Blog #4: The Influence of Multilevel Health Models on Mental Illness

October 21, 2019

Multilevel Health Models and the Influence on Mental Illness

Dahlgren and Whitehead (1991)’s Wider Determinants of Health Model examines the factors that play a role in health outcomes. This model is relevant in the context of mental health in a rural region of Ontario, Canada. Those suffering with mental illness already have difficulty accessing healthcare services and advocating for supports. This framework is used to identify all the factors, outside of physiology, that impact health.

The center of this model is based around personal traits including sex, age, and heredity. In relation to mental health, it’s clear that these are also factors which would impact how treatment starts or what treatment options are considered. Age plays a role in treatment options for both pharmacological interventions as well as non-pharmacological therapies. Age is a factor to take into consideration in terms of comprehension, language, and even attitude towards mental illness.

The next surrounding area is individual lifestyle factors. This will include more personal behavioural and lifestyle choices. Examples of this would be alcohol or substance use, smoking, addictive behaviours, food choices, physical exercise and quality sleep. This factor plays a large role in those suffering with mental illness. In my role as a mental health clincian, I work with patients who are on Ontario Disability Support Program (ODSP) as a means of income. Through this program, single clients have an average income of approximately $1,169.00 a month to live on. This is the amount of money they have to budget for all their living expenses including rent, groceries, and bills. One could deduct that on this limited budget there is not a lot of leftover money at the end of the month to pay for a gym membership, buy the freshest produce or even to cover the cost of living for all their monthly bills.

Moving on through the model we can next examine social and community networks. This area focuses on the importance of a support system whether it’s family, friends or a neighbour. This network of individuals makes up the social involvement someone has with others. This is a barrier for clients with mental illness. I have witnessed clients lose relationships with family and friends directly related to their illness and negative symptoms. Caregivers may feel burdened or fatigued and pull supports away from their loved one and friends have diminished over the years of ongoing psychiatric hospitalizations. This framework acknowledges the importance of a support system outside of health supports and clinicians to evoke the best health outcomes.

Next, living and working conditions is a vast category that encompasses many facets of one’s life. This is directly related to the day to day activities that someone engages in; going to work; their environment; school, housing etc. It is difficult to talk about mental health without discussing the possibility of homelessness and the lack of available affordable housing. Mental illness comes with a difficulty symptomology to manage in the best circumstances. When we consider the fact that there are many reasons why mental illness may result in homelessness, it becomes even more clear that symptom reduction may be the last priority for clients who are suffering and now homeless. Once a client becomes homeless there is even less access to healthcare resources available and with the compounding increase in symptoms, it can be assumed that these clients will not be thriving and will likely end up in the emergency department or with legal involvement.

Finally, general socio-economic, cultural and environment conditions can be understood as any factors that would impact health decisions and availability such as competing financial burdens (ie. child support payments), availability and access to jobs, and transportation services. This model as a whole can identify gaps in services and barriers to services for clients suffering with a mental illness. As a leader in mental health, my role is to advocate to bring services to the clients and make changes to the system in order to provide truly holistic and client centered care.

Reference

Canadian Council on Social Determinants of Health. (2015). A review of frameworks on the determinants of health. Canadian Council on Social Determinants of Health, 17.