Promoting mental health in racialised youth Kwame McKenzie MD

2 outline  Mental health  Importance of time and context  Arguing for preservation of mental capital

3 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.

4 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

5 4 dimensions of causation  Individual  Ecological  Interaction between ecological and individual  Time

Time and Context for youth 6

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8 % immigrant population by electoral ward In Toronto

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10 The problem is not just Bay Street

11 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

12 Ratio of earnings of recent immigrants to Canadian people is decreasing over time

13 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,

14 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.

Time and context for providers 15

16 World financial crash has widespread impacts

17 Austerity – at least for some…

18 Health increasingly seen as a commodity not a right

19 Despite record government bail outs there has been political shifts to the right

20 Public service reform in the hands of bankers

21 Drummond on the problems with health systems

22 Drummond solutions to health care problems

23 Drummond challenges for immigration

24 Drummond Solutions for immigration

What is missing?

How do we deal with time and context changes in policy realm?

27 Motivational interviewing

28 Pathways to change

Are there messages that speak to the economic imperative but offer a win-win scenario for racialised youth mental health?

30 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.

Mental capital = IQ + EQ + mental health

32 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

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

34 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

35 What is social capital?  Social capital is a way of describing social processes that shape communities or groups of people.

36 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.

37 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.

38 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

39 Toronto’s multi-culturalism

40 Toronto multi-culturalism

41 Mosaic without the glue…

42 Shepherd’s bush high street

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44 Promoting mental health in racialised youth  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

45 Mental health promotion is not a mystery  Evidence based, cost- effective 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.

Thanks

47 Simplicity instead of complexity?