Public health research in developed countries consistently demonstrates that rates of the more common forms of mental health disorder increase as one moves down the scale of socioeconomic status, and are significantly higher among socially disadvantaged groups.
This general pattern of outcomes is also present in Australia. In recent decades research has also shown higher rates of mental health problems to be positively associated with social or economic factors such as: low income, insecure housing, unemployment or insecure employment, high-demand or low-control workplace conditions, child abuse or neglect, and low social support.
These and other factors are widely recognised in public health literature and in public policy as ‘social determinants’ having a significant effect on mental health outcomes for individuals and in populations. However, from the perspective of people working within mental health systems and services, these ‘upstream’ determinants have often already ‘done their work’ by the time people come to the health system with a problem; and the capacity to take preventative action on these factors often lies outside the health sector. Although mental health policies now recognise social determinants, the bulk of resource and effort still goes into treating ‘downstream’ effects.
This paper will argue that, despite these obstacles, there are a number of ways in which health professionals can take account of social determinants of mental health, and act to promote more effective policy measures and preventative action on ‘upstream’ social factors.