In this season of New Year’s resolutions, perhaps we should resolve to improve things for the nearly 20% of Americans who experience mental illnesses and the more than 8% with substance use disorders. Mental illnesses are as disabling as cardiovascular diseases and cancers, and may be just as fatal. People with mental illnesses are more likely to die younger from commonly occurring physical health problems. Mental health inequities are rampant. Not only is the mortality risk higher, but among certain population groups, illnesses are more prevalent and more severe, and access to mental health services is still quite limited.
But how much progress are we making on a societal level? Consider some of the big issues our country faces: violence, homelessness, unemployment, mass incarceration, food insecurity, poverty, income inequality. Each is a major contributor to the physical and mental health problems that are experienced by large segments of the population as a whole. We have yet to successfully address any of them. Multiple research studies have supported the idea that mental illnesses, and mental health inequities, are driven by the social determinants of health– how we live, grow, work, and age impact our health and well-being.
Take, for example, adverse childhood experiences, which has been extensively studied and discussed in detail in a series of posts on this blog. Children who experienced abuse, neglect, and a host of other negative events grow into adults with higher rates of a number of physical and mental health problems, including chronic obstructive pulmonary disease (COPD), heart disease, liver disease, depression, and substance use disorders. Adverse childhood experiences also increase the odds of engaging in high-risk behaviors, such as early initiation of smoking, early initiation of sexual activity, and teen pregnancy. These high-risk behaviors increase the chances of someone developing serious physical and mental disorders as they age. In fact, the risk of attempting suicide in adulthood increases exponentially with the increasing number of adverse childhood experiences.
We also know what works; creating healthy neighborhoods, subsidizing and increasing access to healthy foods, providing a living wage and viable employment opportunities, decreasing income inequality, and protecting and nurturing our nation’s children. Programs and interventions that cultivate these values prevent mental illnesses and substance use disorders before they ever begin. Highly successful examples include nurse home visits to pregnant mothers, early childhood education, and programs like Health Leads and Medical-Legal Partnerships. There is no shortage of efforts that prove that targeted investments really work. Some state and local governments have made great strides in this area through the work of committed leaders who understand the importance of social determinants of mental health (and Philadelphia is leading the charge).