Incoming APA President Outlines Specific Plan to Address Social Determinants of Mental Health

By Mark Moran

The “normal” we left behind in March 2020 cannot be the world we return to when the COVID-19 pandemic subsides, said incoming APA President Vivian Pender, M.D., at the closing session of APA’s online 2021 Annual Meeting.

“I begin my presidency amid multiple ongoing crises that have been exposed by a global pandemic—social, economic, environmental, and political,” said Pender, who is focusing her presidential year on the social determinants of mental health. “[W]ith the slowing of the pandemic and increasing talk of ‘getting back to normal,’ there is another danger lurking—that we lose the perspective and vision that this pandemic has afforded us. This pandemic has revealed that previous ideas of normal were unacceptable for many people in this country. In too many places, what was considered normal fell far short of decent or adequate.”

So what can individual psychiatrists and APA do to bring about meaningful change?

“We ask our patients to speak openly and honestly. Psychiatry also has to speak the truth. Psychiatrists must address the systemic disparities so that meaningful empathy and treatment are possible,” said Pender.

“Psychiatrists are not economists, not politicians, nor Wall Street power brokers. But we do have collective experience and knowledge—as an organization of psychiatric physicians, we are experts in mental health and mental illness. And so we have the ability to focus our efforts where we can have the greatest impact—on population health and systems of care.”

The incoming president vowed to move APA toward addressing these issues through the creation of the Presidential Task Force on the Social Determinants of Mental Health. It will focus explicit attention on four broad determinants that ultimately affect health, mental health, and well-being:

• Social: Adverse child experiences, racism, lack of access to health care, and exposure to violence and to the criminal justice system. “Every one of these has an overwhelmingly negative impact on mental health. In our roles as psychiatrists and mental health experts, we know that there are culturally informed programs and interventions that are available. We have to advocate for solutions that are funded, implemented, and accessible.”
• Economic: “According to a 2019 Federal Reserve report—and this was before the pandemic—a third of the families in the United States would be thrown into debt by a $400 surprise. A medical bill, a car wreck, a layoff, any of these things. … Poverty is not relative; it is absolute in the way that it affects a person’s entire existence.”
• Environmental: “It matters where you were born and where you live,” Pender said. “Is there a grocery store nearby or only fast food—known to be factors contributing to obesity. Does your child have a safe playground to enjoy, or are you next to a highway or a polluting factory? Are you dealing with frequent storms or fires because of climate change? On the other hand, is there green space around you with trees, clean water, parks, and playgrounds? This makes a difference in stress levels and all the physiological consequences of increased stress hormones.”
• Political: “There are systemic policies, laws, and enforcement that sometimes serve to maintain social choices. These are the policies that effectively institutionalize forms of discrimination and produce deep disparities. These policies represent barriers to mental health care. I believe APA can make a difference by alerting legislators and the wider public to the deeply harmful effects of these policies on mental health.”

“As the task force begins its work on social, economic, environmental, and political determinants of mental health, we will be studying, educating, and advocating for the solutions we think will make a difference. We’re planning on consulting some of the best experts in psychiatry, sociology, economics, health policy, ethics, and other disciplines to look at how these problems impact people’s mental health.” The goal is to educate psychiatrists, the private sector, and the government and advocate for solutions.

“Our next steps together have so much power and possibility,” Pender said. “We are in the right place at the right time. More than anything, I know right now is the time, and APA is the organization. It is really you, the members, who have the knowledge and power to work toward these changes, and you are the people who make this work.” ■