The Mental Health & Addiction Crisis is Real: Utilizing the Social-Ecological Model as a Blueprint for Change
The social-ecological model (SEM) recognizes that individuals are part of a larger system. The focus is taken away from solely the individual. SEM places an emphasis on “contextual forces that influence health” (Golden & Earp, 2012). This includes interactions between the “individual, interpersonal, organizational, community, and societal/policy factors” (Early, 2016). The Centers for Disease Control and Prevention (2022) breaks it down into four levels: individual, relationship, community, and societal. The individual-level places emphasis on both biological and personal history. This includes age, education, income, and past trauma. The relationship level looks at close relationships including family and peer support(s). The community-level explores settings such as schools, workplaces and poverty. Lastly, the societal level focuses on social norms, inequalities, stigma and policies.
Figure 1: The social-ecological model
(The Centers for Disease Control and Prevention, 2022)
This blog post will emphasize the impact of SEM on mental health and addiction. Both addiction and mental illness can be experienced on their own or concurrently. Addiction and mental illness are terms used to describe several disorders that affect an individual’s mood, thought process and behaviour (Centre for Addiction and Mental Health, n.d.). These disorders include and are not limited to depression, anxiety, schizophrenia, bipolar disorder and substance use disorder. So why is mental health important for an individual’s overall well-being? Because they are interchangeable. For instance, depression increases a person's risk for developing various physical health problems including diabetes and heart disease (The Centers for Disease Control and Prevention, 2022). Likewise, chronic conditions such as diabetes, heart disease and cancer increase the risk of developing mental illness. It is important to note that there is no one cause for mental illness. Several factors can contribute to the development of mental illness.
As stated, there are various risk factors contributing to mental health and addiction. These risk factors include genetic predisposition, biological factors, trauma, cultural influences, poverty and other barriers to accessing services and social determinants of health (Canadian Mental Health Association, n.d.). It is important to identify and understand what social determinants of health are. The World Health Organization (n.d.) defines the social determinants of health (SDoH) as the “non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age and the wider set of forces and systems shaping the conditions of daily life”. Often, these determinants are both unfair yet modifiable. For instance, poverty is a social determinant of health. One that has a profound effect on the development of mental illness. Those living in poverty are three to four times more likely to struggle with their mental health (CAMH, n.d). Research shows how protective factors decrease the risk of developing both mental illness and addiction. These factors include positive peer relations, reliable community support, affordable housing among other things.
As stated above, various contextual forces impact a person’s mental health. These forces have a cascading effect on both the healthcare and the socioeconomic system. Mental illness costs Canadians an estimated 51 billion dollars a year in healthcare-related costs and lost productivity (CAMH, n.d). It is the leading cause of disability within Canada. It is said that “the cost of disability leave as a result of mental illness is about double the cost of a leave due to physical illness” (CAMH, n.d.). The Canadian Mental Health Association (n.d.) reminds us that many people die from mental health and addiction. It is a common misconception that mental illness is not a cause of death, unlike cancer, heart disease, and strokes. For instance, opioid overdoses account for more deaths than car accidents. It is averaged that someone takes their life by means of suicide every 40 seconds. Those with mood disorders are at a higher risk of developing chronic illness and those with mental illness are also more likely to die prematurely compared to the general population. The following graph shows both diagnosis and percentage in relation to admission in Hospital.
Figure 2: Diagnosis Upon Admission
(Centre for Addiction and Mental Health, n.d.)
The literature identifies how promotion, prevention, and intervention yield positive health outcomes. The social-ecological model (SEM) is useful in understanding the cause of health disparities. Using SEM the Minnesota Department of Health (n.d) identified examples of risk factors in the individual, interpersonal, community and societal levels. The individual-level identifies trauma, knowledge of public health and harm reduction, symptom management and physical and mental health as risk factors. The relationship level identifies access to opioids, attitudes and opinions, access to family and peer support and a family history of substance use. The community-level identifies culturally appropriate care and access to culturally specific services, access to naloxone and training and public health and harm reduction programming. The societal level identifies stigma, legislation that supports harm reduction programs, policies that promote health equality, insurance coverage, economic and sustainable housing. This approach requires interdisciplinary collaboration. This will allow us to “adequately address the diversity of issues that bear on the health of a community of people” (Here to Help, 2011) allowing us to provide a clear direction and implement appropriate strategies.
Figure 3: Promoting positive mental health through a socio-ecological approach
(Here to Help, 2011)
Being aware of the cost of mental health and addiction in Canada, I believe that implementing the social-ecological model would support the reduction of this cost. As many know, the health care system is strained. By promotion, prevention and intervention we can appropriately respond to health care needs and create positive change within the health care system. We will challenge both barriers and inequalities thus creating positive change. This has been evidenced in the implementation of harm reduction strategies including safe injection sites and access to both Naloxone and clean supplies. What would the result be if we were to go one step further? In 2001, Portugal decriminalized the consumption of all drugs. Since the decriminalization of drug-related offences, overdose deaths and communicable disease rates have declined drastically (Rajagopalan, 2019).
In conclusion, the SEM can promote health care in a multitude of ways. The Minnesota Department of Health (n.d) notes how programming can focus on a single level of SEM but that success would come from interventions that work across all levels. We must create environments that foster health promotion. As stated by the Office of Disease Prevention and Health promotion (n.d.) “by working to establish policies that positively influence social and economic conditions and those that support changes in individual behaviour, we can improve health for large numbers of people in ways that can be sustained over time”.
References
Canadian Mental Health Association. (n.d.). Factors that impact addiction and problematic substance use. Retrieved February 22, 2022, from https://ontario.cmha.ca/factors-that-impact-addiction-and-substance-misuse/
Centre for Addiction and Mental Health. (n.d.). Mental illness and addiction: Facts and statistics. CAMH. Retrieved February 22, 2022, from https://www.camh.ca/en/Driving-Change/The-Crisis-is-Real/Mental-Health-Statistics
Centre for Addiction and Mental Health. (n.d.). The crisis is real. CAMH. Retrieved March 3, 2022, from https://www.camh.ca/en/driving-change/the-crisis-is-real
Centers for Disease Control and Prevention. (2022, January 18). The social-ecological model: A framework for prevention. Retrieved February 22, 2022, from https://www.cdc.gov/violenceprevention/about/social-ecologicalmodel.html
Early, J. (2016, October 31). Health is more than healthcare: It's time for a social-ecological approach. Retrieved February 22, 2022, from https://www.imedpub.com/articles/health-is-more-than-healthcare-its-time-for-a-social-ecological-approach.php?aid=17440
Golden, S. D., & Earp, J. L. (2012). Social ecological approaches to individuals and their contexts. Health Education & Behavior, 39(3), 364–372. Retrieved February 22, 2022, from https://doi.org/10.1177/1090198111418634
Here to Help. (2011). Promoting positive mental health through a socio-ecological approach. Retrieved March 3, 2022, from https://www.heretohelp.bc.ca/infosheet/promoting-positive-mental-health-through-a-socio-ecological-approach
Minnesota Department of Health. (n.d.). Social determinants of substance use and overdose prevention - minnesota department of health. Retrieved February 23, 2022, from https://www.health.state.mn.us/communities/opioids/prevention/socialdeterminants.html
Rajagopalan, S. (2019). Dpa-drug-decriminalization-portugal-health-human-centered-approach_0 [PDF]. Retrieved March 5, 2022, from https://drugpolicy.org/sites/default/files/dpa-drug-decriminalization-portugal-health-human-centered-approach_0.pdf
Office of Disease Prevention and Health Promotion. (n.d.). Social determinants of health. Retrieved February 23, 2022, from https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health
World Health Organization. (n.d.). Constitution. Retrieved February 5, 2022, from https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1
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