Mental health disorders impose a significant burden on individuals and society, with far-reaching implications that extend beyond personal suffering to substantial economic costs. Public health initiatives have traditionally focused on conditions like obesity and infectious diseases, but public mental health has only recently received comparable attention. This review explores the critical role of public mental health. The discussion highlights key areas, including the impact of social determinants, the importance of integrated care models, the economic and social consequences of untreated mental health disorders, and the unique challenges faced by women during the perinatal period.
Key points
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Mental health disorders impose significant personal and economic burdens, requiring a comprehensive public health approach.
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Addressing social determinants such as poverty, education, housing, and employment is crucial in mitigating mental health disparities.
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Integrated care models, particularly in perinatal mental health, improve access and outcomes by embedding mental health services within primary care.
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Public health interventions must focus on both preventing mental illness and promoting positive mental health, with ethical considerations for reducing stigma and promoting social justice.
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Collaboration across disciplines is essential to prioritize mental health in health and social policies.
Introduction
Mental health disorders impose a significant burden on individuals and society, both in terms of personal suffering and economic costs. While public health has long been an essential aspect of clinical medicine, the focus on public mental health has only recently started to match that of other clinical conditions, such as obesity and infectious diseases. Fortunately, this growing attention to public mental health is critical in preventing treatable mental illness, reducing psychological distress, and promoting overall well-being.
Despite its importance, there remains a lack of consensus on the definition of mental health, with confusion often arising between “mental health” and “mental illness.” Broadly, mental health can be understood either as the absence of mental disease or as a state in which biologic, social, and psychological factors enable a person to function effectively within their environment, realizing their potential and coping with the normal stresses of life.
The role of social determinants in mental health
Understanding the social determinants of mental health is crucial for addressing the etiology and management of psychiatric disorders. Ensuring the availability of accessible services is essential to prevent inequities that may lead to social deprivation and the onset of psychiatric illnesses. Increased rates of mental disorders are associated with factors such as sexual orientation, poverty, low or inadequate education, material disadvantage, poor housing, and unemployment ( Table 1 ).
| Social Determinant | Impact on Mental Health | Public Health Interventions |
|---|---|---|
| Poverty | Increased risk of depression, anxiety, and stress | Economic support programs, job creation, access to affordable health care |
| Low Education | Higher prevalence of mental health disorders, limited access to mental health resources | Educational programs, mental health literacy campaigns, school-based mental health services |
| Poor Housing | Elevated stress, anxiety, and depression | Housing improvement programs, community mental health services |
| Unemployment | Increased rates of depression and anxiety | Job training, employment support services, mental health counseling for unemployed individuals |
| Social Isolation | Higher risk of depression, anxiety, and cognitive decline | Community engagement initiatives, social support programs |
| Exposure to Violence | Post traumatic stress disorder (PTSD), depression, and anxiety | Violence prevention programs, trauma-informed care, safe housing initiatives |
| Discrimination (eg, sexual orientation, race) | Chronic stress, depression, and anxiety | Antidiscrimination laws, inclusion policies, culturally sensitive mental health services |
| Chronic Physical Illness | Increased prevalence of depression, anxiety, and other mental health disorders | Integrated care models, chronic disease management with mental health support |
| Migration and Mobility | Stress, anxiety, depression due to instability and lack of support | Language services, employment, and housing support, culturally competent mental health care |
| Environmental Degradation | Increased stress and mental fatigue | Urban planning with green spaces, climate change mitigation efforts, community mental health initiatives |
The International Organization for Migration highlights the impact of mobility and migration on mental health. Post-migration factors such as language barriers, employment difficulties, and lack of educational or work opportunities exacerbate mental health burdens and stress.
Since 2010, the Royal College of Psychiatrists has advocated a public health approach summarized by the phrase “no health without public mental health.” This mandate underscores the need for public health initiatives to allocate resources effectively, ensuring that public mental health can offer interventions to the broadest possible population.
Clinics care points
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Addressing social determinants: Incorporate strategies to mitigate the impact of social determinants on mental health, such as providing access to community resources and support programs.
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Ethical considerations: Focus on reducing stigma and promoting social justice in mental health care to ensure equitable access and treatment.
Public mental health challenges and interventions
Lyne and colleagues describe mental health as a rapidly evolving public health challenge that is placing enormous strain on resources. They advocate for collaboration between psychiatrists, public health physicians, legislators, and policymakers to prioritize strategies that mitigate these burdens.
Environmental factors also play a role in mental health. Kotozaki discusses research on the mental health benefits of exposure to urban greenways, noting that the presence of shrubs, trees, and grassland significantly reduces stress and mental fatigue. This finding draws attention to the potential mental health impacts of vegetation loss due to climate change.
Addressing the ethical implications of public mental health requires a focus on stigma, social justice, and rights-based commitments in light of widespread health inequities. Traditional approaches to mental health in society have overwhelmingly focused on providing clinical services to individuals, rather than fostering conditions that promote positive mental health, mental health promotion, or the primary prevention of mental illness ( Table 2 ).
| Concept | Definition |
|---|---|
| Positive Mental Health | A sense of well-being, the capacity to enjoy life, and the ability to cope with challenges—encompassing more than just the absence of mental illness. |
| Mental Health Promotion | Actions aimed at enhancing quality of life and well-being, rather than merely addressing mental illness symptoms and deficits. |
| Primary Prevention of Mental Illness | Strategies and actions designed to prevent the onset of mental illness by addressing underlying risk factors. |
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