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I’ve never found the social determinants and in particular the inequalities argument in mental health particularly compelling. Not because I don’t agree with it, but because I do. I just don’t understand who it addresses, what work it does & what it seeks to change. 1/8
Is it government? Because if it is, they’ve already been told this in the U.K. by think tanks from dozens of sectors, & they know and don’t think it is in their gift to change; they know & think that inequality is inevitable or has upsides; or they already agree. 2/8
If they already agree, the actions they take in MH are rooted in the idea that MH isn’t siloed- eg removing benefits sanctions will have a + effect on MH. But the primary argument for removing benefit sanctions isn’t better MH 3/8
It’s because you believe that is the correct thing to do. Better MH is a bullet point in the list of positives. It isn’t and can’t be the driver behind that policy decision. So who are we talking to when we talk about inequalities causing or exacerbating mental ill health? 4/8
Policy arguments don’t generally help clinicians or practitioners who are dealing with the here and now. Yes they can validate individuals who live with mental ill health/distress & who agree with this perspective; but they don’t do anything to help them now 5/8
(Also as an aside the inequalities argument is contested in MH. V strong evidence around eg poverty causing mental ill health but less strong around inequality per se: @vaughanbell https://twitter.com/vaughanbell/status/1045323063078899712?s=21) 6/8
So I’m left with the sense that the inequalities argument is for us, for the people making it. IMO a stronger argument is that improving MH support now is the correct thing to do & that if you are serious about MH you will make other policy decisions in other areas too 7/8
But it’s a different lens. It starts and ends with mental health. And I think that’s our current challenge- because for that argument to have traction, decision-makers have got to care about mental health. And I’m not sure the current ones do. 8/8 https://twitter.com/markoneinfour/status/1326109398293499905
