Promoting mental health in racialised youth

Kwame McKenzie MD

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outline

Mental health

Importance of time and context

Arguing for preservation of mental capital

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Mental health

“a state of wellbeing in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community”• World Health Organization.

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Rates of mental health of racialised youth

Some black and minority ethnic youth in Canada have lower rates of mental health problems others have higher rates

Substance misuse and suicidal ideation on increase

Refugee rates of illness are elevated• Hansson et al feb 2012

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4 dimensions of causation

Individual

Ecological

Interaction between ecological and individual

Time

Time and Context for youth

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% immigrant population by electoral wardIn Toronto

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The problem is not just Bay Street

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City1 City2 City3

Most children in Toronto live in City 3

1/3 of people in City 3 live under low income cut off

50% of the housing for families in City 3 is high rise

Poverty is color coded

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Ratio of earnings of recent immigrants to Canadian people is decreasing over time

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1980 1990 2000 2005

Males w Univ. Deg Females w Univ. Deg Males w/o Univ. Deg Females w/o Univ. Deg

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Canadian-Born Population and Immigrants

Reporting "Fair" or "Poor" Health,

Source: Newbold KB. Self-rated health within the Canadian immigrant population: Risk and the healthy immigrant effect. Social Science and Medicine, 2005.16

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More likely to develop poor health if you are non-European

* Significantly different from estimate for Canadian-born (p <0.01).Note: All explanatory variables are based on the situation in 1994/95. Because of rounding, some confidence intervals with 1.0 as upper/lower limit are significant.Data source: 1994/95 to 2002/03 National Population Health Survey, longitudinal file.

Time and context for providers

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World financial crash has widespread impacts

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Austerity – at least for some…

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Health increasingly seen as a commodity not a right

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Despite record government bail outs there has been political shifts to the right

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Public service reform in the hands of bankers

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Drummond on the problems with health systems

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Drummond solutions to health care problems

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Drummond challenges for immigration

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Drummond Solutions for immigration

What is missing?

How do we deal with time and context changes in policy

realm?

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Motivational interviewing

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Pathways to change

Are there messages that speak to the economic imperative but offer a

win-win scenario for racialised youth mental health?

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Mental capital?

If we are to prosper in a competitive world our mental and material resources are vital

Build environments that enable everyone to realise their potential

crucial for our future prosperity and wellbeing.

Mental capital = IQ + EQ + mental health

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EQ = social skills

Emotional intelligence (EQ) is not a new concept; Socrates: Know Thyself. Studies show that EQ is the best predictor of a child's

future achievement; better than any other single factor.

EQ is a better predictor of success than IQ and technical skills combined

Mental capital and health promotion

The challenge to government is to invest in our future They need to build IQ To get schools to build EQ But also to produce environments that protect mental

health

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Why are rates lower in UK despite ecological risk factors?

In the UK rates of mental health problems are lower in BME groups

Lower rates of mental illness and mental health problems associated with

Having friends from another culture• Bhui et al

? Because of social capital

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What is social capital?

Social capital is a way of describing social processes that shape communities or groups of people.

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Social capital

“By social capital I mean features of social life – networks, norms and trust – that enable participants to act together more effectively to pursue shared objectives”

• Putnam Social capital describes the forces that shape the quantity and

quality of social interactions and institutions “the glue that holds society together”

• Kawachi.

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Social capital: Sub-definitions

Bonding

• Between individuals in families Bridging

• Between different groups in a society Horizontal

• Between individuals and groups at similar levels in a society

Vertical

• Between different strata in society and ability to control government etc.

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Specific impacts on mental health from literature

Social capital’s relation to mental health is complex Different types of social capital impact on health in

different ways Bridging social capital may produce more access to

information, supports and safety nets which buffer the effects of life events on mental health

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Toronto’s multi-culturalism

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Toronto multi-culturalism

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Mosaic without the glue…

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Shepherd’s bush high street

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Promoting mental health in racialised youth

Developing a social system links City 3 - City 1 Decreasing gulf between rich and poor Increasing opportunity to build social capital Increasing opportunities to link culturally Developing a culture of preserving mental capital

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Mental health promotion is not a mystery

Evidence based, cost-effective strategies documented

Ontario legislature - every $1 spent on mental health promotion you get $7 return

PHAC youth tell us what they want..

But we do not do this very well.

Thanks

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Simplicity instead of complexity?