Mental Health Is Public Health

Why we need to reconsider our approach to well-being.

Posted Oct 10, 2019

This piece was originally published on Thriveglobal.com.

The burden of poor mental health is all around us. In the U.S., one in five adults experienced mental illness in 2018 — nearly 48 million people. About 18 million people experienced a major depressive episode. In 2017, over 47,000 Americans died by suicide. Clearly, mental illness is not just a challenge for individuals, but for populations. Yet we tend to think of mental health as a personal matter, something to be faced alone or with a therapist, rather than as a matter of public health. This needs to change. Public health seeks to improve health by improving the conditions in our society that shape it. This World Mental Health Day, it is time we apply a public health approach to mental health.

Our health is a product of the context in which we live. Whether or not we can be healthy depends on the air we breathe, the water we drink, the quality of our neighborhoods, our education and family income, the prejudice we face or do not face, and countless other factors that have little to do with doctors and medicines. Income and race, for example, are linked to asthma risk; income and geography are tied to life expectancy. The influence of these conditions is not limited to our physical well-being — it also shapes our mental health. For example, income inequality has been linked with higher risk of depression, and laws that allow discrimination based on LGBT status can cause mental distress among sexual minority adults.

As a society, we do not often talk about the link between our mental health and these conditions, yet most of us understand it intuitively, an understanding reflected in our art. Perhaps the quintessential example of this is blues music — a uniquely American art form chronicling the psychological effects of racism, poverty, and other large-scale social forces. The phrase itself, “the blues,” has a double meaning, as both a style of music and as the sadness emerging from the socioeconomic hardships black Americans have historically faced. Songs like “Hard Time Killing Floor Blues,” by Skip James, and “Nobody Knows You When You’re Down and Out,” by Jimmy Cox capture how economic distress and social isolation can undermine our sense of ease. Such songs speak to how seemingly impersonal political, economic, and historical forces can influence mental health at an intimate, individual level. They also identify how marginalization — the feeling of being dismissed, of having nobody on one’s side — can contribute to poor mental health.

When we think of psychological health, we often think of providing counseling or medicine to those who need it. These services are important, but they must be part of a broader effort to prevent mental illness from taking hold to begin with. Such an effort requires us to create a context where mental health can thrive — locally, nationally, globally. This means engaging with the foundational forces that shape mental health, the same forces the early blues artists sang about. Fixing the structures that generate income inequality, then, is critical if we are to improve mental health. Strengthening community networks, investing in social capital, creating spaces where people can come together for recreation and mutual support — these, too, are necessary steps.

And we must address another key threat to mental health: hate. In particular, we must address the hate that fuels racism and xenophobia. We know, for example, that the experience of discrimination has been linked to anxiety and depression. We also know that fear of deportation, and the stress brought on by immigration raids, can undermine mental health. While we cannot rid the world of hate completely, we can refuse to tolerate people in positions of power promoting hate and targeting vulnerable groups with policies designed to punish “the other” — whether “the other” is defined as immigrants, persons of color, low income populations, or the LGBT community. 

When we marginalize groups, when we accept conditions that disconnect people from the social and material resources necessary for health, we lay the groundwork for mental illness. Those who have struggled with mental illness know how easy it can be to feel like it is a normal part of life, rather than something that comes from a broken status quo we have the power to fix. The truth is, by applying a public health approach to mental illness, linking the struggle of individuals to the challenges faced by populations, we can create a world that generates health for both our bodies and our minds.