Social Determinants of Health and Mental Health (II): Evaluation, Political Perspectives and Global Implications – Psychiatric Times

Report on Social Determinants of Mental Health and Alignment with Sustainable Development Goals

1.0 Introduction: Integrating Mental Health into the Global Agenda

This report analyzes the critical role of Social Determinants of Mental Health (SDMH) and their alignment with the United Nations Sustainable Development Goals (SDGs). It outlines a comprehensive framework for addressing mental well-being through integrated healthcare, policy reform, and collaborative research, emphasizing the interconnectedness of social, economic, and environmental factors in achieving global health equity.

2.0 A Multidisciplinary Approach to Healthcare Delivery

Achieving SDG 3 (Good Health and Well-being) requires a shift towards a holistic healthcare model that integrates social care. A multidisciplinary team approach is essential for a comprehensive assessment of patient needs.

• Role of Social Workers: Social workers are vital team members who can address fundamental social determinants that clinicians identify but cannot manage alone. Their inclusion as well-trained and compensated professionals supports SDG 8 (Decent Work and Economic Growth).
• Social Prescribing Model: This model connects patients with community resources to address non-medical needs. This directly supports:
  1. SDG 1 (No Poverty) and SDG 11 (Sustainable Cities and Communities) by connecting individuals with housing agencies.
  2. SDG 2 (Zero Hunger) by linking patients to food access programs like Meals on Wheels.
• Clinician’s Role: The psychiatrist acts as the team leader, identifying issues like trauma and homelessness to inform a comprehensive, resilience-focused treatment plan.

3.0 Policy Reform and Advocacy for Systemic Change

Addressing SDMH requires systemic change through targeted policy action at multiple levels, directly contributing to SDG 10 (Reduced Inequalities) and SDG 16 (Peace, Justice and Strong Institutions).

3.1 Levels of Intervention

• Individual Level: Focuses on immediate needs such as transportation and internet access.
• Public/Policy Level: Aims to tackle systemic issues like discrimination (racism, sexism, ageism), income inequality, and social injustice.

3.2 Strategy for Policy Implementation

1. Collaborative Advocacy: Progress, such as the Mental Health Care Parity law, demonstrates the power of partnerships. This approach embodies SDG 17 (Partnerships for the Goals), requiring collaboration between medical associations (e.g., APA, AMA) and non-medical organizations.
2. Public Education: Informing the public is crucial for building support for policy changes, aligning with targets in SDG 4 (Quality Education).
3. Phased Implementation: A strategic approach is recommended, starting with achievable changes at the local and county levels before scaling up to state, national, and international arenas.

4.0 The Impact of Globalization, Migration, and Technology

Modern global trends present both opportunities and challenges for mental health, influencing progress toward multiple SDGs.

4.1 Globalization and Migration

• Negative Consequences: While globalization has made the world smaller, it has also intensified competition and contributed to a “loneliness pandemic,” undermining SDG 3.
• Acculturative Stress: Migration, a key component of globalization, introduces acculturative stress as a powerful social determinant. Addressing the needs of migrant populations is critical for achieving SDG 10. Positive adaptation requires the establishment of social connections and mutual learning between migrant and host cultures.

4.2 Technology and Artificial Intelligence

• Dual Impact: Technology, a driver of SDG 9 (Industry, Innovation, and Infrastructure), has a paradoxical effect. Social media can create superficial connections and increase loneliness and suicide risk, particularly among youth.
• Potential for Good: Conversely, technology can help older adults maintain social connections. Artificial Intelligence (AI) presents a significant opportunity to transform healthcare and could be leveraged to promote well-being.

5.0 Future Directions for Research and Intervention

Advancing the understanding and management of SDMH requires a paradigm shift in research methodology and intervention strategies, rooted in the principles of SDG 17 (Partnerships for the Goals).

5.1 A New Research Framework

1. International Collaboration: Research must move beyond the current imbalance, where 85% of publications are based on only 15% of the world’s population (primarily from the US and Europe). Global collaboration is essential to ensure findings are representative and equitable, supporting SDG 10.
2. Interdisciplinary Integration: Effective research requires the combined expertise of psychiatrists, social workers, nurses, psychologists, and biologists.
3. Biopsychosocial Synthesis: The connection between social factors and biology (e.g., genomics, epigenetics, microbiome) must be explored. A diverse microbiome, influenced by social interaction, is linked to better mental health, highlighting the deep integration of biological and social determinants.

5.2 Innovative Interventions: Wisdom and AI

• Wisdom as an Antidote to Loneliness: Research indicates a strong negative correlation between loneliness and wisdom (defined by components like compassion, self-reflection, and emotional regulation). Promoting wisdom, especially compassion, is a promising intervention to enhance well-being and social connection (SDG 3).
• Artificial Wisdom: The concept of using AI to foster human wisdom and compassion is an emerging frontier. AI and robotics, guided ethically, could help individuals become more compassionate and self-reflective, providing a scalable solution to widespread issues like loneliness, anger, and depression. This innovative use of technology aligns with the ambitions of SDG 9.

Analysis of the Article in Relation to Sustainable Development Goals (SDGs)

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The article discusses various social determinants of mental health, which connects to several Sustainable Development Goals (SDGs) that address health, inequality, poverty, hunger, justice, and partnerships. The primary focus is on mental well-being, but it is framed within a broader context of social and economic factors.

• SDG 3: Good Health and Well-being: This is the most central SDG, as the entire article revolves around mental health, its social determinants, and the need for comprehensive healthcare systems to address these issues. It explicitly discusses loneliness, depression, suicide, and substance use.
• SDG 10: Reduced Inequalities: The article frequently mentions various forms of inequality and discrimination as key social determinants of mental health. It specifically calls out “racism, sexism, and ageism” and discusses the challenges faced by migrants during the acculturation process. It also points to the inequality in global research, where most studies originate from high-income countries.
• SDG 1: No Poverty: The issue of homelessness is raised as a significant problem that a social worker can help address by connecting patients with “local government housing agencies.” Homelessness is an extreme form of poverty.
• SDG 2: Zero Hunger: The article mentions a lack of “food access” as a social determinant and suggests linking patients with services like “Meals on Wheels,” directly addressing food insecurity.
• SDG 16: Peace, Justice and Strong Institutions: The need for policy changes to combat discrimination and promote social justice is a key theme. The article advocates for changing policies at local, state, and national levels to create more just and inclusive societies.
• SDG 17: Partnerships for the Goals: A strong emphasis is placed on collaboration. The article calls for partnerships between professional organizations (like the APA and AMA), different disciplines (psychiatrists, social workers, nurses), different sectors (nonprofits, business leaders), and across countries to conduct more inclusive and effective research.

2. What specific targets under those SDGs can be identified based on the article’s content?

Based on the issues discussed, several specific SDG targets can be identified:

1. Under SDG 3 (Good Health and Well-being):
   • Target 3.4: “By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.” The article’s focus on addressing loneliness, depression, and preventing suicide (“the resulting loneliness leads to a greater number of suicides”) directly aligns with this target.
   • Target 3.5: “Strengthen the prevention and treatment of substance abuse…” The article notes that “substance use has increased among older adults,” highlighting a problem that this target aims to solve.
2. Under SDG 10 (Reduced Inequalities):
   • Target 10.2: “By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, …race, …origin…” The discussion on fighting “racism, sexism, and ageism” and the challenges migrants face with acculturation directly relates to promoting inclusion.
   • Target 10.3: “Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory laws, policies and practices…” The call to “change of some policies” regarding discrimination supports this target.
   • Target 10.7: “Facilitate orderly, safe, regular and responsible migration and mobility of people…” The article extensively discusses migration, its increasing rates, and the “acculturative stress” faced by migrants, which are key considerations for this target.
3. Under SDG 1 & 2 (No Poverty & Zero Hunger):
   • Target 1.3: “Implement nationally appropriate social protection systems…” The role of the social worker in connecting a homeless patient with housing agencies is an example of a social protection measure.
   • Target 2.1: “By 2030, end hunger and ensure access by all people… to safe, nutritious and sufficient food all year round.” The example of addressing a patient’s lack of “food access” by connecting them to “Meals on Wheels” is a direct action towards this target.
4. Under SDG 16 (Peace, Justice and Strong Institutions):
   • Target 16.b: “Promote and enforce non-discriminatory laws and policies for sustainable development.” The article’s argument for changing policies to address discrimination aligns with the enforcement of non-discriminatory policies.
5. Under SDG 17 (Partnerships for the Goals):
   • Target 17.16: “Enhance the global partnership for sustainable development, complemented by multi-stakeholder partnerships…” The call for “real collaboration between different groups of experts in different research areas… at an international level” and collaboration between organizations like the APA and AMA is a clear reflection of this target.
   • Target 17.17: “Encourage and promote effective public, public-private and civil society partnerships…” The suggestion to “work with business leaders, nonprofit organizations” at the local level is a direct example of promoting such partnerships.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

The article, being an interview, does not provide quantitative data but implies several indicators that could be used to measure progress:

• Suicide Mortality Rate (Indicator 3.4.2): The article explicitly mentions that loneliness from social media “leads to a greater number of suicides,” implying that the suicide rate is a key indicator of a mental health crisis.
• Prevalence of Substance Use Disorders: The statement that “substance use has increased among older adults” suggests that the prevalence of substance use is a measurable indicator of mental well-being challenges.
• Prevalence of Food Insecurity (Indicator 2.1.2): The mention of patients who do not have “enough food access” points to food insecurity as a measurable social determinant affecting mental health.
• Proportion of Population Experiencing Discrimination: The discussion on “racism, sexism, and ageism” implies that the prevalence of perceived discrimination is a key indicator for social justice and mental health outcomes.
• Number of International and Interdisciplinary Research Collaborations: The article criticizes the lack of research from low-income countries (“very few from low-income countries, including those from Asia, Africa, etc.”) and calls for interdisciplinary work. The number and diversity of such collaborations could serve as an indicator of progress in global health equity.
• Prevalence of Loneliness: The article refers to a “loneliness pandemic” and cites studies on the relationship between loneliness, wisdom, and well-being. Measuring the prevalence of loneliness in populations is an implied indicator.

4. Summary Table of SDGs, Targets, and Indicators

Source: psychiatrictimes.com