Promoting mental health
in racialised youth
Kwame McKenzie MD
outline

Mental health

Importance of time and context

Arguing for preservation of mental capital
2
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.
3
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
4
4 dimensions of causation

Individual

Ecological

Interaction between
ecological and
individual

Time
5
Time and Context for youth
6
7
% immigrant population by electoral ward
In Toronto
8
9
The problem is not just Bay Street
10
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
11
Ratio of earnings of recent immigrants to
Canadian people is decreasing over time
1
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
1980
Males w Univ. Deg
1990
Females w Univ. Deg
2000
Males w/o Univ. Deg
2005
Females w/o Univ. Deg
12
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
13
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.
14
Time and context for
providers
15
World financial crash has widespread
impacts
16
Austerity – at least for some…
17
Health increasingly seen as a commodity
not a right
18
Despite record government bail outs there
has been political shifts to the right
19
Public service reform in the hands of
bankers
20
Drummond on the problems with health
systems
21
Drummond solutions to health care
problems
22
Drummond challenges for immigration
23
Drummond Solutions for immigration
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What is missing?
How do we deal with time
and context changes in
policy realm?
Motivational interviewing
27
Pathways to change
28
Are there messages that speak
to the economic imperative but
offer a win-win scenario for
racialised youth mental health?
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.
30
Mental capital = IQ + EQ + mental health
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
32
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
33
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
34
What is social capital?

Social capital is a way of describing social
processes that shape communities or groups of
people.
35
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.
36
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.
37
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
38
Toronto’s multi-culturalism
39
Toronto multi-culturalism
40
Mosaic without the glue…
41
Shepherd’s bush high street
42
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Promoting mental health in racialised
youth

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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
44
Mental health promotion is not a mystery



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Evidence based, costeffective 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.
45
Thanks
Simplicity instead of complexity?
47