It’s Time to “De-Privatize” Mental Health

“Climate change will affect every aspect of our health and well-being.”

This is the opening statement in a paper published in The Conversation last November that described five ways the accelerating toxic stresses and disasters generated by what I call the climate-ecosystem-biodiversity (C-E-B) catastrophe are affecting mental health, with a specific focus on alcohol and drug abuse. The five ways include:

• Direct effects on mental health caused by punishing weather events such as extreme heat have been linked to increased distress across the entire population;
• Indirect effects on mental health produced by mounting worry, anxiety, guilt, fear, anger, and helplessness related to what the future will bring that affect many people, particularly youth;
• The psychological distress caused by physical injuries such as inhaling wildfire-generated smoke, and long-term illnesses, disabilities, and other chronic health problems that activate depression and hopelessness;
• The emotional and physical stresses caused by both subtle and overt changes in daily life, such as disrupted sleep patterns caused by hotter weather and people being forced to leave their homes or communities due to a lengthy drought or major disaster;
• And the widespread hardships generated by destabilized ecological, social, built, economic, and geopolitical systems people depend on for food, water, jobs, income, shelter, safety, security, and other basic survival needs.

As the post underscores, in different times, ways, and magnitudes, these traumatic stressors and numerous other climate-generated hardships not mentioned will affect everyone.

Last week, it was announced that global temperatures breached the 2.7 degrees Fahrenheit (1.5 degrees Celsius) threshold for an entire year, the highest 12-month temperature on record. And the heating is speeding up and could become self-sustaining.

We must come to grips with the fact that humanity is in the initial stages of a rapidly accelerating civilization-altering event that will generate multiple interacting traumatic stresses. Without significant changes in the way we respond, the stressors will significantly affect everyone’s social, psychological, emotional, and behavioral health—and much more.

The dominant paradigm in the mental health field today, however, is that the individual alone is responsible for their psychological, emotional, and behavioral struggles. The source of their problems resides solely within them. The proper response, therefore, is to provide mental health services to individuals, mostly one at a time, after they experience symptoms.

Suppose the privatization of mental health issues is correct. How is it possible that psychological, emotional, and behavioral problems have continually grown in the U.S. and other nations to levels that are now epidemic? Are individual genetic problems growing? Is it merely because alcohol and drugs are now more readily available? Not likely.

The reality is that a majority of the growing mental health and psychosocial problems seen throughout the U.S. and internationally are caused by numerous traumatic stresses that include, but go well beyond, individual factors alone.

The social-ecological model offers a helpful way to think about the accumulating stressors.

Individual Factors: Each person’s mental health is indeed influenced by the genetic/biological factors they are born with and by their experiences as young children, including their relationships with their parents or primary caregivers. If children experience neglect or abuse, for example, mental health and physical health issues can emerge that last well into adulthood.

Interpersonal Factors: We humans, however, are social creatures. We are all embedded within circles of relationships with families, friends, and neighbors that influence how we see the world and ourselves. When these relationships exert pressure on people to conform to specific ways of thinking and behaving, or when they isolate, punish, or stigmatize people who look, think, or act differently, they can create mental health issues.

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Community Factors: These relationships, in turn, are significantly influenced by the norms, values, and practices of the organizations people interact with within their physical community (or online). This can include religious institutions, civic groups, clubs, schools, businesses, childcare, healthcare, and other entities.

The type of jobs available, the quality of housing and transportation, communication methods such as social media, and other conditions of the communities where people live, work, and recreate can also have substantial impacts on mental health. Many of these factors are combined to produce vast social isolation and loneliness that today is a major driver of mental health struggles.

Structural Factors: The community is significantly influenced by the norms, values, and practices mandated by local, state, and national policies and regulations, which in the U.S. are almost always fashioned to meet the interests of the institutions and people that hold the most economic and political power.

The vast economic inequality and inflation-adjusted stagnant incomes that affect many people today, for example, result from policies designed to siphon wealth upward from everyday people to corporations and the super-rich. These policies are causing many people to feel left behind economically and socially and producing harmful social, psychological, emotional, and behavioral outcomes.

Environmental Factors: All of these factors are significantly influenced by the environmental circumstances in which people exist. This includes the topography and the condition of food and water, open spaces, forests, waterways, grasslands, biodiversity, and other ecological factors. Polluted air and water, for instance, can generate mental health issues.

The 5 drivers of mental health struggles generated by the C-E-B catastrophe discussed at the start are aggravating all of these stressors and adding many new ones. One of the cumulative effects can be both short and long-term violence that impacts the social, psychological, emotional, and behavioral conditions of families, communities, and all of society.

In sum, the social-ecological model clarifies that, except in rare cases, no single factor alone is responsible for the vast majority of mental health and psychosocial struggles. To use an old Lakota Nation saying, our health and well-being are products of “all our relations.”

Rather than continuing to privatize the responsibility for psychological, emotional, and behavioral problems to the individual alone, we must recognize that the entire population is already, or will soon experience, struggles caused by numerous interacting stressors.

We must expand beyond merely treating individuals who experience symptoms one at a time to proactively help all adults, adolescents, and young children engage with others in activities that strengthen and sustain their capacity to remain socially, psychologically, and emotionally healthy during adversities. This requires the use of a public health approach to mental wellness and transformational resilience.

A public health approach focuses on the entire population, not just on individuals deemed to be at risk or who already exhibit symptoms of problems. And it prioritizes the prevention of mental health and psychosocial problems.

Population-level prevention comes about by actively engaging neighborhood and community members in activities that strengthen protective factors, including social support networks, local resources and services, resilience skills, and more, that help buffer them from severe stresses and traumas and enable them to use adversities as catalysts to find constructive new sources of meaning, purpose, and hope in life.

A number of programs are doing leading-edge work in this arena. The North Carolina Healthy and Resilient Communities Initiative, for example, has 50 multi-sectoral community collaboratives operating or in development working to build mental wellness and resilience. The Community Resilience Initiative in Walla Walla, Washington, is another excellent example. And the Neighborhood Resilience Project in Pittsburg, Pennsylvania, uses trauma-informed community development to achieve its goals. Many other initiatives are underway as well.

In many locations, a public health approach to mental wellness and transformational resilience also integrates group and community-minded healing methods into the prevention strategies to help people recover when they experience serious traumas.

A number of organizations offer effective ways to do this work. The Community Resilience Model developed by the Trauma Resource Institute is an excellent example. The trauma relief and resilience-building method offered by the Center for Body-Mind Medicine is another. Integrated community therapy, advanced by the Visible Hands Collaborative, offers still another effective approach.

When these group and community-minded healing methods are utilized, individualized mental health services remain very important. But they are just one element of a much more comprehensive holistic approach.

To prevent and heal the pervasive social, psychological, emotional, and behavioral struggles speeding toward us due to the C-E-B catastrophe, we must de-privatize mental health and address “all our relations.” We must respond through a population and community lens, not an individual one.