Critical environmental and social determinants of mental health problems and their care

Susie Burke, Joanne Enticott, Anton Isaacs, Graham Meadows, Sebastian P. Rosenberg

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There are things to celebrate as the twenty-first century unfolds. Prior to the COVID-19 pandemic, the size of all global economies combined had increased roughly ninefold in the last 50 years and doubled in the last 20 years (World Bank, 2019a). The proportion of the world that lives in extreme poverty has been progressively going down. Most of the world’s population now lives in middle rather than low income countries, with the greater resource access this implies. Nationally, in the two decades that form the span of the four editions of this text, Australian GDP in current per capita US dollars has increased from $22 000 per capita to $54 000 per capita, and mental health expenditure has more than doubled in that time. In health broadly, smallpox is an increasingly distant memory and the eradication of polio may be in sight. The great majority of children receive at least some immunisation protection and many more of them survive through to their first, fifth or later birthdays than used to be the case (Rosling, Rosling, & Rönnlund, 2018). But the start of the twenty-first century is also a time of inexorable accumulation of evidence, with wider and wider recognition, that the Earth as a whole has not simply buffered the changes that expansions of human activity have brought about. Human societies over time have on many occasions compromised their local or regional environments with sometimes severe consequences for particular societies (Diamond, 2011) but this task of facing up to the current challenge of ecological disruption on a planetary scale is newer. Presenting as it does a source of existential threat to humanity as well as a source of specific impacts on individuals and communities. In this chapter, we will provide consideration of climate change, its implications for mental health and mental health care. Of course, climate change is not the whole story as regards societal or service delivery considerations for mental health care. Beyond the impact of the pandemic, a wide range of environmental and social determinants need to be considered in social policy and in understanding the influences on individual or family presentations. Over time the UN has provided influential direction as to how to consider understanding and address such issues and our next section summarises some key UN statements. A critical influence here is that the material advances and health gains or improvements in service provisions have not been shared equally around either between or within countries—in ways that particularly have changed since the 1980s. In recent years the recognition of this has involved economist writers such as Thomas Piketty (Piketty & Goldhammer, 2017) demonstrating how things have turned around. A period in which many inequalities reduced up until the 1980s has been followed by several decades of increasing disparities. The ascendant monetarism or neo-liberalism of the 1980s and forward led to the taking away of many safeguards against inequities within societies and the relative gap between rich and poor has widened since in many nations (Piketty & Goldhammer, 2017; Milanovic, 2016). So as we move on through the chapter to consider the role of social determinants in mental health, illness and disorder (see Chapter 1.2), and responses to these problems, we also will consider the role that increasing inequality and inequity, things that in turn may be exacerbated by climate change, play as influences on mental health, wellbeing and illness, and to what extent policy and other interventions either work to balance inequality and inequity, or not.
Original languageEnglish
Title of host publicationMental Health and Collaborative Community Practice
Subtitle of host publicationAn Australian Perspective
EditorsGraham Meadows, John Farhall, Ellie Fossey, Brenda Happell, Fiona McDermott, Sebastian Rosenberg, Vrinda Edan, Meinda Epstein, Hamilton Kennedy, Cath Roper
Place of PublicationAustralia
PublisherOxford University Press
Number of pages21
ISBN (Electronic)9780190309923
ISBN (Print)9780190309916
Publication statusPublished - 5 Nov 2020

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