Introduction
With the arrival of World Mental Health Day on the 10th of October 2021 and the theme for this year being ‘Mental Health for All’, we are faced with the harsh reality of whether mental health truly is for ‘all’. Despite promising directions towards prevention, intervention and treatment of mental health, there is a recognised need to scale up the support and services offered worldwide.1,2 The COVID-19 pandemic has only increased this need and made it more urgent.3
In this week’s TVF blog, we will delve deeper into the inequalities surrounding mental health and the various factors contributing to it.
Determinants of Mental Health
Sociological tradition often focuses on class and status as the most prominent determinants of mental health, but recent research is generating a more complex picture that takes into account other politicised social variables such as: gender, sexuality, race and age.4
Gender and Sexuality
Gender differences in mental health are well documented in research. Mental health affects those who identify as men and women, but not in an equal measure. 5Internalising disorders, mainly characterised by anxiety and depression, are more prevalent in women, whereas externalising disorders such as substance abuse and antisocial or disruptive behaviour disorders, are more often reported in men.6,7 These patterns are not necessarily the result of innate differences between those who identify as men and women, but rather emerge from a range of subtle factors such as gender socialisation, coping mechanisms, and differences in the ability to seek help. There may also be gendered biases in the clinical assessment and measurement of mental health conditions, for example underestimating anxiety in men.7,8
Studies have found that the LGBTQIA+ community are negatively impacted by common mental health disorders. Young people aged 14-25 who identify as part of this community often experience several stressors resulting from the pressures of gender conformity in stigmatised societies in comparison to their cisgender and heterosexual peers.9 These stressors can put them at high risk for compromised mental health and psychosocial issues, including but not limited to: post-traumatic stress disorders, eating disorders, depression, and substance abuse.9,10
Race
Understanding racial disparities evident in mental health is also integral in tackling inequalities. Black, Asian and Minority Ethnic (BAME) groups are diagnosed with severe mental health disorders up to eight times more than White British people.11 Post-diagnoses, people from BAME backgrounds are often subjected to compulsory detention as psychiatrists are more likely to label them as a risk to society.12 Yet, the White Irish population report more instances of mental health disorders, with a significantly higher rate of suicide than any other racial group in the UK. These statistics are often ignored when analysing mental health inequalities.11,13
Age
Mental health issues are often associated with younger people. There is some justification for this: for example, more than a quarter of young women aged between 16-24 years old report having a common mental health problem in any given week, compared to 17% of all adults.14 However, mental health – in particular mood disorders – are also a significant problem for adults. In fact, studies have highlighted that due to biochemical and structural changes associated with ageing, adults may be considerably more vulnerable to developing mood disorders, with risk factors including: loneliness, bereavement, and physical health issues.15,16 In people aged 65+, and especially those above 80 years of age, the rate of experiencing depression is significantly higher than that of dementia.17
Raising awareness of inequalities
Inequalities need to be considered and addressed when assessing an individual’s mental health. Understanding the impact of demographics could improve the accuracy in diagnosing mental health disorders.18 It is important we raise awareness that 'Mental Health for All' adopts intervention strategies, which provide holistic support in order to target high risk social groups who struggle with mental illness.19
Access to Support
Recognising mental health inequalities is crucial, but is still only the first step towards addressing the problem at hand. There is also a strong need for widely available and easily accessible services to take account of these inequalities during screening.
Research has shown that young people from BAME backgrounds were twice as likely to be referred to mental health services through unconventional routes, for example through social care and community youth groups. In comparison, access to mental health services for White British young people were more likely to be voluntary and through primary care agencies e.g. GP referrals.20
Further barriers to accessing mental health services include a lack of financial resources and the dismissive attitudes of service providers. In addition, private counselling or therapy proves to be unreachable to those of lower socioeconomic backgrounds.21 85% of elderly people suffering with depression receive minimal NHS support, indicating a clear need for age-appropriate mental health services.22 Understanding the reasons for such referral disparity is key in not only reducing the inequalities associated with mental health but will also improve the pathways to greater access.
Hope for the Future
In recent years, evidence shows an increased public awareness of mental health issues and a reduction in social stigma.23 Closing the gaps in mental health inequality could be the next big challenge. To this end, the World Health Organisation (WHO) aim to share stories, videos and facts about the inequalities people affected by mental health are facing. The objective of the WHO for World Mental Health Day is to mobilise efforts worldwide to make mental health care a reality for all. The next step will be to translate this growing awareness into appropriate provision of services and treatments.
This global effort demonstrates the importance of communication in addressing mental health inequalities: raising awareness of the problems, but also helping to deliver solutions. Clear, relevant and accurate information – for both professionals and the public – enables better decision-making and can facilitate improved access.
TVF Are Here to Help!
Communication such as this is central to TVF’s work. Our medical and client services teams are experts in delivering disease awareness campaigns and medical education. Furthermore, our omnichannel strategies provide updated and relevant information to a wide range of specifically defined audiences. If you would like to know more about what TVF can do in all fields of healthcare communications, please do get in touch!
By Anisa Mohamed
