Let's talk about inequality and its impact on mental wellbeing
This week our social media feeds will light up with Bell Let’s Talk encouragement to collectively work on de-stigmatizing mental health issues by talking about it.
The more we talk about it, the more we de-stigmatize. The more we de-stigmatize it, the more we understand how prevalent mental health issues are: by the time we turn 40, half of all Canadians will have experienced a mental illness, according to a Mental Health Commission of Canada 2013 study, Making the Case for Investing in Mental Health Care.
In its follow up report, Strengthening the Case for Investing in Canada’s Mental Health System: Economic Considerations, the commission reports that the highest rate of mental health problems or illnesses is among Canadians in their 20s and about half of mental health issues likely begin in the teenage years.
But we also know mental health struggles have no age limit: the commission reports that 1.8 million Canadians over 60 live with a mental health condition.
Why do so many people suffer from mental health issues in such a well-off country like Canada? The social determinants of health point us to multiple and sometimes overlapping sources of mental health issues, such as the adverse consequences of income inequality, poverty, homelessness, food insecurity, and forced migration due to factors such as war and climate change.
In their latest book, The Inner Level: How More Equal Societies Reduce Stress, Restore Sanity and Improve Everyone’s Wellbeing, Richard Wilkinson and Kate Pickett point to the devastating effects that income inequality has on a society.
Pickett says “inequality eats into the heart of our immediate, personal world, and the vast majority of the population are affected by the ways in which inequality becomes the enemy between us. What gets between us and other people are all the things that make us feel ill at ease with one another, worried about how others see us, and shy and awkward in company—in short, all our social anxieties.”
Pickett and Wilkinson’s solution: “Empowering people to see the roots of their distress and unease not in their personal weaknesses but in the divisiveness of inequality and its emphasis on superiority and inferiority is a necessary step in releasing our collective capacity to fight for change.”
This Lancet article outlines a framework to address the social determinants of mental health, but the authors say it will require “a coordinated, truly global effort by governments, civil societies, and the private sector.”
Yes, that means public and private investments to create faster access to mental health services, better workplace mental health provisions, and early interventions for children. But it will also require more than simply treating the symptoms.
As Michael Marmot has written: “Why treat people and send them back to the conditions that made them sick? We need to treat people, but we need to address the issues that make people sick.”
The United Nations’ special rapporteur on health, Dainius Pūras, recommends that governments implement early childhood programs, quick intervention for disadvantaged children, as well as “policies to reduce inequality and exclusion, strengthen unionization of the workforce, and improve financial assistance to those in need.
“This would be the best ‘vaccine’ against mental illness and would be much better than the excessive use of psychotropic medication,” Pūras says.
There’s an economic case for tackling the root causes of mental health. The Conference Board of Canada estimates that depression and anxiety alone costs $49.6 billion a year in lost GDP. Investing in prevention and early interventions for children and youth would save the system about 25 per cent in cost savings, according to the Mental Health Commission of Canada.
But economic considerations aren’t the only reason to act. What if we use our annual “let’s talk” conversation to change the frame, beyond de-stigmatization? Are we ready for that next step?
This long read makes a compelling case for shifting the mental illness frame from the economic costs and loss of productivity to something more fundamental: the human right to freedom and dignity.
That approach aligns with New Zealand’s wellbeing budget approach, which explicity acknowledges personal and community wellbeing is a far better indicator of success than GDP growth. New Zealand’s wellbeing strategy includes a strong focus on investing in “the health and disability, social welfare, housing, education, and justice, sectors, as well as social determinants of health, such as housing, employment, poverty, social attitudes, and discrimination. It includes whether approaches to mental health and wellbeing are culturally appropriate.”
What would a wellbeing approach to mental health look like if Canada decided to become a leader in transformative change? That’s the conversation I’d like to have on Bell Let’s Talk day (January 29).
We hear a lot of “you’re not alone” expressions of solidarity on Let’s Talk social media channels, but if we really meant it, we would show that anyone experiencing mental health issues is not alone by transforming the system so we can get at the root causes—including inequality.
That’s a conversation I can get behind. Won’t you join me?
Executive Director, Upstream
Social determinants of mental health
Food insecurity: There is a strong correlation between food insecurity and poor mental health, according to PROOF. Read here.
Poverty wages: Raising the minimum wage can prevent suicide. Read here.
Homelessness: Finland’s solution to homelessness goes beyond giving the homeless a place to live—social workers are in the building. Read here.
Debt and stress: A new survey of Canadians by DUCA Impact Lab and Angus Reid shows a strong link between debt and stress. Read here. Amsterdam has a debt credit bank to buy out youth’s debt. Read here.
Social determinants of mental health primers: This resource from the National Collaborating Centre for Determinants of Health is a keeper. Read here. This short video connects the dots between policy decisions and mental health. Watch here.