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Understanding Mental Health as a Public Health Issue

January 13, 2021

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A therapist holds a notebook and talks to a couple.

Poor mental health not only affects a person’s ability to live a fulfilling life and carry on with their school, work, or familial responsibilities; it also can lead to physical and social problems with serious impacts. By advocating for prevention and developing effective interventions, public health professionals help individuals and communities combat mental health issues.

Mental Health as a Public Health Issue

Public health aims to promote healthy lifestyles, as well as to detect, prevent, and respond to diseases. The prevalence of mental health issues that affect individuals’ physical and social well-being makes dealing with mental health integral to achieving public health goals.

To begin with, mental health has a huge impact on how people relate to others, make decisions, and handle stress. People’s ability to live fulfilling lives often depends on their mental health. This makes protecting and restoring mental health of immediate concern to public health professionals.

Poor mental health influences people’s relationships with their children, spouses, relatives, friends, and co-workers. Often, poor mental health leads to problems such as social isolation, which disrupts a person’s communication and interactions with others. This can have particularly harmful effects on children and adolescents whose development depends on forming bonds with their family members and peers. In adulthood, this social isolation can lead to family breakdown, divorce, or even childhood neglect.

Mental health problems frequently put financial and emotional strain on families. For example, a family trying to address a child’s mental illness may exhaust untold funds in search of treatment. Individual family members may also struggle to cope with their own symptoms that require support, such as depression or sleeping problems.

Children who have family members experiencing mental health problems may blame themselves. This can result in loneliness and feelings of being different. It may also lead to future behavioral or social problems. Additionally, as families address their loved ones’ mental health problems, they may socially isolate out of fear of judgment from others, further disrupting their emotional well-being.

Mental Health and Substance Misuse

A clear relationship exists between mental health issues and substance misuse. Each can lead to the other. In fact, one in four people with a serious mental illness also has a substance use disorder, according to the National Institute on Drug Abuse. Data from the Substance Abuse and Mental Health Services Administration (SAMHSA) shows that people with mental health issues are also at greater risk of using nonprescription opioids.

People with mental illness consume substances that harm their health at higher rates than people without mental health issues, according to the 2018 National Survey on Drug Use and Health. Consider the following statistics: 37 percent of individuals with severe mental health issues smoke cigarettes, while only 16 percent of people without mental health issues smoke; nearly a third of adults with severe mental health issues are binge drinkers, compared to a quarter of people without mental health issues who report binge drinking.

Additionally, the National Institute on Drug Abuse reports an increased risk for the development of substance use disorders among children and adolescents with mental disorders. The research shows that children develop mental health issues such as depression and anxiety before they develop substance use disorders, suggesting mental health issues lead to problems with alcohol and drugs.

Mental Health and School

Evidence suggests that poor mental health affects people’s educational success. Many students experiencing mental health issues struggle to form positive relationships with their teachers. They may also find it difficult to concentrate, feel motivated, or follow school rules. This often results in disciplinary measures that can interrupt their learning process.

According to the Child Mind Institute, the suspension/expulsion rate for students with emotional disturbances, for example, is 64 percent. Additionally, every year nearly 28,000 students with mental health issues and other health issues drop out of school. These individuals who drop out are 63 times more likely to end up in jail than college graduates. People with no high school diploma also live 9.2 years less than high school graduates.

Public health professionals know that education levels play an important role in many aspects of a person’s wellness and quality of life. In fact, greater levels of health correlate with higher levels of education. The Centers for Disease Control and Prevention (CDC) reports that the mortality rates of people with some college are half of those of people who never attend college. Rates of diabetes and asthma are also lower for people who attain higher levels of education.

Mental Health and Work

Mental health issues can also lead to struggles at work. Mental health issues often reduce concentration, which can compromise a person’s productivity. The National Alliance on Mental Illness reports that difficulty focusing often accompanies depression. Reduced productivity can limit one’s ability to earn promotions, excel, and build successful relationships with supervisors and co-workers, which ultimately affects job satisfaction. Mental health issues can also lead to increased absenteeism at work. This can result in job loss or reduced hours, which affects a person’s ability to earn a living.

Job loss can result in the loss of health insurance, and the loss of health insurance reduces people’s access to health care, which can result in untreated health conditions and the inability to receive preventive care. A diminished ability to earn a living can also lead to poverty, which affects people’s ability to find housing and receive a quality education, among other things.

Mental Health and Physical Wellness

Mental health issues influence the onset, development, and effects of physical illnesses. Often, high-risk behaviors such as substance misuse and physical inactivity correlate with poor mental health. Research also indicates that mental illness could reduce life expectancy by 20 years, according to a 2019 study published in The Lancet Psychiatry. The study found people with depression have a 40 percent higher chance of developing cardiac disease, hypertension, stroke, and diabetes than the general population. In addition, the study found that mental illness can reduce life expectancy by up to 20 years. Such statistics highlight that public health and mental health are two sides of the same coin.

Mental Health and Marginalized Communities

Marginalized communities consistently experience worse mental health than other communities for preventable reasons. Racial, gender, and sexual minorities, as well as people from low socioeconomic backgrounds, often find themselves particularly hard hit by mental health issues.

Case in point, Black individuals make up about 12 percent of the US population, but as a result of historical social, economic, and political inequalities, they comprise around 40 percent of those who are homeless, 50 percent of those who are incarcerated, and 45 percent of the children in foster care. Homelessness, prison, and experience in the foster care system all increase a person’s probability of having a mental health condition. As such, Black individuals are often at greater risk for mental illness than others. Consider the following additional mental health disparities among marginalized communities reported by the American Psychiatric Association:

Up to 75 percent of youth in the juvenile justice system, who are disproportionately from racial and ethnic minorities, have mental health disorders.
Minority youth who have behavioral problems are more likely to be referred to the juvenile justice system than to healthcare providers, compared to non-minority youth.
LGBTQ individuals experience depression, anxiety, and substance misuse at a rate 2.5 times higher than heterosexual individuals.
Healthcare providers are less likely to offer African-American patients evidence-based medication therapy or psychotherapy than other populations.

Factors contributing to mental health disparities among marginalized communities include limitations to health care access and negative perceptions about mental health treatment.

Poor Access to Mental Health Care Services

Marginalized communities face many barriers to receiving needed mental health care. For one, individuals from these communities are overrepresented in jobs that do not provide health insurance. Without health insurance, few can afford any type of mental health care service.

Historically, people from marginalized backgrounds with insurance have encountered discrimination when receiving care or disparate treatment. For instance, Black individuals are offered medication and therapy for their mental health issues at lower rates than the general population, according to the American Psychiatric Association.

A lack of cultural competency among mental health care providers can diminish the quality of care marginalized individuals receive as well. According to Mental Health America, the fact that less than 2 percent of American Psychological Association members are Black makes it especially difficult for Black individuals to receive culturally competent care. Organizations that influence treatment approaches need more reflective representation within their ranks to expand marginalized communities’ access to mental health care.

Therapeutic relationships depend on understanding and comfort. A lack of diverse representation in the mental health field can limit both and makes it harder for mental health professionals to understand their patients’ identities and address them openly.

Finally, language barriers and implicit bias can interfere with access to mental health services, resulting in individuals giving up on treatment or not recovering completely. Additionally, many marginalized people have fewer mental health professionals in their communities, which can pose challenges to accessing care as well.

Cultural Stigmas and Negative Perceptions About Mental Illness

Cultural stigmas and negative perceptions about mental illness can discourage individuals from getting help. Attitudes about mental health issues vary among different communities. Both religious ideas and cultural perceptions can shape how people feel about getting mental health care.

Sometimes these ideas and perceptions stigmatize mental illness, which can prevent people from seeking treatment for themselves or loved ones. In some cases, communities may discourage men from showing any signs of weakness. This can result in reticence among men to seek needed mental health treatments.

Understanding different cultural perceptions about mental health is key to developing culturally sensitive programs and services accessible to members of all communities.

The Role of Public Health Professionals in Promoting Mental Health

Public health professionals play a key role in tackling the factors that adversely influence mental health. Addressing a community’s well-being requires a comprehensive approach. To promote mental health, public health professionals find ways to prevent mental disorders, improve access to mental health services, support recovery, and lower the rate of death, disease, and disability among those with mental illnesses. They also work to increase awareness of mental health issues and reduce stigmas, so people can get the treatment they need. Finally, they strive to eliminate health disparities and provide equitable access to health services.

Prevention and Intervention

Public health professionals develop programs that address the factors that contribute to poor mental health or focus on intervention methods known to foster good mental health. Identifying risk factors for mental illness, such as trauma and chronic health conditions, plays an important role in implementing prevention programs. Identifying risk factors also allows for early intervention. Examples of prevention and intervention strategies that can promote mental health include early childhood programs, programs for older adults, and violence prevention initiatives.

Early Childhood Programs

Early childhood intervention programs for at-risk children offer stable, emotionally supportive environments, learning opportunities, and interactions that stimulate development. These efforts help positively shape the architecture of children’s brains and can improve their chances of experiencing sound mental health throughout their lives.

The Infant and Early Childhood Mental Health Consultation (IECMHC) program, for example, helps families and adults who work with young children strengthen their ability to cultivate healthy environments that support a child’s social and emotional development. The program aims to respond before intervention is required.

IECMHC brings mental health consultants to childcare centers, homes, and preschools where they may engage in the following:

Consult with preschool staff, sharing strategies and insights regarding how to handle the mental health needs of families with infants and young children.
Provide childcare staff with referral information for mental health services appropriate for young children.
Consult with administrators regarding policies that support mental health and provide information about the effects of policies, such as expulsion, that affect mental health.

Programs for Older Adults

Programs that support older populations who face isolation may offer social activities, interactions with the community, and assistance dealing with other social and emotional issues. Such programs offer vital support to older adults, 20 percent of whom experience some kind of mental health issue, according to the CDC.

A recent study published by the Scandinavian Journal of Public Health found the most effective mental health intervention programs for older adults tend to have certain characteristics in common:

They take into account the individual needs and preferences of the older adults so as to develop motivation. Participant motivation is key to improving mental health in this population.
They continuously adjust to the changing physical, cognitive, social, and mental functioning levels of the older adults they serve.
They prioritize group-based intervention strategies that offer a social component.

The National Council on Aging lists several programs that can improve older adults’ mental well-being:

Healthy IDEAS (Identifying Depression Empowering Activities for Seniors) aims to detect and mitigate depression symptoms in seniors who have chronic conditions or limited abilities to function. The program screens and assesses older adults and provides education and referrals for mental health professionals as appropriate.
Brief Intervention and Treatment for Elders (BRITE) provides substance abuse intervention for seniors. The program offers substance abuse screening, identifies nondependent use of substances and prescription medication issues, and offers intervention strategies that prevent those issues from requiring extensive substance abuse treatment.

Violence Prevention Initiatives

The American Public Health Association reports that violence significantly harms children’s development and affected communities’ health. In addition to causing physical harm, violence and associated trauma negatively impact behavioral and mental health. In fact, trauma has been linked to substance misuse and self-injury, as well as depression, anxiety, and post-traumatic stress disorder (PTSD), according to the Substance Abuse and Mental Health Services Administration.

Programs that challenge social norms, reduce risk factors for violence, and cultivate resilience help improve a community’s health. For instance, in some communities, attitudes about a woman’s sexual purity and family honor have led to violent acts. Violence prevention initiatives can take on such ideas and make it harder to justify violent behavior on the basis of a social norm.

Whether addressing intimate partner violence or firearm violence, evidence-based programs can have an impact on this public health issue. The CDC offers recommendations for effective approaches to prevent every type of violence. Some proven strategies for addressing intimate partner violence include:

Bystander empowerment programs and education
Social-emotional learning programs for children and adolescents
Healthy relationship programs for couples

In addition to specialized approaches to the different types of violence, the CDC focuses on strategies that apply to addressing all types of violence:

Starting prevention efforts early and continuing them through life
Identifying the populations at greatest risk for experiencing and perpetrating different types of violence
Building prevention programs that consider the risk and protective factors most likely to influence several types of violence so as to make the broadest impact

Policy Advocacy

Public health professionals can fight for policies that foster mental health and allow people living with mental illness to thrive. A public health advocate might work to reduce homelessness and incarceration rates — circumstances that exacerbate mental illness and disproportionately affect people with mental illness. Public health advocates work to change systems that perpetuate mental health problems and the undignified treatment of people with mental illnesses.

A group of mental health organizations including Mental Health America and the National Council for Behavioral Health recently sent a letter to Congress advocating for policies that address mental health during the COVID-19 pandemic. Specifically, the letter exhorted Congress to:

Ensure that nonprofits receiving Medicaid reimbursements are still eligible for the emergency Small Business Loan Program because they are experiencing significant losses due to COVID-19, which can affect their ability to provide mental health services.
Expand flexible reimbursement policies regarding telehealth in Medicare to include audio only telephone services so millions of Medicare patients vulnerable to COVID-19 and in need of mental health care can get the help they need.
Allocate more funds for mental health and addiction care.

Mental Health Research

To identify comprehensive prevention strategies and intervention methods, public health professionals need evidence. When professionals conduct research through a public health lens, they uncover the evidence they need to develop the most effective approaches to prevention and treatment. Research also identifies causes of mental health problems, informing public health professionals’ work in policy advocacy, prevention, and treatment. Research illuminates the public health professional’s understanding of mental health at the individual and community level. Whether studying suicide using an epidemiological approach or examining social media’s effects on self-image, research offers public health professionals important insights.

Earn a Master of Public Health and Tackle Mental Health Disparities

Mental health issues put people at a disadvantage. Not only do mental health issues compromise people’s well-being, they levy social and physical consequences as well. To help individuals and communities foster their individual strengths, gain access to care, and address disparities related to poor mental health, public health professionals need empathy, as well as expertise in the best intervention and prevention strategies. Explore how Tulane University’s Online Master of Public Health program equips graduates to tackle mental health disparities and build healthier communities.