Transformative Education
for Health Professionals

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Mental Health; Context, Exposure, Vulnerabilities, Consequences


Context: The current globalization in the economic, political, social, cultural, environmental and technological spheres has led to rapid changes in the configuration of societies, particularly in poorer countries, which have the weakest social welfare and public health systems. Evidence from longitudinal studies show that unemployment is associated with an increased risk of depression and job insecurity is associated with sub-optimal mental health.

There is a low investment on mental health; on average governments worldwide invest only 3% of their total government health spending on mental health.

Importantly stigma associated with mental disorders can result in discrimination and it can also hinder patients seeking help, thereby increasing the treatment gap for mental disorders. What’s more, stigma can result in a general reluctance to invest resources in mental health care and discrimination among medical professionals, with negative consequences on the quality of mental health services delivered.

Position: The social and economic position of an individual has an important influence on his/her mental health.  The capacity for an individual to develop and flourish is deeply influenced by their immediate social position – including their opportunity to earn a living for themselves and their families. Restricted or lost opportunities to gain an education and income are especially pertinent socio-economic factors influencing their mental health.

Exposure: Persons exposed to violence, armed conflict and natural disasters represent a vulnerable group at a significantly elevated risk of psychological distress and morbidity, as are those forcibly displaced by such events (of whom almost half are children and adolescents).

Vulnerability: Other vulnerable populations include ethnic minorities;  racism or discrimination towards a particular group in society raises that group’s exposure to social exclusion and economic adversity, thereby placing them at a higher risk of stress, anxiety and other common mental disorders.  Similarly, the socially-defined role of women in many societies exposes them to greater stresses, which, together with other factors including family violence and abuse, leads to higher rates of depression and anxiety.  

Outcomes: Low and middle income countries often suffer from poor service quality, poor rapport between service users and providers, and poor adherence, which in turn may be attributable to the factors just mentioned and socioeconomic factors that restrict the ability of people to complete their treatment.

Consequences: The onset or presence of a mental disorder has consequences in other health related issues; as it raises the chance of disability and premature mortality from other diseases, including cardiovascular disease, diabetes, HIV/AIDS and other chronic conditions. The higher than expected occurrence of these diseases in persons with mental disorders can be attributed to a range of factors, including general neglect of their physical health (by themselves, families or care providers), elevated rates of psychoactive substance use in this population, diminished physical activity, an unhealthy diet and, in many cases, side-effects of medication.  Health outcomes for persons with comorbid mental and physical conditions are markedly worse, due to diminished health-seeking behaviour, adherence and follow-up for these cases. All of these consequences will only increase the individual’s disabilities and their social exclusion from society, as they will have lower chances of earning a living for themselves and their families; showing the strong case of the visual cycle of social determinants on mental health.


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