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Social interventions in mental health: a call to action

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Potential reasons for this evidence gap are readily identified. First, the most obvious responses to social determinants of mental ill health, such as poverty and inequality, are political. An attempt… Click to show full abstract

Potential reasons for this evidence gap are readily identified. First, the most obvious responses to social determinants of mental ill health, such as poverty and inequality, are political. An attempt to intervene with individuals to mitigate the consequences of social adversity may be seen as a reductionist diversion of attention from the need for wider societal change [8]. Second, clinical professionals and researchers may feel in danger of paternalism and overstepping role boundaries if they contemplate intervening in areas of private life such as friendships, or they may feel overwhelmed and powerless in the face of the severe social difficulties that many service users face. Third, the range of potential targets for social interventions is dauntingly wide and extends far beyond mental health services, encompassing individual, family, community and societal levels. Fourth, although there are few well-specified and evidencebased interventions that meet criteria for guideline inclusion, forms of help focused on the social have long been offered in many settings. Day centres and sheltered housing are among the environments in which workers offer service users help with social problems and with enhancing their social activities and connections. One might argue that these workers, often people with considerable interpersonal skills and life experience, know how to tailor interventions to clients’ individual circumstances, making development of more structured interventions unnecessary and a possible threat to individualisation. Finally, the dominant clinical professions in mental health care research are psychiatry and psychology, with a less developed research workforce in social care. And yet there are compelling reasons to promote more extensive development and testing of interventions aimed at preventing and/or improving outcomes of mental health problems via social pathways. First, as a group of influential advocates of a social paradigm in With this editorial, I am pleased to introduce a series of reviews on the state of the art in social interventions in mental health. That mental health is intertwined with the social is now accepted by all but the most diehard reductionists. Recent integrated aetiological models bring social factors, such as discrimination and deprivation into the neuroscientific mainstream [1], as explored in a previous Social Psychiatry and Psychiatric Epidemiology series [2]. Meanwhile, advances in data science and epidemiological methods allow deeper understanding of long-established relationships between mental health and social variables [3]. The relationship between social adversity and mental health problems appears bidirectional [4]: social adversity increases risk of poor mental health, and having a mental health condition increases risk of poor social circumstances and limited social connections. An important task for future research is to clarify these complex relationships and the pathways linking social determinants and mental health outcomes, with a view especially to identifying potential targets for intervention [5]. Even though the relationship between the social and mental health is well-established, the social remains the poor relative in the biopsychosocial triad when it comes to evidence-based interventions, such as in guideline recommendations. For example, NICE guidance for major adult mental health conditions has very brief lists of suggested social interventions alongside much more extensive lists of psychological and pharmacological interventions [6, 7].

Keywords: social adversity; interventions mental; epidemiology; health; social interventions; mental health

Journal Title: Social Psychiatry and Psychiatric Epidemiology
Year Published: 2017

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