Mental health is an issue that affects one in five Canadians (“Mental Health Promotion in Ontario: A Call to Action.” 2018). An article was posted by The Star’s Peter Goffin (2017) which described how a famous rapper, Logic, spread awareness about this important issue. He wrote a song and used America’s suicide hotline phone number as the title. This raised discussion in Canada since we did not have a national, well-marketed, recognizable phone number for citizens in crisis (Goffin, 2017). Since then, the Canadian government has worked with Rogers to create one central line which will link existing hotlines across the country. This paper will discuss specific Canadian populations that are most at risk of impaired mental health due to the Social Determinants of Health (SDOH) impacting their lives. In addition, some nursing implications will be included to better understand Canadian mental health and preventing suicides.
SDOH: Early Life
Childhood experiences shape individuals more than most people understand. This determinant of health has lasting effects on a child’s biological, psychological, and social abilities even as adults (Mikkonen, J., & Raphael, D., 2010). The Canadian Facts states that the longer children live in adverse conditions the more likely they are to have developmental issues leading to cognitive deficits (2010). This source also states 15% of Canadian children are living in poverty, as defined as their parents earning less than 50% of median family income. A study in Utah evaluated over a thousand women’s self-reported abuse during their childhood and their dependence on government assistance as well as their current mental health (Cambron C., Gringeri C., Vogel-Ferguson M., 2014). This report found childhood abuse linked to many negative outcomes such as lowered academic, behavioural, and mental health. Adults exposed to violence in their early life are more dependent of government assistance due to lowered education and less successful employment outcomes. Abused adults are more likely to become obese and need further healthcare treatments and possibly medications. Lastly, antisocial and criminal behavior is more likely for an individual who has experienced childhood violence. In light of this data, early childhood development is integral to improving mental health across the nation. In addition, another report done by Larkin, H., & MacFarland, N. S. (2012) states that one in four adults is experiencing mental health disorders, a great number of those were affected by adverse childhood experiences. This report also explains that these same mental health and substance abuse problems have a strong correlation to increased suicides.
Nursing Implication: Building Healthy Public Policy
Improving early life development can be addressed with both a downstream and an upstream approach (Morse, 2018). A downstream approach is focused on treating the effects of a health issue. Talk therapy is an ideal example of this approach in cases of trauma or any other mental health concern. Nurses should be aware of the negative effects of childhood trauma in order to better recognize those affected and provide more specific resources or support groups. Nurses working in a low-income community should be especially knowledgeable as it was previously mentioned that affected adults tend to achieve lower paying jobs (Cambron et al., 2014). If these resources prove unsuccessful a suicide hotline would also be included in the downstream approach. On the other hand, the upstream approach focuses on prevention of the concerning health issue. For instance, finding ways to reduce childhood abuse and discrimination and in turn improve overall mental health would exercise this approach as described in the Canadian Mental Health Associations’ website (2018). One way in which children could spend time in a safe environment is through adequate daycare services. The Ottawa Charter’s health promotion strategy Building Healthy Public Policy would be an effective approach to accomplish this (The World Health Organization, 1986). A report written by Amber Moodie-Dyer in Missouri states that proper childcare improves childhood development and in turn, prepares youth for a successful education (2011). While her report discusses American states and by-laws the idea of childcare being un-affordable for low-income families remains universal. She explores the safety of children in unlicensed care and explains the likelihood of single mothers leaving their children with live in partners or friends (Moodie-Dyer, A., 2011). Using Canadian data nurses can create policies to implement better childcare in their cities by writing reports to Government decision makers. The government should be aware that early life development is a healthcare issue that has detrimental effects that will only end up spending healthcare dollars in years to come. Issues such as mental health disorders are a huge cost that can be avoided by investing into Canadian youth.
SDOH: Social Exclusion
Minority groups in Canada who are marginalized and limited in their access to social, cultural, and economic resources are said to be socially excluded according to York University’s list of Social Determinants of Health (SDOH) (Mikkonen, J., & Raphael, D., 2010). Social Exclusion encapsulate Aboriginal Status, Gender, Race, and Disability which are also included in York University’s list of SDOH. Individuals in any of these populations are more likely to be unemployed or earn lower wedges, have less access to healthcare and social services, and are far less likely to be given opportunities to further their education. For Aboriginal peoples in Canada, this exclusion is due to the brutal social, political, and colonial history (Cameron, Carmargo Plazas, Salas, Bourque Bearskin & Hungler, 2014). This includes the Indian Act of 1876, with a series of amendments which served as gateway to assimilation, The 60’s Scoop, in which over 11 000 children were removed from their homes and placed in child welfare system, and the Residential School system which displaced children from their homes and stripped them of their culture and language (Indigenous Culture Card London and Middlesex, 2016). In a study done in Alberta, inequities in accessing health care by Aboriginals was explored. Two Indigenous persons who had been to the Emergency Department recently were interviewed about their stay. Both expressed feeling less than other patients, having difficulty understanding the language and their own care, and feeling alone and judged (Cameron et al. 2014). With regards to Gender as a SDOH, women face more adverse social and professional conditions. Socially there is an expectation on raising children and professionally women are paid 80% of a man’s pay in the same position (Mikkonen, J., & Raphael, D. 2010). Canadians who are a part of the visible minority commonly face racism, lack of respect, and de-humanization. Similarly, individuals with a disability are part of a visible minority, they too face the same hardships as citizens of colour (Mikkonen, J., & Raphael, D. 2010). All of these SDOH create unsafe experiences and situations that negatively affect an individual’s health, as well as bringing a feeling of powerlessness. With regards to Canada’s new suicide hotline, these individuals are not likely to reach out and access this helpful resource in times of crisis.
Nursing Implication: Reorienting Health Services
Reorienting Health Services is the act of thinking outside the box, and outside the healthcare sector. This strategy revolves around the community and is sensitive to the needs being expressed by that specific population (Morse, 2018). In order to help Aboriginal individuals being affected by social exclusion it is important for nurses to advocate for their patient (World Health Organization, 1986). There is often a language barrier that requires nursing action to ensure their patient understands their own care plan. This often includes providing resources to patients. With regards to patients dealing with mental health disorders, resources may include expanding circle of care include a social worker or translator. As well as emergency or crisis actions such as a helpline. A report done by Lynne Pearce (2014) explains the nurses perspective on the other end of a helpline. A nurse states that operators have strong communication skills and are experts in the field of which they work. When discussing use of a helpline with patients experiencing social exclusion it should be important to explain the positive relationship individuals build with the operator. Helplines are free of judgment and many people benefit from an anonymous conversation.
Education may not seem as important to an individual’s health as proper food or housing for example, but it is a crucial determinant of health. Education creates a snowball effect which positively impacts people’s lives. Level of income, employment security, and working conditions are all improved when someone is educated (Mikkonen, J., & Raphael, D. 2010). When discussing mental health concerns education can be improved through resources. Whether an upstream or downstream approach is taken, if an individual or population is knowledgeable in finding help for themselves their overall health will be improved. Knowledge is power that can allow an individual to become an expert in their own care. Nurses and other healthcare professionals must also take on the role of being an educator in the sense that they have more information available to them than their patients might. For example, if a patient was experiencing mental health issues it is crucial that they are aware of local services that could help them. The one service all Canadians should be aware of and educated about is the suicide hotline, it works by locating a call and redirecting it to a local operator (Goffin, 2017).
Nursing Implication: Developing Personal Skills
In order to give the best care, it is integral that nurses use the Ottawa Charter’s strategy, developing personal skills (World Health Organization, 1986). This strategy supports personal development by providing education so that individuals have control over their health and are aware of opportunities available to them (Morse, 2018). In addition to aiding patients understand their conditions, this strategy is important for healthcare providers as well. There is always room for improvement and training programs should always be available and taken advantage of. The results of various training programs can have a large impact of nurse and patient relationships as displayed in a study done by Martha Scheckel and Kimberly Nelson (2014). The study focused on caring for suicidal persons. First the study explained that reading about a patient’s mental health status and previous behaviours contributed to fears before meeting with the patient. Charting describes a previous nurse’s perception of the patient and their actions, while it is necessary for that information to be documented, the context of which that occurred may be much different. As the nurses in the study began approaching clients with an open mind and the idea of wanting to understand the patients point of view they were able to extinguish fears and provide better care (Scheckel, M. M., & Nelson, K. A. 2014). Throughout this training nurse also learned that although suicide is an uncomfortable topic, many patients opened up easily about their troubles.
Nursing Implications are one of the most successful ways to positively impact a community. While suicide remains a prominent issue facing many Canadians, awareness is constantly being spread. Resources such as a suicide crisis hotline and other forms of therapy are readily available to citizens that simply need to be aware of these opportunities. Nurses across the country use many strategies to help individuals impacted by social determinants of their health.
- Cameron, B., Carmargo Plazas, M., Salas, A., Bourque Bearskin, R., & Hungler, K. (2014). Understanding Inequalities in Access to Health Care Services for Aboriginal People. Advances In Nursing Science, 37(3), E1-E16. doi: 10.1097/ans.0000000000000039
- Cambron C., Gringeri C., Vogel-Ferguson M.; Physical and Mental Health Correlates of Adverse Childhood Experiences among Low-Income Women, Health & Social Work, Volume 39, Issue 4, 1 November 2014, Pages 221–229, https://doi-org.proxy1.lib.uwo.ca/10.1093/hsw/hlu029
- Goffin, P. (2017). Canada is getting a national suicide hotline in 2017 | The Star. Retrieved from https://www.thestar.com/news/gta/2017/09/06/canada-is-getting-a-national-suicide-hotline-in-2017.html
- Indigenous Culture Card London and Middlesex. (2016). [Ebook]. London. Retrieved from http://www.healthyweightsconnection.ca/culturecard/london-indigenous-culture-card-.pdf
- Larkin, H., & MacFarland, N. S. (2012). Restorative Integral Support (RIS) for Older Adults Experiencing Co-Occurring Disorders. The International Journal of Aging and Human Development, 74(3), 231–241. https://doi.org/10.2190/AG.74.3.d
- Mental Health Promotion in Ontario: A Call to Action. (2018). Retrieved from http://ontario.cmha.ca/documents/mental-health-promotion-in-ontario-a-call-to-action/
- Mikkonen, J., & Raphael, D. (2010). Social Determinants of Health: The Canadian Facts. (p 32-53) Toronto: York University School of Health Policy and Management.
- Moodie-Dyer, A. (2011). A Policy Analysis of Child Care Subsidies: Increasing Quality, Access, and Affordability. Children & Schools, 33(1), 37–45. Retrieved from http://search.ebscohost.com.proxy1.lib.uwo.ca/login.aspx?direct=true&db=cin20&AN=108243804&site=ehost-live
- Morse, A. (2018). Student Health Promotion SDOH [PowerPoint presentation]. Retrieved from OWL.
- Scheckel, M. M., & Nelson, K. A. (2014). An interpretive study of nursing students’ experiences of caring for suicidal persons. Journal of Professional Nursing, 30(5), 426-435. doi:10.1016/j.profnurs.2014.03.003
- World Health Organization. (1986). Ottawa Charter for Health Promotion: First International Conference on Health Promotion Ottawa, 21 November 1986. Retrieved from https://www.healthpromotion.org.au/images/ottawa_charter_hp.pdf
- Pearce, L. (2016). Helpline nursing. Nursing Standard (2014+), 31(16-18), 20. doi:http://dx.doi.org.proxy1.lib.uwo.ca/10.7748/ns.31.16-18.20.s23
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