22 SUMMER 2016
Inequalities in mental health: geographical perspectives Professor Sarah Curtis, Professor Emeritus, Department of Geography, Durham University; Dawn Everington, Scottish Longitudinal Study, University of Edinburgh; Dr Claire Niedzwiedz, Centre for Research on Environment, Society and Health, University of Edinburgh When discussing health inequalities, it is important to consider mental as well as physical health. Mental health issues affect a large proportion of the population in countries around the globe. For example, NHS Health Scotland reported that ~15% of the adult Scotland population who participated in the Scottish Health Survey reported common mental health problems in response to the General Health Questionnaire.
that urban planning and development and local community policies may contribute in positive ways to mental (and physical) health and help to reduce health inequalities in our society. NHS Scotland is attending seriously to these issues and has developed policies and indicators to address mental health inequalities. Research can often help to inform these efforts. Health geographers are working, for example, to measure and map inequalities in mental health, and show how they are associated with ‘environmental determinants’, in order to identify the areas where intervention may be most necessary and urgent and to assess which are the most ‘powerful’ environmental and social determinants of mental health. The graph shows how the risk of reporting a mental illness among people living in Scotland in 2011 increases as the level of deprivation in their neighbourhood increases. Information on reported mental illness was summarised across data collected from more than 150,000 adults who are anonymously represented in the Scottish Longitudinal Study (a large-scale linkage study created using data from administrative and statistical sources). For those living in the most deprived areas the likelihood of reporting mental illness is almost three times that found among people in the least deprived areas (after adjusting for sex, age, family composition and economic position). This suggests that living in a deprived area may present an extra risk for mental illness, in addition to personal characteristics.
“Our mental (and physical) health can be influenced by the material, social and symbolic aspects of our environment.”
The pattern of mental disorders is socially uneven, and people in more disadvantaged groups tend to be more likely to suffer from problems with their mental health. The places where we live are important for mental health inequalities, as well as individual and family factors.
There is a growing interest in what makes for good mental health and well-being since, according to the WHO, mental health should not only be considered as the absence of disease, but rather as “a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.” Information on health inequalities is collected in population surveys, mental health service records or data on mortality attributable to mental health problems. Other research draws on in-depth studies of individual experience. The research demonstrates inequalities in mental health and well-being, across a number of social dimensions such as gender, ethnicity and income. While personal and family factors are important for these differences in mental health, various aspects of places are important for mental health inequalities. For example, the literature on ‘therapeutic landscapes’ explores how our mental (and physical) health can be influenced by the material, social and symbolic aspects of our environment. A number of studies by geographers in Scotland (and elsewhere) have shown that mental health can benefit from ‘salutogenic’ material aspects of the environment, such as visually attractive and comfortable buildings and greenspace which may feel ‘natural’ and ‘safe’, and where the economic situation is favourable, with good access to jobs, services and other resources. Mental health is generally better in places where we have a sense of ‘belonging’, and supportive links with others in the community. We may also benefit from places which are symbolically important, such as places of worship, memorials, and public buildings that represent positive aspects of our society. A sense of feeling ‘at home’ in the place where we live is also important. If the places we inhabit lack these salutogenic features, this may be damaging for our mental health. Environmental conditions in terms of greenspace accessibility and quality, built environment, economic and social conditions, vary from one area to another, and these environmental inequalities are likely to contribute to inequalities in mental well-being, mental health disorders, and use of mental health services (with associated variations in cost to health and social care services). Geographers are increasingly working with partners in non-academic agencies to develop planning strategies that are sensitive to the idea of ‘place shaping for health’, so
Our ongoing research is also examining how mental health may change over time, as socio-economic or physical environmental conditions change. We are involved in new research concerned to identify ‘what works’ to improve mental health and well-being at the community level, as well as for individuals. Given the high, and growing, frequency of common mental health disorders within the general population and large societal costs, this research is timely and important.
Geographical inequalities in risk of reporting a mental illness, showing how risk increases as area deprivation score increases. Carstairs Deprivation Indicator combines information on different aspects of deprivation in small geographical areas across Scotland, based on data from the 2011 population census. Source: Scottish Longitudinal Study. Census output is Crown copyright.
FURTHER READING Good Mental Health for All (2015) NHS Health
Scotland (www.healthscotland.com/documents/25928.aspx)
Professor Curtis is the author of Space, Place and Mental Health (Ashgate, August 2010).