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Addressing the Social Determinants of Mental Health:

A (Informed) Consumer's Perspective


on 30 March 2015

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Transcript of Addressing the Social Determinants of Mental Health:

Peer-Led Initiatives
"understanding another’s situation empathically
through the shared experience of emotional and
psychological pain.” (5,6)
Health Equity
equal opportunities for good mental health
Interactions of multiple levels of oppression or disenfranchisement
Access to Services
Getting the right support at the right time
Coping Skills and Strategies
What You Can Do
to address the SDOH
Resources for support
Social network
Self-care, stress management, resiliency
Detect stressors and triggers
When to seek assistance
Effective Navigation of the Mental Health Care System
Good Mental Health
Especially with Depression/ Anxiety - able to recover and maintain good mental health (and everything that encompasses)
Understand what mental health is
Gain an understanding of how social factors are connected
Don't feel isolated and alone
Addressing the
Social Determinants of
Mental Health:
An (Informed) Consumer's Perspective


Untangle/unpack some of the deeper, root causes of mental health concerns
Share personal interactions with and reflections on the mental health care system
Share lessons learned and some tips on mental health care
Try to help you do a better job of helping me
What I will do:

Speak from personal experience + the evidence
Question buzz words and the status quo
Keep the audience in mind - Many people here are the "experts" in MH care
Do my best to ensure this is a safe space
If you aren't a newcomer, don't pretend to know what the experience is like
Credentials do not override experience.
Check your privilege - I am privileged to have the education which allows me to better understand and deconstruct these issues.
Be an ally to your clients
Difference between solidarity (working on their behalf against discrimination etc.) and perpetuating the status quo
Issues to Keep in Mind
Income (and Income Distribution)
Education and Literacy
Unemployment and Job Security
Employment and Working Conditions
Social Exclusion
Food Insecurity
Citizenship Status
Mental Health Care Collaboration
The Family Health Team
Team makes sense - collaboration between professionals
Family doctor referred me to the social worker because of something that I said during an appointment
Free - huge plus
Short term - what does that mean? - actually fell off the radar after my 8 sessions...

Mental Health Care can benefit from integrating anti-oppression principles, thinking about the barriers being put up by systemic discrimination.

If you aren't aware of these issues and
actively thinking about it within your practice
, and engaging with your clients appropriately, you're contributing to the problem by
perpetuating the problem.
Sri Lankan aka "Brown"
Recent Immigrant
"Visible Minority"
Within 5 years of moving to Canada, many immigrant families are living below the poverty line

We became part of the statistic.

6.5 years ago I came to Canada from the United Arab Emirates
Parents were qualified as a physician/surgeon and chartered accountant in the United Kingdom & their credentials are not recognized here (even though we share the same queen as the UK!).

There is a disconnect between the promise to potential immigrants & reality.

More and more evidence to demonstrate link between social determinants and health
The Opening Doors Project
Especially important in the context of mental health care because it creates an
"us" vs "them"


"experts" and the "consumers"

Definition of Consumer:

"Someone who is accessing mental health services currently. "
(Personal Communication, 2014)

If you are involved in research, what is your research giving back to the community or population in question?
Through my professional training, I was aware of what was out there. I have sought services and care from:

Family Doctor
Social Worker
Pharmacist (for medication)
Suicide Hotline
University health clinic
University counselling and psychological services
Private Therapist

I have no conflicts to disclose
It is important to understand the words we're using. I emailed in for clarification....
With that definition, I became a consumer long before I was aware of it.
My introduction to mental health came through my professional work trajectory:

I am a Master of Public Health candidate at the Dalla Lana School of Public Health, U of T

I have worked with children and youth from various socio-economic backgrounds, coming from abusive home environments etc.

In these various roles, I have been a youth peer trainer
As humans we like to label and this can be tricky -

because a label only captures one single aspect of a complex human being....

so when I identify as a consumer for the purposes of this presentation... that doesn't mean that's all I am

Theme throughout this presentation:

For us to try and see beyond words.

To question how we think and how that influences our actions.

Untangle some of the messiness behind mental health care.
Social Determinants of Mental Health
Mental Health Care Initiatives
Health Inequities or Health disparities are differences in the health outcomes of specific populations that are

systemic, patterned, unfair, unjust,
as opposed to random or caused by those who become ill.”
Micro-aggressions are "everyday verbal, behavioral or environmental indignities, intentional or unintentional, that communicate hostile, derogatory slights and insults towards marginalized people". -

NOT helpful when unknowingly used by mental health care providers
therapeutic in a way I did not expect
Different types of stigma that originate from different sources ....

1. Public Health Agency of Canada (PHAC) [Internet].Canada: Public Health Agency of Canada; [date unknown] [updated 2011 Oct 21; cited 2014 June 6]. Key Determinants. Retrieved from: http://www.phac-aspc.gc.ca/ph-sp/determinants/#determinants

2. World Health Organization. (2008). Commission on Social Determinants of Health – Executive Summary. Geneva, Switzerland: WHO. Retrieved from http://www.who.int/social_determinants/final_report/csdh_finalreport_2008_execsumm.pdf

3. Beiser, M., Hou, F., Hyman, I. & Tousignant, M. Poverty, Family Process, and the Mental Health
of Immigrant Children in Canada. American Journal of Public Health. 2002; 92(2): 220‐227.

4. Dunn JR and Dyck I. 2000. Social determinants of health in Canada's immigrant population: results from the National Population Health Survey. Social Science & Medicine. 51(11):1573-1593.

5. Sunderland, Kim, Mishkin, Wendy, Peer Leadership Group, Mental Health Commission of Canada. (2013). Guidelines for the Practice and Training of Peer Support. Calgary, AB: Mental Health Commission of Canada.
Retrieved from: http://www.mentalhealthcommission.ca

6. Mental Health Commission of Canada, Making the Case for Peer Support,
2010, p. 70

Other resources:

7. Fisher, M. & Baum, F. (2010). The Social Determinants of Mental Health: Implications for Research and Health Promotion. Australian and New Zealand Journal of Psychiatry, 44,1057-1063.

8. Khanlou, N. & Wray, R. (2014). A whole community approach toward child and youth resilience promotion: A review of resilience literature. International Journal of Mental Health and Addiction, 12(1), 64-79.

9. Veenstra G. 2009. Racialized identity and health in Canada: results from a nationally representative survey. Social Science and Medicine. 69(4):538 -542.

10. Doyal L. 2001. Sex, gender and health: the need for a new approach. BMJ. 323:1061 - 1063.

15. McDonald JT and Kennedy S. 2004. Insights into the "healthy immigrant effect": health status and health service use of immigrants in Canada. Social Science and Medicine. 1613-1627.

16. Khosla P. If Low Income Women of Colour Counted in Toronto. The Community Social Planning
Council of Toronto; 2003: 110p.

Nadha Hassen, HBSc, MPH (c)
@nadhassen #2014_CCMHCC

"Your English is absolutely perfect !"
End of the "honeymoon" period
"That is not an option for me."
Tips and Lessons Learned
Sexuality, Income, etc.
Same Family Health Team
The Goals
Look to your left and look to your right - who isn't here today?
People are falling through the cracks... the people who do not know where to access the appropriate services.
"This category includes persons who are non-Caucasian in race or non-white in colour and who do not report being Aboriginal." - Statistics Canada, 2014
understand the complex nuances
safe, nonjudgemental space
tools and strategies for coping
living this reality
similar experiences
Free workshops on anti-discrimination, migration and mental health and wellness
Anti-Oppression Principles
Stigma is still a big issue - which is why peer-led initiatives can help mitigate much of that. We need to break down stigma within these populations (e.g. newcomer, racialized, low-income) and peer initiatives are one way to make a significant impact in this area.
“Peer support is about providing all the tools besides medication – the tools for the other 80% of your life.”
-Mental Health Commission of Canada, Making the Case for Peer Support, 2010, p. 46
Workshop by The Opening Doors Project:
Joining Hands: Cross-Cultural Mental Health

"This workshop helps service providers understand
how individuals from different cultures view mental illness
, what their understanding of treatment is, and
how that impacts the way in which they seek help
. The workshop also
raises awareness of the barriers newcomers encounter
when trying to access services. Participants are encouraged to re-examine their assessment methods and are given strategies on how to build rapport and relationships with their clients based on a cross-cultural approach."
Aware of what appropriate resources and support services are available
Able to make informed decisions about their mental health - relates back to coping strategies
Understand what stigma and discrimination are and be able to
advocate for themselves
What are the SDoH?
Thank you !
(3, 4)
Discussion in groups: (5 min!)

Through a respectful discussion, and sharing your thoughts and experiences (if you wish), think about the following:

1. Which subset of the population has the highest power/most privilege in Canadian society? [Based on the social determinant assigned]

2. Why is this the situation?

3. What are some ways to overcome these barriers to appropriate care in your practice or work?
The Opening Doors Project

Tyler I and Amare H. (n.d.) Facilitators and barriers to the application of health equity assessment tools: Results of case study analysis. Public Health Ontario. Retrieved from: http://www.publichealthontario.ca/en/LearningAndDevelopment/Events/Documents/Equity_tools_facilitators_barriers_2013.pdf
Full transcript