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“Efforts should include universal programs in school that help students develop views of themselves that are protective.”
OVER THE LAST THREE DECADES, Dr. Carol Aneshensel has earned a reputation as a leading scholar in how societal factors affect the mental health of populations. Much of her research in recent years has focused on the impact of social inequalities. Aneshensel has shown, for example, that where we live can have a significant effect on both our emotional wellbeing and cognition. In large national studies, she has found that the psychological benefits of living in affluent neighborhoods are greatest for residents with fewer financial resources. Similarly, Aneshensel and her colleagues were among the first to show that the cognitive function of individuals who are socioeconomically disadvantaged is higher, on average, when they live in a more affluent neighborhood compared to similar individuals who live in a low-income neighborhood.
Aneshensel, professor and vice chair of the Fielding School’s Department of Community Health Sciences, is also a leading voice on behalf of intensifying public health efforts to improve mental health while preventing and addressing mental disorders.
She spoke with the Fielding School’s UCLA Public Health magazine on that topic.
Q: People often think of public health goals in terms of physical outcomes. Why is it important to view mental health as a public health issue?
A: Mental health is inseparable from physical health. One in two Americans is at risk for having a mental, emotional, or behavioral disorder in their lifetime. One in four is affected in any given year. A major depressive disorder can sap people of their ability to concentrate. They may lose interest in the things that they usually enjoy, or their ability to function. The lost productivity runs in the billions of dollars – and that’s for depression alone, which is the single most common disorder. Anxiety disorders are also highly prevalent. And the suffering isn’t confined to the people with the disorder. Spillover to families is substantial and it is not uncommon for families to be unaware that something is seriously wrong until a crisis has occurred.
Q: What is public health’s role in trying to address mental health? Do we need to focus more on prevention for people who are at risk?
A: We do. The median age of onset for psychiatric disorders in the U.S. is 14, which means that primary prevention efforts should begin early in life. These efforts should include universal programs in school that help students develop views of themselves that are protective, such as programs that promote self-esteem and self-efficacy, along with positive social relationships that help people cope with life’s difficulties. Specific coping strategies, such as those involved in cognitive behavioral therapy, can be taught as ways of keeping stressful experiences from becoming instances of depression, anxiety, or other mental or behavioral disorders. Also, primary prevention activities should address mental health literacy: Adults as well as children should know the signs and symptoms of mental illness, so that they know when to get help or when to assist others in getting help before a crisis erupts.
Q: And it’s also important for public health, as a field, to work toward removing the stigma and encouraging people who are suffering to get treatment.
A: Right. I think that’s the number one thing here – working to remove the stigma so that those who are suffering aren’t afraid to come forward.
Q: What developments make you hopeful about progress toward these goals?
A: The most promising sign is the increasing attention to mental health by the World Health Organization through its annual World Mental Health Day, observed October 10, and its Comprehensive Mental Health Action Plan 2013–2020. Pending legislation at the national level in the U.S. also promises better and more accessible, comprehensive and integrated mental health treatment services. At the same time, the media has begun a noticeable shift in its coverage of mental health issues, from focusing exclusively on instances in which a person with mental illness perpetrates an act of violence to covering instances in which people lead productive lives and contribute to the community.