Social Factors and Mental Health Services (AQA A-Level Sociology): Revision Notes
Social Factors and Mental Health Services
Social factors play a vital role in shaping both the incidence of mental health problems and the demand for mental health services. These factors operate at multiple levels and create complex patterns of inequality in mental health outcomes across different social groups.
The relationship between social factors and mental health is complex and multifaceted, with influences operating simultaneously across different levels of society. Understanding these interconnections is crucial for developing effective mental health policies and interventions.
Determinants of mental health across social levels
Mental health is influenced by factors operating at four key levels:
- Society level: Factors include equality versus discrimination, unemployment levels, social coherence, and healthcare provision
- Community level: Personal safety, housing quality and access to open space, economic status of the local area, and neighbourliness all impact mental wellbeing
- Family level: Family structure, family dynamics (such as highly expressed emotion), genetic makeup, and parenting styles contribute to mental health outcomes
- Individual level: Lifestyle factors (diet, exercise, alcohol intake), attributional style (how events are understood), debt versus financial security, and individual relationships all influence mental health
These levels interact with each other, creating complex pathways through which social circumstances affect mental wellbeing and the need for professional support.
Social class and mental health
Research consistently demonstrates an inverse correlation between social class and mental health problems. Mental illness rates are approximately two to two-and-a-half times higher among the most deprived groups compared to the least deprived populations.
This relationship appears to be circular in nature. Poor mental health can lead to social disadvantage, including periods of unemployment, which in turn creates further mental health challenges. This creates ongoing cycles of disadvantage that are difficult to break without targeted intervention and support.
Inequities tend to accumulate over time, making elderly people from lower socioeconomic backgrounds particularly vulnerable to mental health difficulties.
Gender and mental health
ONS data from 2014 reveals stark gender differences in mental health statistics. Women in the UK are almost twice as likely to experience anxiety and receive treatment for mental health problems compared to men (29% versus 17%). Eating disorders also show a pronounced gender difference, being far more common among women.
However, these statistics require careful interpretation. The gender gap may partially reflect help-seeking behaviour rather than actual prevalence rates. Women are generally less reluctant to report symptoms and more willing to seek medical help - one in four women seek treatment for depression during their lifetime, compared to just one in ten men.
Underdiagnosis in men is a significant concern, as men may not refer themselves to GPs initially. When men do seek help, they often use different language, describing their experiences as 'stress' rather than 'depression', which can lead to misdiagnosis by healthcare professionals.
Men do manifest mental health issues, but often in different ways. For instance, 67% of British people who consume alcohol at hazardous levels are male, as are 80% of those dependent on alcohol and 69% of those dependent on illegal drugs.
Feminist analysis by researchers like Phyllis Chesler (2005) suggests that stereotypes about women being dependent, emotional and excitable in crisis situations become linked with definitions of mental illness. This gendered understanding of psychological distress may explain why women are more prone to mental illness labelling, diagnosis and treatment, though such stereotypes are increasingly recognised as generalised and outdated.
Ethnicity and mental health
Different ethnic groups experience varying rates and experiences of mental health problems. The Mental Health Foundation (2013) identified that BME (Black and Minority Ethnic) groups living in the UK are generally more likely to be diagnosed with mental health problems, admitted to hospital, and experience poor treatment outcomes.
Several factors contribute to these disparities:
- Socioeconomic factors: BME groups are often concentrated within deprived areas in lower social classes, which correlates with higher mental health risks
- Discrimination: Research by Rehman and Owen (2013) found that experiences are compounded by discrimination. African-Caribbean males are between three and five times more likely to be diagnosed with schizophrenia than white males
- Diagnostic bias: Mallet et al (2003) investigated the alleged overdiagnosis of African-Caribbeans with schizophrenia by conducting studies in Trinidad and Barbados. They found that schizophrenia rates there were lower than among London's African-Caribbean community
- Criminal justice pathways: African-Caribbeans are more likely to receive mental health diagnoses through referrals from the criminal justice system rather than initially through the NHS
The diagnostic bias findings suggest that either racial bias or lack of cultural sensitivity leads psychiatrists to misinterpret psychological distress and overdiagnose schizophrenia. This implies that negative labelling may significantly influence mental health statistics for certain ethnic groups.
However, James Nazroo (2001) noted that other equally deprived BME groups have much lower mental illness levels, indicating that higher rates among African-Caribbeans cannot be entirely explained by racist discrimination and deprivation alone.
Policy implications and service improvements
The King's Fund (2012) estimated that at least £1 in every £8 spent on long-term conditions is linked to poor mental health and wellbeing, representing between £8 billion and £13 billion annually in England.
Service Improvement Recommendations:
They suggested mental healthcare could be improved through:
- Integrating mental health support with primary care and chronic disease management programmes
- Improving liaison psychiatry services in acute hospitals
- Providing all health professionals with basic mental health knowledge and skills
Key research studies
Research Study: Brown and Harris (1978) - Provoking agents and protective factors
Participants: Nearly 600 women living in London
Aim: To investigate factors that influence depression in women
Procedure: Developed concepts of 'provoking agents' and 'protective factors' through community-based research
Findings: Women with children were prone to depression, but risk was increased by provoking agents such as overcrowding, poverty, chronic ill health, bereavement and marriage breakdown. Women could be protected from depression by protective factors such as a supportive marriage.
Evaluation - Strengths: Large sample size provided robust data; identified clear risk and protective factors that inform intervention strategies
Evaluation - Weaknesses: Limited to women in London, reducing generalisability; correlational design cannot establish causation
Research Study: Pickett et al (2006) - Income inequality and mental illness
Participants: Population data from developed countries
Aim: To investigate the relationship between income inequality and mental illness prevalence
Procedure: Cross-national comparison examining income inequality levels and mental health statistics across developed nations
Findings: Mental illness is more common in countries where income inequality is high, demonstrating a clear linear relationship between inequality and emotional wellbeing
Evaluation - Strengths: Large-scale international data provides strong evidence; clear practical implications for social policy
Evaluation - Weaknesses: Correlational design cannot prove causation; cultural factors may confound the relationship
Research Study: Morrison (2012) - Cognitive therapy for schizophrenia
Participants: 20 individuals with schizophrenia spectrum disorder not taking antipsychotic medication
Aim: To evaluate whether cognitive therapy could be effective for people with schizophrenia who choose not to take antipsychotic medication
Procedure: Longitudinal survey design with participants receiving cognitive therapy in an open trial. Success measured using Positive and Negative Syndromes Scale (PANSS) at start, nine months (end of treatment), and 15 months (follow-up)
Findings: Cognitive therapy proved acceptable and effective for people with psychosis choosing not to take medication. Improvements seen in hallucinations, delusions, self-rated recovery and social functioning
Evaluation - Strengths: Addresses important gap in treatment options; longitudinal design allows assessment of lasting effects
Evaluation - Weaknesses: Small sample size limits generalisability; open trial design lacks control group for comparison
Key Points to Remember:
- Mental health is influenced by factors at society, community, family and individual levels that interact with each other
- Social class shows an inverse relationship with mental health - higher deprivation correlates with higher rates of mental illness
- Gender differences in mental health statistics may reflect help-seeking behaviours as much as actual prevalence rates
- BME groups face higher rates of diagnosis and poorer outcomes, partly due to socioeconomic factors and discrimination, but diagnostic bias may also play a role
- Income inequality at a societal level correlates with higher rates of mental health problems across populations