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PREPUBLICATION COPY: UNCORRECTED PROOFS 1 1 Introduction1 The social determinants of mental health (SDMH), as recognized by the World Health Organization (WHO) and the Calouste Gulbenkian Foundation, involve the economic, social, and political conditions into which one is born that influence a personâs mental healthâand, 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 14â15, 2019. 1 The planning committeeâs role was limited to planning the workshop, and the Proceedings of a Workshop has been prepared by the rapporteurs (with the assistance of staff as appropriate) 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. Highlights â¢ It is not just the physical health or the mental health of a person that requires support; moving forward, health professionals must bring together the mind and body so learners and practitioners can recognize the importance of caring for the whole person. (Sheperis) â¢ There is limited training on mental health incorporation in health professional education outside of the training of mental and behavioral health professionals. (Sheperis, Talib) This list is the rapporteursâ summary of the main points made by individual speakers (noted in parentheses), and the statements have not been endorsed or verified by the National Academies of Sciences, Engineering, and Medicine. They are not intended to reflect a consensus among workshop participants.
2 EDUCATING HEALTH PROFESSIONALS TO ADDRESS THE SDMH PREPUBLICATION COPY: UNCORRECTED PROOFS BOX 1-1 Statement of Task A planning committee will plan and conduct a 1.5-day public workshop to explore how health professions education and practice organizations and programs are currently addressing social determinants that contribute to mental health disparities across the lifespan. The workshop will also set the stage for discussions on how disparities can affect the mental health and well being of patients, families, communities, and care providers across the learning continuum. 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 communityâeducation 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 planning of this workshop, which was titled Educating Health Professionals to Address the Social Determinants of Mental Health.
INTRODUCTION 3 PREPUBLICATION COPY: UNCORRECTED PROOFS BOX 1-2 Bringing Students into the Community Timothy âNobleâ Jennings-Bey, Chief Executive Officer Street Addiction Institute Inc., Syracuse, NY Street Addictions, Inc., has educated more than 1,000 Syracuse University students by bringing them out of the classroom and into the community to hear from people like Timothy âNobleâ Jennings-Bey, the chief executive officer of Street Addictions Institute and Mothers Against Gun Violence, a grassroots activist group addressing violence in at-risk neighborhoods. According to Nobel, his hometown of Syracuse in upstate New York is one of the most at-risk cities in the United States. The Street Addiction Institute was set up in 2015 to focus on community violence and trauma in Syracuse. Noble, who is director of the trauma response ream for the City of Syracuse, said his team responds to shootings and homicides on a 24-hour basis. âThis is not a job for me,â he said. âItâs a ministry.â These are messages that Noble shares with students to underscore his theory that the streets have an addictive nature, just like cocaine, alcohol, or gambling. Individuals reared in that process are in need of respite and rehabilitation before Noble and others like him can mainstream them back into any educational process or career path. Noble said he understands all too well the lure of âstreet addiction,â having grown up in âone of the worst zip codes in the city of Syracuse.â He describes existing between two parallel universes. One is the world of academia, while the other echoes the voices of his peers, many of whom have been murdered in the prison system. In his role as an educator, Noble said, he offers messages that range from getting students to understand what itâs like growing up in these traumatized zip codes to inspiring young people from his zip code to aim for goals in the world of academia that they might not ever have thought were possible. Noble said he disagrees with those who argue that âbecause youâre from a different culture or a community, thereâs no way you can understand what Iâm going through.â Regardless of where you are coming from, he said, âwe all have stories to tell,â and some of these stories are rooted in trauma. You do not know what people have been through to get here in this time and in this space, he said, âso a simple gesture of âGood morning,â and I just humanized this entire space and gave credence to my existence.â That is one of the ways and one of the strategies that Noble said he uses to take some of the burden off of young people. While a warm greeting sets the tone, it is the honest sharing of experiencesâpast and presentâamong communities, educators, and learners that builds relationships and starts the healing process, because, in the words of Noble, âwe all need each other to heal.â SOURCE: Presented by Timothy âNobleâ Jennings-Bey on November 14, 2019. Workshop Objectives Carl Sheperis, the dean of the College of Education and Human Development at Texas A&M UniversityâSan Antonio, opened the workshop by introducing the participants to the overall objective of the workshop: âto 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.â 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,
4 EDUCATING HEALTH PROFESSIONALS TO ADDRESS THE SDMH PREPUBLICATION COPY: UNCORRECTED PROOFS with the meso focusing on how to provide effective education on the SDMH, with 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 âmental healthâ 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, a medical officer at the Health Resources and Services Administration (HRSA) 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 âtrain the trainerâ 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 personâin her case a teenager growing up in Los Angelesâcan 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.
INTRODUCTION 5 PREPUBLICATION COPY: UNCORRECTED PROOFS 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 social determinants of mental health across the lifespan. It also includes a discussion on effective educational methods on the social determinants of mental health for faculty and other health professional educators. Chapter 3 explores how to build and recruit a health workforce to address the social determinants of mental health. 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. REFERENCES Patel, V., and A. Kleinman. 2003. Poverty and common mental disorders in developing countries. Bulletin of the World Health Organization 81(8):609â615. 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. BOX 1-3 Learning Objectives of the Workshop After this workshop, participants will be able to: 1. Understand the impact of the social determinants of mental health across the lifespan 2. Understand how mental health can be incorporated into the HPE framework for the social determinants of health 3. Differentiate the impact of the social determinants on physical and mental health at macro, meso, and micro levels 4. Examine opportunities to expand health professional education to incorporate the social determinants of mental health 5. Identify experiential learning opportunities related to the social determinants of mental health for health professional education 6. Design a framework for delivering education on the social determinants of mental health to health professionals in training 7. Implement strategies for health professional education that incorporate the social determinants of mental health SOURCE: Presented by Carl Sheperis on November 15, 2019.
6 EDUCATING HEALTH PROFESSIONALS TO ADDRESS THE SDMH PREPUBLICATION COPY: UNCORRECTED PROOFS https://apps.who.int/iris/bitstream/handle/10665/112828/9789241506809_eng.pdf;jsessionid=0038B0 C30674BF3E2FB51AA66F11B74F?sequence=1 (accessed January 28, 2020).