1 The planning committee’s role was limited to planning the workshop, and the Proceedings of a Workshop was prepared by the rapporteurs as a factual account of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants and are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine. They should not be construed as reflecting any group consensus.
The social determinants of mental health (SDMH), as recognized by the World Health Organization and the Calouste Gulbenkian Foundation, involve the economic, social, and political conditions into which one is born that influence a person’s mental health—and, in particular, that affect the likelihood a person raised in deficient or dangerous conditions often associated with poverty will develop persistent mental health challenges throughout his or her life (WHO and Calouste Gulbenkian Foundation, 2014). This definition was part of a background paper presented on January 11, 2019, by Zohray Talib of the California University of Science and Medicine and Carl Sheperis, formerly with the National Board for Certified Counselors, at the information-gathering session held in Irvine, California, in preparation for a workshop of the Global Forum on Innovation in Health Professional Education. The information gathering was intended to provide members of the workshop planning committee with an opportunity to gain a better understanding of stakeholder views on educating health professionals to address the SDMH. Conversations that took place during the sessions were framed by the Statement of Task (see Box 1-1), which would form the foundation of the workshop on this topic taking place in Washington, DC, on November 14–15, 2019.
In setting the stage for the information gathering, Sheperis pointed out that not all individuals raised in poverty would necessarily experience the mental trauma often associated with being affected by the social determinants of health; however, he did acknowledge the work of Patel and Kleinman, who, as set forth in the background paper, linked mental disorders with low levels of education and inadequate housing, both of which are likely results of poverty (Patel and Kleinman, 2003). Talib expanded the conversation by introducing health professional education. A growing awareness of the negative impacts of the social determinants of health, she remarked, has led many health professional educators to incorporate the social determinants of health into their learning activities.
Sheperis and Talib both emphasized the lack of mental health incorporation into health professional education, outside of the mental and behavioral health professions. Participants at the information-gathering session offered their perspectives on the SDMH, which ranged from psychological trauma experienced by individuals living in underserved communities to mental health challenges faced by practitioners, educators, and learners that often go un- or under-addressed.
Sheperis concluded the information-gathering session by reflecting on what he heard. It is not just the physical health or the mental health of a person that requires support, he said; moving forward, we must bring the mind and the body together so that learners and all practitioners recognize the importance of caring for the whole person. Making sure that health professional educators call out the mental health challenges in their education on the social determinants of health is one potential way to better ensure that mental health is not neglected (see Box 1-2 for an example of a community–education partnership). The current and next generation of providers, Sheperis said, must be made aware of the potential physical and mental health challenges faced by all persons affected by the social determinants of health, as well as of their own mental health vulnerabilities. This orientation formed the basis for the planning of this workshop, which was titled Educating Health Professionals to Address the Social Determinants of Mental Health.
Carl Sheperis, dean of the College of Education and Human Development at Texas A&M University–San Antonio, opened the workshop by introducing the participants to the overall objective of the workshop: “to understand the mental and physical health impacts of being exposed to the social determinants from macro and meso levels so the knowledge can be applied in a micro level.” For this workshop, he said, the macro involves work and education aimed at influencing higher-level policy decisions. The other two levels directly target education, with the meso focusing on how to provide effective education on the SDMH and the micro being the content of that education.
Each of the three levels would purposefully address mental health. Sheperis explained that the workshop was placing particular emphasis on the mental health aspects of the social determinants of health for two reasons. First, compared with physical health, mental health generally does not receive adequate attention, particularly as it relates to social determinants. Second, mental and physical health are inextricably linked and are negatively affected by the violence and trauma that can stem from the dangerous or substandard living conditions frequently associated with
poverty. The economic conditions, as well as the social and political circumstances in which a person is born, are what form the social determinants of health and the mental health challenges that people face throughout their lives. For the purposes of this workshop, Sheperis said, the term “mental health” includes a range of conditions from basic human functioning and wellness to severe mental health disorders.
Following these foundational remarks, Sheperis then introduced the participants to the learning objectives of the workshop (see Box 1-3). He stressed that the workshop was designed for active participation, and he encouraged the audience to think critically about what they would like to learn at the workshop, what personal experiences they brought to the workshop, and how they would move forward to integrate the social determinants of mental health into health professional education. Kennita Carter, medical officer at the Health Resources and Services Administration who worked with Sheperis in establishing the framing of the workshop, added that the planning committee hoped the workshop participants would collectively contribute to the development of a “train the trainer” educational module to address the social determinants of mental health from social, political, and economic perspectives. Carter then shared a story about how she first realized that one person—in her case a teenager growing up
in Los Angeles—can affect social and political discourse, in this case by rallying friends, making posters, and marching to city hall in protest of injustices. Her reason for sharing the story, she said, was to get participants to think about how they, or people they know, may have similarly brought attention to an important issue and to consider how they might apply lessons learned from such experiences to the education of health professionals on the SDMH.
The 1.5-day workshop included presentations on a series of topics as well as small group and breakout group discussions. These small group discussions allowed participants to engage with colleagues from other professions and across sectors, while encouraging in-depth exploration of the topics. Appendix B lays out the agenda set up by the workshop planning committee (see page v for the list of planning committee members). This Proceedings of a Workshop follows the general structure of the agenda. Chapter 2 summarizes the presentations and conversations on understanding the SDMH across the lifespan. It also includes a discussion on effective educational methods on the SDMH for faculty and other health professional educators. Chapter 3 explores how to build and recruit a health workforce to address the SDMH. Chapter 4 captures the presentations and conversations about how to create and improve community-engaged experiential learning opportunities. Chapter 5 summarizes discussions on the importance and impacts of mental health policy and includes a section on interprofessional policy and advocacy training among students. This final chapter ends with messages expressed by individual participants underlining the need for faculty to provide learners with interprofessional policy and advocacy training. Any suggestions made throughout the workshop and captured in this proceedings were made by individual participants and should not be interpreted as consensus opinions or recommendations.
Patel, V., and A. Kleinman. 2003. Poverty and common mental disorders in developing countries. Bulletin of the World Health Organization 81(8):609–615. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2572527/pdf/14576893.pdf (accessed January 22, 2020).
WHO (World Health Organization) and Calouste Gulbenkian Foundation. 2014. Social determinants of mental health. World Health Organization. https://apps.who.int/iris/bitstream/handle/10665/112828/9789241506809_eng.pdf;jsessionid=0038B0C30674BF3E2FB51AA66F11B74F?sequence=1 (accessed January 28, 2020).