1. Mental health, youth and racism Kwame McKenzie MD

2. 2 Mental capital the new frontier  If we are to prosper and thrive in our changing society and in an increasingly interconnected and competitive world, both our mental and material resources will be vital.  Encouraging and enabling everyone to realise their potential throughout their lives will be crucial for our future prosperity and wellbeing.

3. Mental capital = IQ + EQ + mental health

4. 4 EQ = social skills  Emotional intelligence (EQ) is not a new concept;  Around since 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  Robin Stern NYU

5. 5 Mental illness is costly  4 of the top 10 leading causes of disability  30% of disability claims and 70% of the total costs  estimated cost of mental illness to the Canadian economy is $51 billion  At least 50% starts before age of 14

6. 6 Mental illness prevention  Evidence based, cost- effective strategies documented  Ontario legislature concluded for every $1 spent on mental health promotion you get $7 return  But we do not do this very well.

7. 7 Mental health in IRER groups Canadian literature tagcloud

8. Rates 8

9. 9 Clusters of research  Rates  Social determinants  Barriers and facilitators of care

10. 10 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 16

11. 11 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.

12. 2011 schools data CAMH 12

13. Ontario Schools

14. Social determinants 14

15. 15

16. 16

17. 17 The problem is not just Bay Street

18. 18 % immigrant population by electoral ward In Toronto

19. 19 Ratio of earnings of recent immigrants to Canadian people is decreasing over time

20. 20 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

21. 21 A problem in the future?  City 3 is high poverty and high immigrant  Our population growth is due to people in City 3  If we are going to move forward and be competitive we need to invest in City 3  Parents doing a good job buffering children from problems  But what happens if we want to move forwards and integrate economies so that children can get access to resources and help build our future?

22. Racism

23. 23 Recorded racially aggravated crime England and Wales (data Home Office)

24. 24 Hate crimes in Canada in 2006 

25. Models of pathways to health impact of racism

26. 26 Pathways to racism’s health impact  Socially inflicted trauma mental, physical, or sexual  Economic and social inequality Decreased mobility due to racism (education, employment)  Inadequate, inappropriate or degrading medical care  Targeted marketing of commodities and lifestyles that can harm health: alcohol, tobacco, drugs

27. 27 US Surgeon general report mental health pathways  Internalization of racial stereotypes & negative images which denigrate individuals’ self-worth and adversely affecting their social and psychological functioning;  Institutional racism resulting in stressors that can affect mental health due to living conditions, crime, violence, poverty …

28. 28 Racism effects – getting under the skin  Acute stressor (life events)  Chronic stressor (micro-aggression)  Body: adreno-corticoids t-cell change early aging weathering foetal growth  Cognitive development Long term change in cognitive focus eg / increased vigilance  Personality/ identity (resilience/ vulnerability)

29. 29 Racism stress is different 3 stage model: 1) Stress because of life event 2) Stress because life event considered unfair 3) Stress because of inability to do anything about it

30. 30 Pascoe and Richman

31. 31 Pascoe and Richman  Links between racism and health occur through the mechanisms of stress responses and health behaviors.  Our synthesis of existing literature also suggests that social support, active coping styles, and group identification were most likely to serve a protective function in these pathways.

32. Racism and schizophrenia

33. 33 Stress of Migration increases risk of schizophrenia. Cantor Graae and Selten 2005

34. 34 Genetics

35. 35 Stress and daily hassles

36. 36 Stress  Increased rates of schizophrenia if you: live in neighborhoods that are stressful have numerous daily hassles

37. 37 Racism psychosis risk factor cross sectional  Odds of suffering from a psychosis: Verbal abuse victims – 2.86 (1.69-4.83) Racist attack victims – 4.77 (2.32-9.80) Thinking most employers racist – 1.57 (1.02-2.42) Karlsenn & Nazroo Am J Public Health. 2002

38. 38 Racism psychosis risk factor – cross sectional  Karlsenn et al Psychological Medicine 2005

39. 39 Racism ecological risk factor for psychosis  South London: rates of psychosis in ethnic minorities by ward taking into account age, sex, deprivation  Ethnic minorities more likely to suffer from psychosis: in areas 28-60% ethnic minorities = 2.4 in areas 13-28% ethnic minorities = 3.6 in areas 8-12% ethnic minorities = 4.4 Boydell et al BMJ 2001

40. 40 Discrimination psychosis risk factor - longitudinal  The Netherlands:  4722 people asked about discrimination (age, sex, handicap, appearance, ethnic group and sexual orientation).  Followed up for 3 year  Rates of psychosis increased in ethnic groups  Discrimination, not being an ethnic minority most important factor.  Janssen et al British Journal of Psychiatry 2003

41. 41 Interaction of race and other risk factors

42. 42 conclusion  We know that there are difference sin health  We know what keeps people in healthy  We know we have to integrate Toronto if we are going to move forward  We know that this may be at a cost to the diverse population because of racism  What are we going to help develop resilience?

43. Thank you