Chapter 2-2: Social Determinants of Behavioral Health

The social determinants of health are well-known.  There really are some things that all of us need in order to live and be well.  According to the World Health Organization:

'Poor social and economic circumstances affect health throughout life. People further down the social ladder usually run at least twice the risk of serious illness and premature death as those near the top. Nor are the effects confined to the poor: the social gradient in health runs right across society, so that even among middle-class office workers, lower ranking staff suffer much more disease and earlier death than higher ranking staff.' 

'Both material and psychosocial causes contribute to these differences and their effects extend to most diseases and causes of death. Disadvantage has many forms and may be absolute or relative. It can include having few family assets, having a poorer education during adolescence, having insecure employment, becoming stuck in a hazardous or dead-end job, living in poor housing, trying to bring up a family in difficult circumstances and living on an inadequate retirement pension.' 

'These disadvantages tend to concentrate among the same people, and their effects on health accumulate during life. The longer people live in stressful economic and social circumstances, the greater the physiological wear and tear they suffer, and the less likely they are to enjoy a healthy old age.'

Social determinants of health: the solid facts (2nd ed.) p. 10 (Wilkinson, R. & Marmot, M. eds. 2003), http://www.euro.who.int/__data/assets/pdf_file/0005/98438/e81384.pdf.

Here is how this plays out - as a practical matter - in behavioral health.  In behavioral health demographics, adverse life experiences are nearly universal. An estimated ninety (90!) percent of those in the public mental health system are ‘trauma survivors.’ We have grown up without reliable access to same basic needs that the United Nations recognized as essential over six decades ago. Universal Declaration of Human Rights, http://www.un.org/en/universal-declaration-human-rights/

The same applies to the other so-called ‘problem’ groups in our society.  Yep, ninety (90!) percent or more of us in substance use, criminal justice, and homeless settings are ‘trauma survivors’ as well.
This is not just about individual needs, but also family needs and the needs of entire communities. These issues affect all of us across demographics.

Don’t believe it?  Check out the following:

• National Association of State Mental Health Program Directors (NASMHPD), The Damaging Consequences of Violence and Trauma: Facts, Discussion Points, and Recommendations for the Behavioral Health System (2004)., http://www.nasmhpd.org/content/damaging-consequences-violence-and-trauma-facts-discussion-points-and-recommendations.
• National Council for Behavioral Health (Breaking the Silence: Trauma-informed Behavioral Healthcare (2011), https://www.thenationalcouncil.org/wp-content/uploads/2012/11/NC-Mag-Trauma-Web-Email.pdf.
• Nadine Harris, MD, How Childhood Trauma Affects Health Across a Lifetime (TED Talk), https://www.ted.com/talks/nadine_burke_harris_how_childhood_trauma_affects_health_across_a_lifetime?language=en. 
• Substance Abuse and Mental Health Administration, SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach SAMHSA (2014), http://store.samhsa.gov/product/SAMHSA-s-Concept-of-Trauma-and-Guidance-for-a-Trauma-Informed-Approach/SMA14-4884.
• The School of Life, Sanity of Madness (1/18/2016), https://www.youtube.com/watch?v=tYfQSyDuriA&feature=youtu.be.

Yet, for all the fanfare about the need for more ‘trauma-informed care,’ there has been little systemic response directed toward basic human needs.  Equally disturbing, behavioral health system involvement has become an independent, exacerbating source of harm for many.

The results speak for themselves.

Resources:

Boisvert CM, Faust D  (2002) Iatrogenic symptoms in psychotherapy: A theoretical exploration of the potential impact of labels, language, and belief system. Am J Psychother. 2002;56(2):244-59

Cassani, M (August 9, 2014)  Treatment resistant mental illness? or Iatrogenic (drug-induced) illness?, https://beyondmeds.com/2014/08/09/treatment-resistant-mental-illness-or-iatrogenic-drug-induced-illness/ (and resources cited therein)

National Council on Disability (January 20, 2000), From Privileges to Rights: People Labeled with Psychiatric Disabilities Speak for Themselves, http://www.ncd.gov/rawmedia_repository/21553992_2d13_4dcb_a1c4_ee6c9e9434e8.pdf