PSYCHIATRY AT LARGE The social factors that drive

PSYCHIATRY AT LARGE The social factors that drive mental health Apu Chakraborty BA MB BS MA MRCPsych MSc Ph. D 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, 2 nd 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 apu. chakraborty@vch. ca