Citation

Bhavsar V, Bhugra D, Persaud A. Int. J. Soc. Psychiatry 2020; ePub(ePub): ePub.

Affiliation

The Centre for Applied Research and Evaluation International Foundation (CAREIF), Centre for Psychiatry, Barts and The London, Queen Mary's School of Medicine & Dentistry, London, UK.

Copyright

(Copyright © 2020, SAGE Publishing)

DOI

10.1177/0020764020915236

PMID

32223492

Abstract

Many governments around the world have made political commitments to ‘parity of esteem’ between mental and physical health. Challenges remain, particularly in how this talk of parity relates to equity in resources for provision and research in mental and physical health (Ashton, 2017). Sen (2013) speaks of ‘equality of what’, and we can also ask ‘equity of what’. In line with policymakers and clinicians, patients and the public enthusiastically support the idea of equity between mental and physical health. Contained in this equity are multitudes of possible pathways to mental–physical health equity. Fundamental to inequity between mental and physical health is the disparity in regard given to causes and moderators of mental ill health, compared to physical health. That is, a recognition that smoking or poor diet, which are predominantly risk factors for poor physical health, are of equal relevance to risk factors for mental health, such as trauma, substance use, and socioeconomic disadvantage. Paralleling the increasing visibility of mental health on the world stage has been the emergence of violence as a global policy issue. In 2004, World Health Organization (WHO) helped to establish the violence prevention alliance, aiming to address violence and improve services for victims. WHO defines violence as

the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation.

This definition gives rise to the classification of violence into self-directed, interpersonal and collective forms of violence. Each of these forms is further classified, with interpersonal violence subdivided into family and intimate partner violence, and community violence, and collective violence classified into social, political and economic violence. The rise of coordinated efforts to address violence, and increased visibility of mental health in global policy, is not coincidence – violence is important, both as a risk factor for mental ill health in individuals and as a society-level problem which shapes society’s capacity to respond to challenges of identifying, assessing and mitigating the impact of mental and behavioural disorders. Eco-social models of incidence, care and provision have been advanced for both mental ill health (Mair et al., 2010) and violence (Garcia-Moreno et al., 2005). In this regard, government policies relating to public institutions such as health care, education, criminal justice, and social care, form an important but usually under-considered influence on health. Mental health is relevant for understanding and developing public policy on violence, including violent crime, and could be used to develop more effective policy and interventions to improve public safety. More explicit framing of geopolitical influences in violence and mental ill health could be beneficial in understanding and responding to the burden of mental ill health globally.

Public health involves theoretically guided, multidisciplinary, empirical, and practically focused approaches to the prevention, treatment and alleviation of ill health and its impact on populations. So public mental health is about the research, policy and practice that influences mental health at a population-level ...

Language: en