Why Are Mental Health Issues More Prevalent Among Certain Groups?
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What would your thoughts be like if you felt isolated from other people on a regular basis? Where would your head be if you were denied the same rights as your neighbor based on differences between your authentic selves? What would your internal state be if you found employment difficult, were largely seen as invisible, and had no voice in the groups that determined the direction of your life or state of your community? How would your mental health be if the system supposed to rehabilitate you made your life exponentially harder to live?
Mental health is the capacity for any person to show up in wholeness and resilience in their own lives, in their relationships, in their communities, and in society. The World Health Organization (WHO) stresses that mental health is fundamental to interpersonal interaction, thinking, emotion, productivity, and the enjoyment of life. From this viewpoint, WHO asserts that the promotion of mental health is vital on the level of the individual, community, and society.
Mental health is a state of well-being characterized by:
- An individual’s ability to see their own abilities
- The capacity to cope with normal life stresses
- The capacity to contribute to one’s community
- More than just the absence of disease or infirmity
According to WHO, the ability for people across our globe to live authentically in wholeness can be undermined by a vast and complex array of interconnected external and internal conditions. Refining the complexity down to into understandable essence, WHO identifies that mental health can be fostered or disrupted as a result of:
- Opportunities and rights at the broader environmental level
- Living and working conditions at the social level
- Cognition and behavior at the individual level
Groups with Greater Risk for Mental Health Issues
According to a 2017 report on the Global Burden of Disease by the Institute for Health Metrics Evaluation (IMHE), just shy of 971 million people around the world experienced mental disorders, slightly more than one out every ten humans alive. According to authors of a 2018 article on Mental Health published on the site Our World In Data, it’s entirely possible that this number is higher as uncertainty on the data on mental health is high. Mental health disorders are wholly underreported, especially in data-scarce lower-income countries.
With a minimum of 10 percent of the global population experiencing depression, anxiety disorders, bipolar disorder, eating disorders, schizophrenia, or other disruptions to mental health, there are some groups on our earth that experience higher rates of mental health issues than others.
Populations at increased risk for mental health problems include:
- People affected by violence, conflict, and forced migration
- Children and young people in vulnerable circumstances
- People living in poverty
- LGBTQIA+ people
- Indigenous people
- People with disabilities
The Underpinnings of Mental Health Struggles for Vulnerable Populations
According to The Lancet Commision on Global Mental Health and Sustainable Development, there are four common underpinnings to struggles with mental health in vulnerable populations:
- Denial or lack of access to fundamental rights and services
Keep reading to learn more about how each of these experiences impacts mental health generally, including one example of how that experience plays out for one vulnerable group in our world.
The Impact of Isolation on Mental Health – Adolescents
Social isolation is a condition whereby people lack relationships and interactions with other people. While the impacts of isolation on mental health vary depending on the extremity and length of isolation, social isolation can lead to mental health issues like higher stress levels, insomnia, self-medication using drugs and/or alcohol, depression, anxiety, hopelessness, and increased suicide risk. In addition, the impacts of isolation on mental health can continue to manifest well beyond the period of isolation. The groups most vulnerable when kept in isolation include children, older adults, minority populations, people living in poverty, women, and adolescents.
While isolation can be impairing to all humans, the period of adolescence (age 10 to 24) brings with it heightened sensitivity to social deprivation. According to an article in The Lancet published in 2020, adolescence is a time where teens experience heightened attenuation to the judgment and acceptance of peers. The importance of this judgment and acceptance is greater than any other time in life. During this period of development, teens and young adults are also learning how to reflect on themselves, empathize with others, and build the necessary social skills to build refined and reciprocal relationships.
As social animals, a person’s capacity to navigate interpersonal interactions with some measure of awareness and skill is crucial to coping with life’s stresses and contributing to society and adolescence is a key time in the development of social skills.
Despite the heightened importance of social interaction for mental health, physical health, and brain development in adolescence and beyond, isolation is pernicious. For some teens, social isolation can become a self-perpetuating cycle whereby social anxiety or fear of peer interaction can lead to a teen choosing isolation both from peers and trusted adults. When a teen feels the need to diminish interaction, it can stem from the teen’s capacity to develop the necessary interpersonal or social skills that could break the cycle of isolation. This can lead to struggles with mental health that last well beyond adolescence and into adulthood.
And while isolation is far from the only cause of mental health disorders in adolescents, it is one of the factors that leads to the high rates of mental health struggles that can be seen in this population. UNICEF estimates that nearly 20 percent of adolescents experience struggles with mental health—a number that could easily be higher as a result of underreporting in low- and middle-income countries.
WHO also points out that most mental health disorders begin by age 14, but are often undetected or untreated. In teens between the ages of 15 and 19, suicide is the third leading cause of death across the world, and depression is the fourth leading cause of illness. The WHO adds that even if mental health isn’t caused by isolation, other manifestations of mental illness, like depression, can exacerbate isolation and the cycles of disruption to healthy coping, contribution, and self-esteem.
The Impact of the Denial of Fundamental Rights on Mental Health – LGBTQIA+ Community
Groups who experience the denial of fundamental rights and/or lack of access to needed services are more likely to experience disruptions or barriers to mental health.
According to a WHO report called “Promoting Mental Health,” both extreme and subtle violations of rights can contribute to the development of mental health issues. More extreme forms of human rights violations (torture, rape, genocide, domestic violence, etc.) lead to PTSD, chronic mental health disorders, and the more visible and diagnosable forms of mental illness.
On the more subtle side of human rights violations, things like lack of access to healthcare, the inability to express one’s opinion, and limitations to freedom of movement can all limit capacities for wellness, mental health, and the capacity to improve one’s situation within the self and the greater society.
On this flip side of this, it’s been found that when human rights are adopted into healthcare and other service delivery, there are widespread benefits to people, budgets, systems, and society.
Although circumstances for LGBTQIA+ people are improving in many places across our world, homophobia, heterosexism, and discrimination are still very much alive and encoded into many of the systems and structures that impact our daily lives.
According to Equaldex, a user-informed database of LGBT rights across the 195 countries on earth, homosexual activity is illegal in 40 percent of countries and the right to change gender is illegal or not fully legal in 32 percent of countries. Same-sex marriage is illegal in 36 percent of countries and not fully legal in 57 percent of countries—making same-sex marriage illegal or limited in 93 percent of places on earth.
Same-sex adoption is illegal or limited in 92 percent of all countries. Also, 77 percent of countries offer no protections (or limited legal protections) against discrimination impacting LGBTIA+ people. Fifty-four percent of countries offer no housing protections for this community and 43 percent offer no protection from employment discrimination.
In the U.S., one of the manifestations of denial and lack of access to fundamental services for LGBTQIA+ people can be witnessed in healthcare. According to an article by the Center for American Progress written in 2018:
- 8 percent of lesbian, gay, and bisexual people were denied care because of their orientation
- 6 percent were refused care specific to their orientation
- 9 percent were subject to abusive or harsh language during treatment
- 7 percent were sexually assaulted by a healthcare provider
These numbers double, triple, and quadruple when looking at trans populations:
- 29 percent of trans patients experienced denial of care
- 12 percent experienced denial of care related to gender transition
- 21 percent of trans patients were subject to abusive language
- 29 percent (almost 1 in 3 surveyed) were assaulted by a practitioner
This was while there were protections in place for LGBTQIA+ people in healthcare under the Affordable Care Act. Protections based on gender identity in healthcare were removed by the Trump administration in 2020.
While lack of access to services and denial of fundamental rights is only part of the mental health puzzle for the LGBTQIA+ community in the U.S, just this one element of the reality of their lives opens the window to a potential reason why this community experiences disruptions to mental health at a far greater clip than other populations.
The National Alliance on Mental Illness (NAMI) reports that 37 percent of lesbian, gay, and bisexual adults experience struggles with mental illness. This is a rate that is twice the level of all adults in the U.S (19 percent). According to a report in Transgender Health, trans adults may be four times as likely to experience mental illness (58 percent) than cisgender adults (13.6 percent). In addition, those who experience discrimination in healthcare settings are six times as likely to avoid seeking care at all, which also contributes to the cycle of struggles with mental health.
The Impact of Social Exclusion on Mental Health – People Living In Poverty
According to WHO, social exclusion is a phenomenon whereby people who want a chance to contribute are non-consensually excluded from participation in the economic, political, social, and cultural dimensions of life at scales that range from the personal to the global.
Mostly a construct that pertains to countries with high inequality differentials, social exclusion centers around a person’s ability to be an active participant in the labor market and is seen as a cyclical phenomenon. Someone can’t work and this leads to a decrease in living standards and access to resources. The decrease in living standards and access to resources leads to increased difficulty in finding work. Because social exclusion is dynamic and multi-layered, ever-increasing struggles with mental health can be a reason for the cycle, and a consequence of the cycle.
While social exclusion can definitely be felt on the level of the individual, it extends to the greater society as well. Those who live in poverty are often ignored and othered, live in ghettoized areas where their struggles can’t be seen, and don’t have seats at the tables where decisions about their communities and their lives are being made.
In addition to lack of representation in political arenas, poor people do not have voices in regard to things like neighborhood design, the design of public places in their communities, policy for medical assistance, the functioning of labor unions, and more. Poor people are often seen as chattel for industry, and sometimes, their value as people is only seen as far as they can help life for the middle and upper classes go more smoothly. The consequences of social exclusion on mental health can include depression, anxiety, substance abuse, and suicide.
While rates of struggles with mental health cannot be explained simply by social exclusion, this factor contributes to higher rates of mental health for populations living in poverty. In the UK (a high inequality region) in 2014, for example, those in the socioeconomic bottom 20 percent were two to three times more likely to develop mental health problems than those in the highest echelons of socioeconomics.
It’s even worse for children. Children in the lowest income families are 4.5 times more likely to experience severe mental health problems than those in the highest. The unemployed experienced common mental health problems at a rate of around 30 percent—twice that of full- and part-time employees (15 percent).
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. adults 26 or over living under the poverty line were 1.8 times more likely to experience severe mental illness than those living 100 to 200 percent over the poverty line. They were 2.5 times more likely to experience serious mental illness than those living 200 percent or more above the poverty line.
The Impact of Prejudice and Stigma on Mental Health – Prison Survivors
WHO Europe founded the Health In Prisons Project (HIPP) in response to lack of fundamental care for the imprisoned and in response to the fact that prisons have become receptacles for those who would be better cared for through addiction and mental health treatment.
HIPP asserts that prisoners perform services that meet fundamental societal needs. Their holistic health is essential to good overall public health and improving health issues within this population does a public service by treating highly disadvantaged populations. In the WHO guide on how to foster health in prisons, it is estimated that of the nine million people incarcerated across the planet:
- 50 percent struggle with personality disorders
- 11 percent suffer from serious mental disorders
- 89 percent of prisoners have symptoms of depression
- 74 percent have stress-related symptoms
While many of the world’s incarcerated enter imprisonment with mental health struggles, there are many elements of prison existence that push people with mental illness deeper into disorder or result in the development of a mental health issue while in prison. Factors that create or worsen mental health disorders in prison include deprivation of liberty, limited communication with the community, overcrowding, dirty/depressing environments, poor food quality, lack of access to adequate healthcare, aggression (racial, verbal, physical, sexual), a lack of activities with purpose, drugs, enforced solitude, lack of privacy, lack of time for reflection, and shame and guilt.
And while some prison systems across the planet are working to become true agents of rehabilitation and uplift of the citizenry, others are institutions of modern slavery who benefit from recidivism and excessive punishment. Regardless, it is a fair bet that the mental health issues that develop or worsen during incarceration follow the formerly imprisoned well beyond the cell.
The challenges for the formerly incarcerated across the planet are numerous, especially in the country with the highest incarceration rates on earth. In the United States, ex-offenders are referred to as inhuman or “non-citizens” and scapegoated for problems with society within the political rhetoric of some. Media coverage of crime adds to these stigmas through disproportionate coverage, and popular culture feeds into stigmas for ex-offenders through promoting images of all criminality as pathology.
Even when someone is wrongly convicted, prison stigma can result in barriers to finding housing and gaining life-sustaining employment. Sometimes, survivors of prison even face discrimination at the social services programs designed to help them reintegrate into society. Within this system, five out of every six (83 percent) prisoners released from state prisons in the U.S. in 2005 were arrested again at least once in the nine years that followed.
In the U.S., it is estimated that up to 70 percent of the formerly incarcerated leave prison with chronic medical issues, substance abuse, or other mental health problems.