Learn how social factors promote mental health, influence the onset and course of mental illness, and affect how mental illnesses are diagnosed and treated. This course explores how our understanding of mental health and illness has been influenced by social attitudes and social developments in North America and around the world. The course begins by situating our contemporary mental health practices in historical context, then looks at different aspects of mental health, mental illness and mental health services and their connections to what’s going on in our social environment.
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From the course by University of Toronto
The Social Context of Mental Health and Illness
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From the lesson
What is mental health and what causes mental illness?
Meet the Instructors
Charmaine WilliamsAssociate Professor
Faculty of Social Work
Okay. So I assigned a paper for this week that
was called colonialism as a broader social determinant of health.
I hope you had the chance to read it because I think it's actually a great
application of the social determinants of health framework, both so that you
understand how it works in its narrow sense but also what kind of thinking you
need to do to be able to address some of the issues that I raised at the end of
the last segment. So I realized that not all of you are
necessarily going to be familiar with the history of indigeneous people in Canada.
Unfortunately it has been a history that has been replicated many places so if you
have read the paper then perhaps even if you're from other parts of the world you
will, you will have heard about similar
processes where you are. Basically since the time of English and
French settlement here in Canada, there has been a long term
there has been a long term process of colon, colonialism in Canada that has
meant that indigenous peoples are largely controlled by the government.
And in its earlier phases this was manifested in things like people being
removed from their land. And and then later it morphed into things
like un, large scale attempts at assimilation
which had communities being disrupted, families being disrupted children being
taken away from their families so that they could be schooled to be proper
Canadians in a things that we call residential schools where a lot of,
of very unfortunate and damaging and traumatizing practices took place, and
then later on, even though the residential schools are no longer, they
eventually went away, not as, not as long ago as you might think, but they did
eventually go away. then what happened was a lot of child
welfare involvement that had children being removed from their families and
placed in non, non-aboriginal, non-indigenous families and, and really
in a big picture through many processes at many different levels that are
described in this paper indigenous people in Canada have been separated from each
other, from their cultures, from their language, from their ways of life, from
the ability to be educated and employed, etcetera, etcetera, etcetera.
It goes on and on. And so I, I really liked his paper
because like I said it, it talks about the social determinates of mental health
but then also talks about this broader context that also contributes to that to
those social determinants and it really reminded me of some of the work that I
had refer to in the first lecture by Frantz Fanon who wrote about colonialism
in the context of Algiers. And he talked about, he wrote about how
the experience of colonialism has this incredibly damaging effect on the psyche
of people who were colonized, the effects of systemic racism, the effects of the,
the erasure of identity and that identity not being valued and in fact, that
identity being denigrated, the effects of everyday violence and aggression against
a group of people by people that have control over them that this has effects
not only in the immediate moment but from many generations and I think this is,
this is something that helped us understand what is happening with our
indigenous people in Canada as well. So I, I thought that they were actually
be a great way to sort of think about how social determinants of health play out.
So, that's what we're going to be doing in this segment but if you are interested
in writing about colonialism and its effect on mental health, then I would
really recommend going to Frantz Fanon where I think it started it has certainly
been taken up by others and two books that I would recommend and I'll put them
in the resource list are Black Skin White Masks.
I just realize that I have two copies of Black Skin White Masks.
Oh, [LAUGH] it's that good I have two copies and then this other one the
Wretched of the Earth. These are the ones that that I would
recommend and there is lot of other writing but unfortunately its not
available in English. So those of you that speak French
probably have access to even more interesting stuff.
With that let's turn to what what we learn about in this paper.
So the Canadian document on social determinants of health clearly names
aboriginal status as a social determnant. Aboriginal status refers to be identified
as a person and recognized by the federal government of Canada as being of first
nations maite or inuite origins. to get aboriginal status, people have to
be registered with the government. So this is one of the ways, one of the
very tangible ways in which colonialism continues to exist for indigenous peoples
in Canada. Because of all the intrusion in
indigenous communities and families, it's not always an easy thing to determine
whether or not you have this status. And there are all kinds of privileges and
problems that are associated with it. So that's a whole other discussion but in
noting the use of the term aboriginal status here I want to signal that this
may be referring to people who have the official government status or it may be
more widely applicable to people who are socially associated with indigenous
groups in Canada but don't necessarily have the government paperwork that
demonstrates that. I've already cautioned you against
reading the inclusion of aboriginal status here as a suggestion that being
aboriginal predisposes people to ill health or poor health outcomes.
again it is the social process and conditions associated with aboriginal
status that are implicated in the health and health outcomes and this is what, I
think your paper made so clear. The mental health outcomes of concern in
indigenous in Canada's are the ones you see here.
There are high rates of mental illness and suicide in aboriginal communities
particular among young people. We also see a lot of alcohol and
substance use problems and these are grouped under mental disorders.
There's also a very commonly overlap between mental illness and substance use
problems. I've also included family problems here
because indigenous peoples are disproportionately represented in the
caseloads of child welfare agencies. And the type of family disruptions that
lead to and result from child welfare involvement has mental health
consequences as well. Now [UNKNOWN] names familiar social
determinants that are linked to those health outcomes.
We see here low education and unemployment as an issue.
Under housing and homelessness. We commonly see housing.
And certainly dangerous physical environments.
You may have noticed in the paper that she tells you that some of these reserve
spaces are, are dangerous places to be in and that there are several of them that
don't even have drinkable water available so we're talking about a very salient
experience of danger and risk in those physical environments.
The other thing that I have here is trauma and violence because trauma and
violence is something that we see affecting indigenous communities both
from the inside and the outside and this create, creates environments that of
course, have an effect on people's mental health.
But this paper wants us to understand that looking at just these immediate
social determinants is too shortsighted of view.
It's actually a demonstration of how the social determinants can be limited in
terms of not taking into account. The full range of determinants that
effects specific populations. If we want to understand the determinants
of mental health in indigenous communities, she suggested that you need
to start with colonialism. You need to recognize that colonialism is
this overarching, organizing policy that started in continuous to orchestrate the
processes that eventually lead to those negative social determinants of health.
Colonialism and its operation of things like systemic racism, cultural genocide.
Here I'm referring to the assimilation processes that interrupted culture,
language and family ties. community and family disruption as I've
already mentioned and then also the removal of self determination.
These are all strategies or tactics that are part of colonialism.
And colonialism essentially puts control in other people's hands.
It has consequences for those social determinants.
So, if you look at all of these things, the systemic racism, the cultural,
genocide, the disruption, and the lack of self-determination, all are connected to
the things that we are identifying as social determinants of health here in
this row. If we keep moving on,
one of the consequences of having no self determination is that there are not
appropriate services to address the problems that are promoting ill health.
In the paper the author refers to an ecocentric approach that is consistent
with indigenous perspectives. There are others of course but the
removal of self determination has meant that this has not been available to
indigenous peoples. What has been available are services that
are inappropriate and at times actually harmful.
When we get to the lecture on culture and mental health, I'll be, I'll be talking
more about the work that indigenous people around the world have done to
address the harm that has been inflicted by health and mental health services and
the need to develop the services that are culturally safe.
your paper does refer to this a bit in terms of how there has been an accepted
discourse around the idea of the depressed Indian, the disordered Indian,
the the addicted Indian. These are all parts of the type of,
of harm, of harm that we see resulting from inappropriate services and frankly
services that are actually dangerous in some ways to certain communities.
In the absence of these culturally safe services or even a belief that there is a
need for culturally sensitive services, it means that people do not get the help
they need for either health problems or for the conditions that lead up to health
problems like the ones that we see here. This isn't addressed in your article but
I have added oppression related stress as a negative health code outcome that
results from colonialism as well. Literature in this area has been mostly
developed around racism in the context of the United States.
and the thing is that what that literature talks about is how it's not
just that the, the exposure to explicit, violent, and over racism that takes a
toll on people. But the daily exposure to what they refer
to as microaggressions, small acts and experiences, small everyday acts and
experiences that reinforce your status as a person that is not valued or that is
even held in contempt. These microaggressions have a cumulative
effect that materializes in things like cardiovascular disease and mental
illness. Indigenous people certainly face what we
could call racism related stress but because it's in the context of this wider
experience of colonialism, it's much bigger than just racism, so I name it as
a pressure related stress here. I suppose you could also call it
colonialism related stress. Finally, I want to mention that as well
has having as well as these determinates having an effect on mental health they
have an effect on physical health. Indigenous communities have higher rate
of infection, injury, chronic disease. It's not surprising of course that things
that negatively affect mental health also have an affect on physical health.
This may be hinting at that false division between mind and body that I
mentioned earlier. So, there are these physical health
outcomes that take, to take into account. And they also have mental health
consequences. As there is a lot of co-morbid anxiety
and depression with physical illnesses. Another consideration is the mental
health consequences for caregivers of people with mental and physical
disorders. Caregivers can experience high levels of
psychological distress, depression, anxiety, and their own physical health
consequences as a result of it being in the caregiver role and of course we'll
talk about that when we get to the lecture on families.
So, why are some people mentally healthy and why is it harder for some other
people to stay mentally healthy? I hope that thinking through the
situation that's described in your paper helps you see that there's definitely a
connection between the social environment that people are in and their health.
It, it has to do with attitudes, it has to do with tensions.
It has to do with the level of violence and trauma.
It has to do with things like whether you have drinking water, and you, what you
have to go through to get it. All of that has an effect on people's
health. Both physical and mental.
But what that paper also shows us so well is that there are broader issues that are
also implicated. That it doesn't just stop or start at
this place of well, if you have the right kind of housing, if you have the right
kind of education, employment and all that, that if all these things are in
place then your chances of being healthy are much better.
That's certainly true but there are things that promote and undermine the
ability to have those things in place. And that's what I think that paper
demonstrates so beautifully and so unfortunately.
So, we've talked now quite a bit about how the social context affects mental
health. But how is it that, that social context
somehow turns into something that affects the way that your brain is functioning or
effects the way that you're feeling and behaving and, and thinking.
what we're going to try to do is answer that question by looking at the bio
physchosocial perspective and seeing if it can give us some answers.
That's coming up next.
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