To better tackle mental illness, look to the societies in which it occurs.

The enjoyment of the highest attainable standard of physical and mental health is a human right. That’s according to the Office of the United Nations High Commissioner.

Few Prospect readers would argue against human rights. But we usually view health, particularly mental health, as an individual affair, seeing it only as an internal state. In truth we are all greatly influenced by wider society.

When large numbers of people become unwell, we need to look beyond biology and consider what is happening at the societal level.

In their new book The Inner Level, Richard Wilkinson and Kate Pickett reflect on the social factors influencing mental health. They reveal that the incidence of mental illness in the UK is twice that in Germany. Americans are three times more likely than the Dutch to develop gambling problems. The mental health of children is worse in New Zealand than it is in Japan.

Wilkinson and Pickett examine the effects of living in such different societies. And this new understanding of powerful societal influences chimes with much other recent work.

People working in separate disciplines are coming to the same conclusion: that our social worlds impact on us, they can give us health or cause us harm. As the UN puts it, “mental health policies and services are in crisis—not a crisis of chemical imbalances, but of power imbalances. We need bold political commitments, urgent policy responses and immediate remedial action.” This recent report calls for a shift from biomedical models of mental distress to a more radical, human rights-based approach, acknowledging the impacts of social inequality.

Another recent report published by the British Psychological Society, “The Power Threat Meaning Framework,” looks at the contextual factors which may make us sick. PTM acknowledges power inequalities and the impact of oppression. Being on the wrong side of power can lead to feelings of entrapment, shame and humiliation, as well as a sense of lacking control.

The framework highlights links between “poverty, discrimination and inequality, along with traumas such as abuse and violence, and the resulting emotional distress or troubled behaviour.Adverse childhood experiences have a negative impact on health and wellbeing, for example.

Both The Inner Level and PTM reframe the narrative around why people get sick—refocusing the question from “What’s wrong with this individual?” to “What’s going wrong in this society?”

Whilst these new ways of thinking are works in progress, they open up new vistas. There is a renewed possibility of collaboration between geographers, sociologists, psychologists, public health and local communities to really understand the pathways from oppressive inequality to ill health.

But as Wilkinson and Pickett say, “Change on the scale needed… can only be achieved if large numbers of people commit themselves to achieving it.” And as they conclude in a recent newspaper interview: “It is clear that differences in cognitive development and intelligence are the consequence of inequality rather than its cause.”

That is a call to action, and we need to rise to the challenge for the sake of a healthy and sustainable future.

The original article by Danny Dorling and Khadija Rouf that this post is based on was published in Prospect Magazine on June 1st and is available here. The Book, ‘The Inner Level’, is available here

The Inner Level: How More Equal Societies Reduce Stress, Restore Sanity and Improve Everyone’s Wellbeing by Richard Wilkinson and Kate Pickett (2018)