. Giachello spoke about the social conditions that impact the mental health of Latino communities.
On the second day of the conference, the plenary speaker was Sandro Galea, professor and chair of the Department of Epidemiology at the Columbia University Mailman School of Public Health, New York. In his comments, Dr. Galea described the growing role of the urban environment as a critical determinant of mental health. He also noted, “An institution, such as the Adler School, can be quite powerful in pushing awareness of and action on the social determinants of mental health, and leading the way forward.” He added, “This group has an important role to play in nurturing practitioners who can provide effective one-on-one therapy while also advocating for and working in partnerships that can achieve real structural change.”
In addition to the keynote, panel and plenary presentations, the conference included more that 25 papers and poster presentations on a range of topics including “Economic Downturns and Population Mental Health: A Systematic Review”, “Social Determinants of Suicidal Behaviors among African American and Hispanic Adolescents”, “The Impact of Neoliberal Ideology on Policy and Practice in the Field of Mental Health”, “The Refugee Resettlement Process: Impact of Policy and Funding on the Mental Health of Chicago's Refugees”, and “Social Determinants of Mental Health: Outcomes of Child Soldiers versus Children in Gangs.”
As a follow-up to the conference, the ISE is taking “action” on the social determinants of mental health by working to advance the practice of HIA. The purpose of HIA is to prospectively assess the impacts of public decisions and actions, such as new legislation or a change in pubic policy, on health outcomes. HIA findings are used to recommend solutions that mitigate adverse health impacts and enhance positive impacts. Our work will advance the practice of HIA by (1) expanding it beyond its traditional focus on physical health to include a focus on mental health, and by (2) assessing the mental health impact of proposals other than those related to planning, land use and built environment (e.g., zoning changes; residential, commercial, and transportation projects) to include a broader range of proposals (e.g., labor, education, social welfare, public safety).
The resulting Mental Health Impact Assessment (MHIA) tool will act on the social determinants of mental health by assessing and addressing the impacts of public decisions and actions on determinants such as neighborhood environment (e.g., safety, open space, air quality, noise, employment and retail establishments); material living conditions (e.g., housing quality/density, food security); public service systems (e.g., health, education, transportation); and broader social and economic conditions (e.g., exclusion, racism, distribution of income and wealth).
The ISE is currently undertaking an MHIA on a recently proposed amendment to Chicago’s Vacant Property Ordinance. If passed, the amendment will hold banks and other financial institutions accountable for the maintenance of properties on which they foreclose. The MHIA will assess the impact of the proposal on social determinants of mental health such as crime and violence, property values, neighborhood investment, employment opportunities, tax base and public services. Our goal is to ensure that, if enacted, the ordinance supports good community mental health.
The conference was supported, in part, by the Robert Wood Johnson Foundation; The Kresge Foundation; and the Substance Abuse and Mental Health Services Administration, a division of the U.S. Department of Health and Human Services.
Adler Institute on Social Exclusion
The ISE was established in 2005 to advance the social justice mission of the Adler School. The ISE states its mission as seeking to create a socially inclusive society by building strategic alliances that work to ensure that all members of society benefit from safe housing, quality education and health care, fair terms of employment, nutritious food, personal safety, and judicial equity. The ISE works to dismantle the barriers that prohibit access to these essential rights, resources and opportunities by advocating for structural change in our society. The ISE pursues its mission through three areas of activity:
- Research to identify the structural origins of social disadvantage and to inform structural approaches to change;
- Community outreach to respond to community-identified needs; and
- Public Awareness to increase public understanding of how disadvantage is structured and the imperative for structural intervention
The Adler School of Professional Psychology (Adler School) was established in 1952 and is a private, not-for-profit intuition of higher education. With a commitment to continuing the work of the first community Psychologist, Alfred Adler, the Adler School hold the following values as core to our educational programs: social interest, compassion, justice, respect for the individual, honor for diversity and difference, intellectual rigor, optimism, collaboration and pragmatism. The school is an independent school of professional psychology, drawing students from North America and internationally.
Adler was among the first to document the impact of social conditions on population health. Adler’s first book, more than 100 years ago, described how social factors impact health and well-being. His book demonstrated how poor living and working conditions in 19th century Vienna caused health problems such as respiratory, infectious, and other diseases.
Lynn C. Todman, Ph.D. is the director of the Institute on Social Exclusion (ISE) at the Adler School of Professional Psychology in Chicago, IL. For more information on the ISE and the Adler School of Professional Psychology, please visit: