Mental Health and Society
Professor Bonnie Kerker, PhD ()
Session / Topic and Description1. / Overview of mental health as a public health issue
What role does society play in mental health? Is mental health a public health issue? In this session we will review the concept of public health and the history of how it’s changed over time. Why is mental health often considered a public health concern now, when it wasn’t 100 years ago? What’s changed? Should we be more concerned about mortality or morbidity? What are the implications of each? What does it mean to be a “public health issue” (e.g., individual vs. population-based, social and environmental influences, structural and systems approaches, levels of prevention)? How can that approach help us address mental health differently? We will also examine several public health theories (e.g., ecological theory and social capital theory) and discuss which ones are the best matches for thinking about mental health. Class expectations, including readings, papers, presentations, final exam, and grading will also be reviewed.
Readings:
1. Novick LF & Morrow CB. Defining Public Health: Historical and Contemporary Developments. In Public Health Administration. (Novick, L. F., Morrow, C. B., & Mays, G. P., eds.) Jones and Bartlett. Pages 1-34. 2008.
2. Report of the Surgeon General’s Conference on Children’s Mental Health: A National Action Agenda. American Journal of Health Education, 32(3):179-182. 2001.
3. NYC Mayor’s Office. Thrive NYC. https://thrivenyc.cityofnewyork.us/wp-content/uploads/2015/11/MentalHealthRoadmap.pdf. Pages 1-31.
4. Krieger N. Theories for social epidemiology in the 21st century: An ecosocial perspective. International Journal of Epidemiology. 30:669-677. 2001.
2. / Mental health: Biological or social construct? Or both?
Where do you fall in the debate – nature or nurture? Can’t decide? In this class we will discuss the origins of the biological conceptualization of mental health, and explore more recent epigenetic theories, which suggest that environment can actually have an impact on how genes are expressed. For children, this process can even begin in utero.
Readings:
1. Hurley D. Grandma’s experiences leave a mark on your genes. Discover Magazine. June 25, 2015. 1-9.
2. Epigenetics: Fundamentals. http://www.whatisepigenetics.com/fundamentals/ 1-3. 2016.
3. Carey N. Beyond DNA: Epigenetics. Deciphering the link between nature and nurture. http://www.naturalhistorymag.com/features/142195/beyond-dna-epigenetics.
4. Yehuda R, et al. Holocaust exposure induced intergenerational effects on FKBP5 Methylation. Biological Pychiatry. 80:372-380. 2016.
5. Thomson H. Study of Holocaust survivors finds trauma passed on to children’s genes. The Guardian. 2015. https://www.theguardian.com/science/2015/aug/21/study-of-holocaust-survivors-finds-trauma-passed-on-to-childrens-genes
6. Hamilton J. How a pregnant woman’s choices could shape a child’s health. NPR shots. 2013.http://www.npr.org/sections/health-shots/2013/09/23/224387744/how-a-pregnant-womans-choices-could-shape-a-childs-health
3 / Mental health surveillance
In order to understand how society and environment affect mental health, it is necessary to track population health. In this class we will discuss the importance of data to understand a public health problem and to track change. What are the different ways of collecting surveillance data? How has it been done in the past? How might it be done in the future? We will review examples of how surveillance data have been used to inform mental health and non-mental health policies in NYC, and explore what we can learn from population-level data (e.g., disparities, trends, risk factors). We will use first onset schizophrenia as an index of a surveillance program that both tracks current disease and prevention efforts. What does it mean for a mental health disorder to be “reportable”? Why is this important and how did it come to be?
Readings:
1. Mortality and Morbidity Weekly Report. Evaluation of a methodology for a collaborative multiple source surveillance network for autism spectrum disorders – Autism and developmental disabilities monitoring network, 14 sites, United States, 2002. 56(SS01): 29-40, 2007.
2. McCarthy MJ. Internet monitoring of suicide risk in the population. Journal of Affective Disorders. 122:277-279. 2010
3. Perou R. Mental health surveillance among children – United States, 2005-2011. Morbidity and Mortality. 62(02): 1-35. 2013.
4. Hennessy CH, Moriary DG, Zack MM, Scherr PA, Brackbill R. Measuring health-related quality of life for public health surveillance. Public Health Reports. 109(5):665-672. 1994.
5. Lieberman JA, Dixon LB, Goldman HH. Early Detection and Intervention in Schizophrenia: A New Therapeutic Model. JAMA. 310(7):689-690. 2013.
6. New York City Department of Health and Mental Hygiene. New York City Health Code. Pages1-29.
7. Other Media: Review Epi Query Website: https://a816-healthpsi.nyc.gov/epiquery/
4 / The influence of early childhood experiences on mental health
What’s your earliest memory? Babies and toddlers will not remember their first years, but – as we have now discussed – research shows that early childhood and prenatal experiences do matter and can have a great impact on both health and mental health. In this class we will explore research showing just how important those early years are. In addition, we will discuss how this knowledge can influence our thinking about primary prevention interventions to change the course of a young child’s life.
Readings:
1. Schonkoff JP, Garner AS, and the committee on psychosocial aspects of child and family health, committee on early childhood adoption and dependent care, and section on developmental and behavioral pediatrics. Pediatrics.129:e232-e246. 2012.
2. Centers for Disease Control and Prevention. The ACE study (About the Study, The ACE Pyramid, Major Findings, Questionnaires). http://www.cdc.gov/violenceprevention/acestudy/
3. Starecheski L. Take the ACE quiz – And learn what it does and doesn’t mean. National Public Radio. March 3, 2015. http://www.npr.org/sections/health-shots/2015/03/02/387007941/take-the-ace-quiz-and-learn-what-it-does-and-doesnt-mean
4. Boo K. Swamp Nurse. The New Yorker. February 6, 2006, 54-65.
5 / No Class
Assignment due: 5 – 7 page paper
Choose a mental health condition that affects children and/or adolescents. Explain why it’s important to public health and if it’s important to monitor (why or why not?). Identify a data source that can be used to monitor the condition and discuss the pros and cons of this data source.
6 / The influence of individual income and neighborhood on mental health
Have you ever wondered how your surroundings impact your health? Plenty of research has shown that it does. In this class, we will explore some environmental risk factors to poor mental health, including poverty, neighborhood and housing. However, being poor does not necessarily mean that you are going to develop a mental health disorder. We will discuss what it means to be “at increased risk” and how to properly interpret study findings. We will also address potential primary prevention interventions to counter the impact of these environmental factors. For example, do you think handing out money would impact mental health? The results of some studies may surprise you.
Readings:
1. A Summary Overview of Moving to Opportunity: A Random Assignment Housing Mobility Study in Five U.S. Cities. http://www.nber.org/mtopublic/MTO%20Overview%20Summary.pdf
2. MacDonald F. Study accidentally shows the incredible effect of helping the poorest families. Science Alert. http://www.sciencealert.com/a-study-has-accidentally-shown-the-incredible-effect-a-little-extra-money-has-on-the-poorest-families
3. Kamenetz A. How Trauma Affects The Brain Of A Learner. NPREd. June 2014. http://www.scpr.org/blogs/education/2014/06/02/16743/poverty-has-been-found-to-affect-kids-brains-can-o/
4. Velasquez-Maoff M. What happens when the poor receive a stipend? The New York Times, Opinionator. 2014. http://opinionator.blogs.nytimes.com/2014/01/18/what-happens-when-the-poor-receive-a-stipend/?_r=0
5. Other media: How poverty affects mental health. The Leonard Lopate Show. http://www.wnyc.org/story/how-poverty-affects-mental-health/ (16 minute audio)
6. World Health Organization and Calouste Gulbenkian Foundation. Social determinants of mental health. Geneva, World Health Organization, 2014.
7 / Discrimination, stigma, media and social media
Can how we’re treated by others affect our mental health? How does society’s reaction to mental illness (i.e., stigma) impact mental health treatment? Does this vary by culture? How can we reduce stigma? We will spend time in this class exploring initiatives to reduce these environmental stressors and discussing how far we have come, or not come. The impact of media on mental health will be addressed, in particular how celebrities and other role models affect how we view mental illness. We will also discuss the influence of social media on mental health, specifically depression and suicide among adolescents.
Readings:
1. Wortham J. Racism’s psychological toll. New York Times Magazine. June 2015. http://www.nytimes.com/2015/06/24/magazine/racisms-psychological-toll.html
2. Wyckof WB. Despite Deeper Understanding Of Mental Illness, Stigma Lingers. NPR Shots. September 2010. http://www.npr.org/sections/health-shots/2010/09/17/129937437/still-a-stigma-for-mental-illness
3. Donvan J. Behind Mental Health Stigmas In Black Communities. NPR. August 2012. http://www.npr.org/2012/08/20/159376802/behind-mental-health-stigmas-in-black-communities
4. Shapiro J. Study: Tolerance can lower gay kids’ suicide risk. NPR Health. 2008. http://www.npr.org/templates/story/story.php?storyId=98782569
5. Gregoire C. Heavy Social Media Use Linked With Mental Health Issues In Teens. Huffpost Science. July 2015._ http://www.huffingtonpost.com/entry/social-media-mental-health_us_55b129d9e4b08f57d5d3eedf
6. A.J. Morgan, A.F. Jorm. Recall of news stories about mental illness by Australian youth: associations with help-seeking attitudes and stigma. Aust N Z J Psychiatry, 43: 866–872. 2009.
Assignment due: 5 – 7 page paper
Choose a social or environmental factor and describe its impact on mental health. Should we monitor this factor in the population? Why or why not? Would it be ethical to do so? Is it ethical not to do so? How would it be helpful/harmful to do so? How could knowledge of the prevalence of this factor impact the implementation of primary prevention interventions?
8 / In-class Midterm Exam: 75 minutes
In the second half of this class, we will highlight the case of maternal depression. Why is this condition receiving so much attention? What are some public health approaches to addressing this condition? What barriers stand in the way of these approaches succeeding?
1. Solomon A. The secret sadness of pregnancy with depression. New York Times Magazine. http://www.nytimes.com/2015/05/31/magazine/the-secret-sadness-of-pregnancy-with-depression.html. 2015.
2. US Preventive Services Task Force. Final Recommendation Statement: Screening for Depression in Adults http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/depression-in-adults-screening1
3. Kerker BD, et. al, Identifying Maternal Depression in Pediatric Primary Care: Changes Over a Decade. Journal of Developmental and Behavioral Pediatrics.37(2):113-120. 2016.
9 / Structural interventions: Intentions and consequences
What is a structural intervention? How does it differ from an individual intervention? In this class, we will discuss the ethics of structural interventions and their ability to address disparities in a population. Are there ways of addressing a whole population of people in a positive manner? Or are such efforts just another example of a “nanny” state? We will discuss examples from both physical and mental health. In addition, we will examine the case of de-institutionalization and the resulting criminalization of mental health. Why did a policy with such good intentions have such unintended consequences?
Readings:
1. Cohen DA, Scribner RA, Farley TA. A structural model of health behavior: A pragmatic approach to explain and influence health behaviors at the population level. Preventive Medicine. 30:146-154. 2000.
2. Siberner J. Depression screening recommended for all pregnant women, new mothers. NPR Shots. http://www.npr.org/sections/health-shots/2016/01/26/464415212/depression-screening-recommended-for-all-pregnant-women-new-mothers. 2016.
3. Ellis J, Perl SB, Frieden TR, Huynh M, Ramaswamy C, Gupta LS, KerkerBD. Decline in smoking prevalence – New York City 2002-2006. MMWR. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5624a4.htm
4. CDC’s Frieden Spearheaded New York’s Nanny State. http://www.nationalreview.com/article/390619/cdcs-frieden-spearheaded-new-york-citys-nanny-state-brendan-bordelon
5. Deinstitutionalization: A psychiatric “titanic.” PBS Frontline This excerpt is drawn from Chapters 1, 3 and the Appendix of: Out of the Shadows: Confronting America's Mental Illness Crisis by E. Fuller Torrey, M.D. (New York: John Wiley & Sons, 1997). http://www.pbs.org/wgbh/pages/frontline/shows/asylums/special/excerpt.html.
6. Doll W. Family coping with the mentally ill: An unanticipated problem of deinstitutionalization. Hospital and Community Psychiatry. 27(3):183-185. 1976.
7. Talbott J. Deinstitutionalization: Avoiding the disasters of the past. Psychiatric Services. 55(10):1112-1115. 2004.
8. Westman J, Gissler M, Wahlbeck K. Successful deinstitutionalization of mental health care: increased life expectancy among people with mental disorders in Finland. European Journal of Public Health. 22(4):604-606.
10 / Harm reduction
What is harm reduction? Is it ethical to aim to reduce, rather than eliminate, harm? In this class we will explore both the practical and ethical issues around harm reduction. We will discuss specific techniques, investigate their effectiveness, and debate the morality of these policies. Suicide and substance abuse prevention programs will receive particular attention.
Readings:
1. MacCoun RJ. Toward a psychology of harm reduction. American Psychologist. 53(11):1199-1208. 1998.
2. Hathaway AD. Shortcomings of harm reduction: toward a morally invested drug reform strategy. International Journal of Drug Policy. 12: 125-137. 2001.
3. Sontag D. Addiction with a dark side. The New York Times. 2013. http://www.nytimes.com/2013/11/17/health/in-demand-in-clinics-and-on-the-street-bupe-can-be-savior-or-menace.html
4. Beller S. The New York Times is dead wrong about drug addiction. Salon. http://www.salon.com/2013/12/22/the_new_york_times_is_dead_wrong_about_drug_addiction/
5. Mohl A, Stulz N, Martin A, Eigenmann F, Hepp U, Husler J, Beer J. The “suicide guard rail”: a minimal structural intervention in hospitals reduces suicide jumps. BMC Research Notes.5:408-412. 2012.
Assignment: 5 – 7 page paper
Choose a mental health condition and argue for or against a structural intervention approach to address it. What are the ethical issues? What are the practical/logistical issues? If you don’t agree with a structural approach, what approach would work better? Why?
11 / The mental health system in the US and international comparisons
In this class we will explore the history of the mental health system for children in the U.S., and the likely direction in which the future system is headed. What makes up a mental health system? Is the system the same for everyone? If you could wave a magic wand, how would you structure it differently? We will also talk about how mental health care is delivered in other countries and examine how the structure of the system, in addition to differences in environment and structural approaches, may impact treatment and outcomes.
Readings:
1. Levine M. Children come first? A brief history of children’s mental health services. American Journal of Orthopsychiatry. 85(5):S22-S28. 2015.
2. Behrens D, Lear JG, Price OA. Improving access to children’s mental health care: Lessons from a study of eleven states. George Washington University, Washington DC. http://hsrc.himmelfarb.gwu.edu/cgi/viewcontent.cgi?article=1066&context=sphhs_prev_facpubs 2013.
3. Kataoka SH, Zhang L, Wells KB. Unmet need for mental health care among US children: variation by ethnicity and insurance status. American Journal of Psychiatry.159(9):1548-1555. 2002.
4. Harvard Medical School. Survey finds US has high rate of mental illness, low rate of treatment compared to other countries. Science Daily. https://www.sciencedaily.com/releases/2003/05/030507080958.htm 2003.