5 things everyone should know about mental illness
The role and importance of social determinants in improving mental health
June 2, 2021

May was Mental Health Awareness month, and organizations across the country are turning to self care as a solution for addressing and improving mental health. 


It’s well documented that chemical imbalances and genetic variants can lead to mental health conditions, but there are also elements in an individual's environment—or social determinants—that impact mental health. Better understanding these elements can help us improve the way we address mental illness.


This month, we’re exploring mental health conditions in a three-part series on mental health and social determinants. And to kick it off, we’re diving into five things everyone should understand about mental illness. 


Man with depression sits at oak table


Number one: Mental health and mental illness are not the same thing


The World Health Organization defines mental health as “a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.” 


In other words, just as “health” is not simply the absence of illness—but a state of physical, mental, and social well-being—just because someone has not been clinically diagnosed with a mental disorder does not mean they have good mental health.


Number two: Mental illness comes in a variety of forms and severity—and all are important to address


When we talk about physical health, it’s well accepted that diseases and conditions come in all forms and severities. But many times, behavioral health diagnoses are lumped into one, large category: mental illness. 


To properly support and address individuals with mental health conditions, we need to begin looking at each condition individually and build solutions designed to help members with those conditions. 

Mental health diagnoses, at a glance

The most commonly discussed mental disorders include anxiety, depression, schizophrenia, bi-polar disorder, and alcohol and illicit substance dependency. 


Infographic illustrating that 1 in 4 adults in the US have a mental disorder


These can be further divided into sub-threshold mental disorders and severe mental illness. 




Number three: A person’s environment significantly impacts mental health


Many mental and behavioral health conditions can be linked to environmental stressors. As outside events or circumstances create a state of strain from an individual’s inability to meet certain “capabilities,” the prolonged stress can negatively impact mental health. 


Political Theorist Martha Nussbaum’s 10 Domains of Capabilities

  1. Life: Not Dying Prematurely
  2. Bodily Health: Being able to have good health
  3. Bodily Integrity: Having autonomy in movement and security
  4. Senses, Imagination, and Thought
  5. Emotions: Having freedom of emotional expression
  6. Practical Reason: Using practical reasoning to plan one’s life
  7. Affiliation: Ability to interact with others in a way that entails respect and non-discrimination
  8. Play: Being able to laugh, play, and enjoy recreation with others
  9. Other Species: Being able to live with concern and empathy for others
  10. Control: Being able to participate and exert control over one’s environment 


The intersection of socioeconomics and mental health disorders

Out of 115 studies on socioeconomic status and mental health, 70 percent of studies showed a correlation between different poverty measures and occurrence of common mental disorders. 


Analysis was performed across different sectors that determine socioeconomic status:  debt, low education attainment, material disadvantage, and unemployment. A distinct gap appeared between wealth and opportunity between the richest and poorest populations, correlating lower social gradient placement with higher numbers of mental health disorders. These differences were exacerbated in marginalized groups such as people of color, immigrants, women, and the LGBTQ community. 


The presence of comorbidities in lower socioeconomic populations is also much higher than in populations of higher economic status. Compounding complications occur frequently—due to lack of access to proper educational resources or health care as a result of historical systematic racism and discrimination. These complications often include comorbid mental health conditions.

Number four: Relief is more nuanced than just taking a pill 

Medication adherence is key to successfully managing mental and behavioral health conditions, but establishing that adherence can prove challenging.


Why? 


In addition to the mental strain that behavioral health conditions cause, the medications used to address these conditions often cause side effects that make taking the medication unpleasant. 


The unfortunate side effects of many medications and their impact on medication adherence

The side effects of modern antidepressants and antipsychotics have hardly changed over decades of psychopharmacology. These side effects can often make a patient feel worse before they get better—or cause side effects which the patient perceives as worse than the disorder itself. 

One of the common side effects found in antidepressants and antipsychotics is weight gain, which correlates with physical health issues and a loss of self esteem and perceived self value. Marginalized groups are disproportionately affected by the negative psychological side effects, particularly women, women of color, and the LGBT community because standards of beauty and cultural stereotypes place additional pressure to conform and isolate those who do not fit into conventional beauty standards. 

Other medications can lead to increased risk of hypertension or other medical conditions. Individuals in low-income communities may only be able to afford to see one provider, leaving them to choose between addressing their mental health condition or the physical health symptoms. This stress can further compound depression or other mental health disorders (ex: bipolar depressive disorder).

The importance of motivating members to take medications

Because medications for mental health conditions can take months and many adjustments before they begin to take full effect, many patients stop taking medications because they do not believe the medications are alleviating their mental health symptoms. As one Wellth member shared: 

I used to take 25 and a half prescribed medications a day. I have to advocate for myself because one medication will make your hair fall out, this one will make my stomach hurt. I also had a hydrochloric one for my rheumatoid arthritis, which caused me to lose focus out of my right eye. I said there’s  gotta be a better alternative so I quit taking it because my vision hasn’t changed in the last five years.”

Feedback from Wellth Member
Trisha

Photo of Wellth Member, Trisha

Great care must be involved in prescribing and monitoring medications, especially when an individual has co-morbidities and the medicines may react negatively to one another and be detrimental to the patients health. Providing individuals with support to encourage them to continue taking medications as prescribed, attending physician appointments, and communicating with care teams can be the difference between managing a condition and continued struggling. For Trisha, having a program like Wellth helped her take her medications consistently enough, long enough, to accurately report side effects to her care team and make adjustments to improve her quality of life with a new care plan that works. 

An incentive based program, such as Wellth, can help reward patients taking their medicine to push through the present bias and get to where they can really reap the benefits of sustained medication usage. Wellth’s live member support also provides someone for members to talk to about complications involving their medication regimen while also giving care teams an insight to their patient’s adherence and monitoring issues as they arise. The monetary rewards can also help give people in lower income households a leg up on providing for themselves and their family, allowing them to invest in their health and consequently, their community.

Number five: Supporting those with mental health conditions starts with empathy


Wellth supports our members by approaching them where they are, and working with them to achieve the outcomes the health teams are looking for. Our Wellth app and incentive program are designed to uplift members in the capabilities they are struggling with and support them in their journey to condition management through medication and care plan adherence. 


Proper medication adherence in patients with mental health disorders can improve their capabilities interpersonally as well as socio-economically. When a patient is taking their medication consistently and as prescribed, their ability to participate in meaningful connections increases—making other things, like holding steady employment, easier. 


Daily medication adherence provides:

  • Improved longevity
  • Increased bodily autonomy through consistent physical health and the ability to meet one’s own health needs
  • More opportunities to participate in community and recreational activities as mood and mobility improves



“I have 5 different diagnoses. I’m diagnosed bipolar, poly-substance abuse, anxiety, PTSD, and depression. I didn’t want to accept my diagnoses, so I would take my pills for a little while and then I start feeling better—so of course I stop taking my pills… As long as I take my medication I don’t have to worry about my diagnosis…Not only have I taken my medication, I have also been able to keep a job, to keep my apartment, to keep my lights on, to keep food in the refrigerator…It’s just with me taking my meds, I get to live a full life.”

-Feedback from Wellth Member

Photo of Wellth Member