A Deconstruct of Mental Health Issues: My Journey Through MHST601

Throughout my journey in MHST601, I reflected on facets of mental health specifically related to the course units of social determinants of health, vulnerable populations, multilevel models of health, vulnerable populations and future directions of health. I drew upon my experience as a Registered Social Worker on inpatient mental health units to conceptualize how these frameworks impact direct patient care and the overall health care system. Recognizing my role as a Registered Social Worker, and how my professional identity impacts my work was of significant importance throughout the course. This allowed for me to deconstruct and analyze issues throughout a diversity of constructs, overall, grasping a new level of understanding and knowledge towards critical foundations in health disciplines.

Social Determinants of Health

The Government Of Canada identifies 12 main determinants of health as, “a broad range of personal, social, economic and environmental factors that determine individual and population of health.” (Government of Canada, n.d.).Of the determinants discussed throughout this unit, gender, culture, race, income, education level, and childhood experiences effect patient trajectory and contribute towards patients being exposed to health inequalities. Examples on inpatient mental health units I recognized are inability to obtain identification, misdiagnosis, lack of available mental health supports, and racism. Much like a disease being modifiable with medication, social determinants of health are also examples of modifiable factors which may lead to improvements for patients and subsequently contribute toward prevention of mental health issues. (Sederer, 2016).

Compton, M.T., & Shim, R.S. (2020). Why Employers Must Focus on the Social Determinants of Mental Health. American Journal of Health Promotion, 34, 215 - 219.

Within course forums, discussions identified how leaders in Canadian health care have progressively acknowledged requirements for a social determinants of health approach for minimizing demand and improving overall sustainability of the Canadian health system. Furthermore, themes amplified in the course echoed how significant strides have been made with regard to awareness and importance of health inequities; albeit, throughout collaboration with my peers, I began to query with the broad scope of Canada’s social determinants of health, are we as a country minimizing potential for fortitude if combined.

Chronic Disease

Previously, I conceptualized mental health as a chronic disease itself; however, throughout my journey I was enlightened how mental health is not immune to coexistence with chronic disease. Specifically, type 2 diabetes as a chronic disease is highly related to schizophrenia (Mizuki et al., 2021).This is correlated to antipsychotic medications used to treat schizophrenia contributing to metabolic syndrome (Mizuki et al., 2021).Moreover, patients with schizophrenia are more likely to live sedentary lifestyles increasing chances for comorbidities to present (Bresee et al., 2010).

Furthermore, throughout the Chronic Disease unit, my perspective expanded to recognize a strong link between depression and physical health exists; especially as it relates to occurrence, course and treatment of chronic disease. As per Perry et al. (2010) depression has been shown to, “affect the occurrence, treatment, and outcome of several chronic diseases and conditions, including heart disease, diabetes, hypertension, cancer, and obesity” (p. 2337). In addition to schizophrenia, depression is related to certain risk behaviors, including physical inactivity, smoking, drinking, and insufficient sleep; subsequently increasing likelihood of occurrence for chronic disease (Perry et al., 2010).

Chen, C. Y. A., Goh, K. K., Chen, C. H., & Lu, M. L. (2021). The Role of Adiponectin in the Pathogenesis of Metabolic Disturbances in Patients With Schizophrenia. Frontiers in Psychiatry, 11(January), 1–11. https://doi.org/10.3389/fpsyt.2020.605124

Chronic disease prevention and maintenance strategies which may support individuals living with schizophrenia and additional mental health issues such as depression should involve multi-faceted public health measures. When we omit evaluation of comorbidities which exist in our healthcare system, we contribute toward increasing chances of re-hospitalization. This dichotomous view of healthcare only invalidates and places our patients at greater risk for deterioration upon discharge and throughout their trajectory.

Vulnerable Populations and The Social Ecological Model

With regard to vulnerable populations, I chose to reach outside of my comfort zone and focus on an issue with a recent media presence in Calgary. On February 19th, 2022, a Sudanese refugee was killed by a Calgary Police Service (CPS) member. This individual experienced mental health issues when the CPS officer deployed their weapon (Herring, 2022). It is unfortunate when tragic situations occur and subsequently become catalyst for conversation around deficiencies of mental health supports for our refugees. When associated with mental health, refugees experience limited access and many barriers to support contributing towards solidifying of inequities within Canadian society. In 2019, Canada displayed itself as world leader with regard to resettlement of refugees; ranking number one among 26 countries. (UNHCR, 2022). Notwithstanding Canada’s inclination to receive refugees and encourage resettlement process, refuges still experience discrimination and deterioration of mental health due to racism and traumatic experiences.

Initially I chose to analyze Intimate Partner Violence (IPV) with the Social Ecological Model (SEM). As a reflection of my growth, change in perspective, and course learnings I opined to re-examine refugee mental health within the SEM for this specific assignment. Numerous factors guide refugees’ access to mental health care in Canada, particularly those conceptualized within a SEM. Pre-settlement trauma may predict mental disorders and PTSD; however, post-settlement context and environment may powerful as a determinant of mental health. Moreover, post-settlement factors may moderate ability of refugees to recover from pre-settlement trauma (Hynie, 2018). Pre and post settlement trauma is an example of how individual level of the SEM impacts refugee population, as this trauma may impede with ability for refugees to access care (Jannesari et al., 2020). Furthermore, mental health care in Canada for refugees is impacted on the relationship and community level of the SEM, as refugees may be inhibited by lack of translators or use of inappropriate translators such as friends and family, or male interpreters for women’s sexual health services (Jannesari et al., 2020). With regard to the organization and policy level, refugees are required to engage in a settlement process associated with stressors. Refugee applicants often are faced with awaiting a preliminary acceptance of their claims prior to accessing any kind of employment, let alone a temporary permission for employment (Hynie, 2018). As a reflection, refugees may spend months or even years without access to gainful, legal employment, increasing their vulnerability towards obtaining permanency (Hynie, 2018).

Combination of experiences within the SEM in addition to prevalence and re-occurring nature of social determinants of health are suggestive Canadian refugees are a vulnerable population which experiences multifaceted and multilayered barriers to accessing mental health care. My engagement in this course has amplified my passions as an RSW to work to deconstruct imbalances of power and systemic exclusionary characteristics of polices.

Hynie, M. (2018). The Social Determinants of Refugee Mental Health in the Post-Migration Context: A Critical Review. Canadian Journal of Psychiatry, 63(5), 297–303. https://doi.org/10.1177/0706743717746666

Any attempt to deconstruct these barriers should be addressed with all levels of a SEM, displaying a collaborative approach to the domain of reconciliation and refugee asylum of which Canada humbly attributes towards its’ identity. By choosing to use a multilevel approach to analyze mental health issues for Canadian Refugees, I was able to further understand how multilevel and comprehensive interventions are critical when enacting social change.

Future Directions

Provincial programing has rapidly pivoted our practices to telepsychiatry interventions to support individuals throughout COVID 19 pandemic (Roberts et al., 2021). While telepsychiatry may increase availability of programing for some individuals, it has a complex success rate as there are many barriers to a successful uptake (Husain et al., 2021). When engaging in this course unit, I was able to contemplate how telepsychiatry may benefit vulnerable populations and queried the specific relationship towards remote indigenous communities and refugee population. At baseline, many remote indigenous communities and refugee populations may not have access to direct onsite mental health care; therefore, availability of telepsychiatry may benefit. However, these communities require access to equipment and internet to support with these initiatives, in addition to required education to increase competency. Language and cultural appropriateness may also be required before we assume this incredible development in telepsychiatry is beneficial for all. Specifically,

Remote care methods have improved access to care for many during a time of widespread physical distancing, they also present critical issues of accessibility and equity for disadvantaged groups who may not have reliable access to telephone and/or internet, or a private space to attend appointments. (Ceniti et al., 2022, p. 10)

Arriagada, P., Hahmann, T., & O’donnell, V. (2020). Perceptions of safety of Indigenous people during the COVID-19 pandemic Data to InsIghts for a Better CanaDa. 45280001. www.statcan.gc.ca

Although initially I assumed telepsychiatry may be a groundbreaking solution for delivering psychiatric services, reflection upon my course learnings specific to the SEM, social determinants of health, and vulnerable populations led me to conclude telepsychiatry is not a panacea and requires careful consideration for appropriateness depending on client needs, provider capability, confidentiality, and standards for ensuring optimal outcomes for patients and recognition of social determinants of health which may impede one’s ability to engage with telepsychiatry care. (Madigan et al., 2020). Reflection on these course theories allowed me to view new perspectives and identify how despite increase in access and ability to maintain mental health supports in periods of lock down, telepsychiatry may also be inappropriate for vulnerable populations with serious mental illness (e.g., active psychosis) who require in-person services to mitigate acute risk, or in situations in which a high degree of confidentiality is critical for accurate disclosure (e.g., domestic violence) (Zhou et al., 2020).

Overall, as a Registered Social Worker, I am a change agent with a desire to gain trust from vulnerable populations; primarily, those who are experiencing addiction and mental health issues. Throughout my engagement in this course, I was able to further establish my professional identity by reflecting on course participation and contributions enabling me to identify myself as a systemic ally in my front line practice; all the while, recognizing how social determinants of health and impacts of chronic disease may negatively influence successful health outcomes among people who are most marginalized in society. I have developed skills to address mental health issues from the Social Ecological Model and become aware of vulnerable populations in addition to the future directions for mental health and how they are contributory factors for successful patient outcomes. Throughout my course journey I have grown exponentially.

References

Arriagada, P., Hahmann, T., & O’donnell, V. (2020). Perceptions of safety of Indigenous people

during the COVID-19 pandemic Data to InsIghts for a Better CanaDa. 45280001. www.statcan.gc.ca

Bresee, L. C., Majumdar, S. R., Patten, S. B., & Johnson, J. A. (2010). Prevalence of

cardiovascular risk factors and disease in people with schizophrenia: A population-based study. Schizophrenia Research, 117(1), 75–82. https://doi.org/10.1016/j.schres.2009.12.016

Ceniti, A. K., Abdelmoemin, W. R., Ho, K., Kang, Y., Placenza, F., Laframboise, R., Bhat, V.,

Foster, J. A., Frey, B. N., Lam, R. W., Milev, R., Rotzinger, S., Soares, C. N., Uher, R., & Kennedy, S. H. (2022). “One Degree of Separation”: A Mixed-Methods Evaluation of Canadian Mental

Health Care User and Provider Experiences With Remote Care During COVID-19. Canadian

Journal of Psychiatry, 1–11. https://doi.org/10.1177/07067437211070656

Chen, C. Y. A., Goh, K. K., Chen, C. H., & Lu, M. L. (2021). The Role of Adiponectin in the

Pathogenesis of Metabolic Disturbances in Patients With Schizophrenia. Frontiers in Psychiatry, 11(January), 1–11. https://doi.org/10.3389/fpsyt.2020.605124

Compton, M. T., & Shim, R. S. (2020). Why Employers Must Focus on the Social Determinants of

Mental Health. American Journal of Health Promotion, 34(2), 215–219. https://doi.org/10.1177/0890117119896122c

Government of Canada. (n.d.). Social determinants of health and health inequalities. Retrieved

February 9, 2022, from https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html

Husain, M. O., Gratzer, D., Husain, M. I., & Naeem, F. (2021). Mental Illness in the Post-

pandemic World: Digital Psychiatry and the Future. Frontiers in Psychology, 12(April), 10–13. https://doi.org/10.3389/fpsyg.2021.567426

Hynie, M. (2018). The Social Determinants of Refugee Mental Health in the Post-Migration

Context: A Critical Review. Canadian Journal of Psychiatry, 63(5), 297–303. https://doi.org/10.1177/0706743717746666

Jannesari, S., Hatch, S., Prina, M., & Oram, S. (2020). Post-migration Social–Environmental

Factors Associated with Mental Health Problems Among Asylum Seekers: A Systematic Review. Journal of Immigrant and Minority Health, 22(5), 1055–1064. https://doi.org/10.1007/s10903-020-01025-2

Madigan, S., Racine, N., Cooke, J. E., & Korczak, D. J. (2020). COVID-19 and telemental health:

Benefits, challenges, and future directions. Canadian Psychology, 62(1), 5–11. https://doi.org/10.1037/cap0000259

Mizuki, Y., Sakamoto, S., Okahisa, Y., Yada, Y., Hashimoto, N., Takaki, M., & Yamada, N.

(2021). Mechanisms Underlying the Comorbidity of Schizophrenia and Type 2 Diabetes Mellitus. International Journal of Neuropsychopharmacology, 24(5), 367–382. https://doi.org/10.1093/ijnp/pyaa097

Perry, G. S., Presley-Cantrell, L. R., & Dhingra, S. (2010). Addressing mental health promotion in

chronic disease prevention and health promotion. American Journal of Public Health, 100(12), 2337–2339. https://doi.org/10.2105/AJPH.2010.205146

Roberts, C., Darroch, F., Giles, A., & van Bruggen, R. (2021). Plan A, Plan B, and Plan COVID-

19: adaptations for fly-in and fly-out mental health providers during COVID-19. International Journal of Circumpolar Health, 80(1). https://doi.org/10.1080/22423982.2021.1935133

Sederer, L. I. (2016). The social determinants of mental health. Psychiatric Services, 67(2), 234–

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UNHCR. (2022). www.unhcr.ca/in-canada/refugee-statistics/. Refugee Statistics.

https://www.unhcr.ca/in-canada/refugee-statistics/

Zhou, X., Snoswell, C. L., Harding, L. E., Bambling, M., Edirippulige, S., Bai, X., & Smith, A. C.

(2020). The Role of Telehealth in Reducing the Mental Health Burden from COVID-19. Telemedicine and E-Health, 26(4), 377–379. https://doi.org/10.1089/tmj.2020.0068