Pender Urges Psychiatrists to Address Social Determinants of Mental Health

Psychiatry should resume a focus on the prevention of the social, economic, and political factors that impact mental health outcomes, said outgoing APA President Vivian Pender, M.D., at the Opening Session of APA’s 2022 Annual Meeting. Her remarks expounded on the theme she had chosen for her presidential year: “Social Determinants of Mental Health.”

“It’s been said that your ZIP code or the color of your skin has the potential to influence your general health,” said Pender. “But it’s also clear that not enough attention is paid to how these factors influence your mental health, both negatively and positively.

“It may seem like these issues are outside our ‘traditional lanes,’ but mental health does not occur in a vacuum, and our models of mental health should similarly not ignore evidence of factors that affect our patients—such as racism, violence, migration, neighborhood, and climate change—and how our patients’ ancestry, their traditions, and culture that are transmitted from one generation to the next influence their mental health. Native American reservations are an example of our history that remains essentially hidden and neglected.”

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A central piece of Pender’s presidential year was the appointment of the Task Force on Social Determinants of Mental Health, chaired by past APA President Dilip Jeste, M.D. The task force developed recommendations for psychiatric education, research, advocacy, and clinical practice.

In clinical practice, Pender urged psychiatrists to talk deeply with patients about their social and family environments. “What does their average day look like? How are they paying their bills? We must ask them more about violence—any kind of aggression, but particularly domestic violence, not just today, but also in their past. We know that often they won’t volunteer this information, so we must ask. If we are genuinely interested, they will trust us and share their lived experience.”

To achieve and maintain the effort to bring about positive change, strong advocacy is needed. “We can also be ambassadors, educating students, other clinicians, and other disciplines about the importance of acknowledging the social determinants of mental health,” she said.

“No one is proposing that psychiatry abandon our medical precepts. But it is undeniable that understanding the social context in which our patients live has the potential to enhance care and their well-being. We have to extend ourselves to all stakeholders, local community groups, Black churches, reservation councils, law enforcement, schools, and so on and not wait for them to come to our siloed offices.”

Psychiatrists who speak with a united voice to federal, state, and local policymakers will have the broadest effect on the social determinants of mental health—advocating for policies that address structural racism, human trafficking, violence, and the neglect of children, she said.

“Over the years, I have been inspired by all those who volunteer their time and energy to [advocacy in] psychiatry. It is a field with a strong ethos of working in the public interest,” Pender said. “When we advocate together with one voice, we can wield substantial influence for the greater good.

“We have a collective and individual duty to not stand by, but to act where we can help those who cannot help themselves. The world will listen to us if we are genuinely caring. And this effort will go far to eradicate the stigma that exists within psychiatry.” ■