January 14, 2016

On January 13, Dornsife School of Public Health welcomed its first speaker of 2016, Ruth Shim, MPH, MD, Vice Chair of Education and Faculty Development in the Department of Psychiatry at Lenox Hill Hospital. Framing disparities in mental health as a social justice problem, Dr. Shim claimed that disparities in mental health, "has everything to do with the distribution of money, power, and resources which are determined by policy decisions." Health disparities, including disparities specific to mental health, are determined by how resources are distributed and who receives them.

Dr. Shim began researching health disparities in mental health populations when she noticed that her psychiatric patients who are markedly poorer and lived in disorganized neighborhoods had a higher tendency of having persistent mental health problems, despite treatments and medicine. Some of the mental health-related outcomes that studies have shown to be associated with poverty and income inequality are depressive disorders, drug overdose deaths, juvenile homicides, and cognitive, behavioral, and attention-related problems in children. "It felt to me like I wasn't doing anything. I was handing prescriptions and saying 'good luck,'" said Shim.

In an Op-Ed piece published in the Philadelphia Inquirer's Public's Health blog before her talk, Shim noted that with 20 percent of Americans having serious mental illness, this inequity is something that needs to be addressed. Although programs like the Nurse-Family Relationships Study and Medical-Legal Partnerships have minimized the gap, "as a society, we must determine that this is important enough for us to pursue, and develop the political will to change the system," argued Shim.

Looking at the causes for the disparities led her to the top social determinants of mental health: discrimination and social exclusion, adverse childhood experiences, education, health care access, and poverty, to name a few. In line with social determinants of health in general, Dr. Shim adds that a few other factors contribute to the disparities that are not necessarily always linked to mental health, such as food insecurity and the built environment.

Part of the problem, Dr. Shim contended, is culture. She provided the example of psychiatrists being quick to diagnose children who do poorly in school with attention-deficit disorders, without questioning underlying causes of social determinants like food insecurity and poverty. "Psychiatrists don't think about stigma and health disparities at all, and this is the biggest problem," said Shim.

Dr. Shim called on public health professionals, psychiatrists, and other healthcare providers to extinguish the stigma on mental health in an effort to achieve the long-term goals of eliminating disparities.