Transcript PSYCHIATRY AT LARGE The social factors that drive mental health

PSYCHIATRY AT LARGE
The social factors that drive mental health
Apu Chakraborty
BA MB BS MA MRCPsych MSc PhD FRCPC
Medical Manager, Community Mental Health
HOpe Centre
Disclosures
Relationships with commercial interests:
•Unrestricted educational grants from Lundbeck & Lilly
Managing potential bias:
•The industry companies listed above were not involved nor
did they influence the content of this presentation
•The following content complies with the UBC CPD standards
A Model of the Determinants of Health
Social Determinants of Health
Aboriginal status
disability
early life
education
employment and working conditions
food insecurity
health services
gender
housing
income and income distribution
race
social exclusion
social safety net
unemployment and job security
Source: Raphael, D. (2009). Social Determinants of Health: Canadian Perspectives, 2nd
edition.
Toronto: Canadian Scholars’ Press.
Social Determinants of Health and the Pathways to
Health and Illness
Figure shows how the organization of society influences the living and working conditions we experience that then go on to shape
health. These processes operate through material, psychosocial, and behavioural pathways. At all stages of life, genetics, early life, and
cultural factors are also strong influences upon health.
Source: Brunner, E., & Marmot, M. G. (2006). ‘Social Organization, Stress, and Health.’ In M. G. Marmot & R. G. Wilkinson (Eds.), Social
Determinants of Health. Oxford: Oxford University Press, Figure 2.2, p. 9.
The “total drug effect”
patient
doctor
intervention
the room
the world
Working with ethno-cultural identity
and values

story of our connections to heritage, ancestors;
evolution of group identities as we migrate, organise,
reorganise

cultural/religious tradition shapes myths, beliefs,
organises perception of experience, determines limits of
behaviour

cultural identity is basic to self respect, core values

important for therapeutic work to acknowledge, and use
as source of resilience and strength
Services perceived
to be discriminatory
Distrust is fuelled
Avoidance
Poorer service-related outcome:
Police involvement,
Compulsory admissions
Poor medication adherence,
missed appointments,
disengagement from services
Thank you
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