Interpreting the Causality of Mental with the Illness with the Social Ecological Model of Health Framework

        The Social Ecological Model (SEM) focuses on health and uses a broad approach to find various factors that may affect an individual’s health and/or population’s health. This broad approach to thinking of health, advanced in the 1947 Constitution of the World Health Organization, includes a person’s physical, mental, and social well-being (World Health Organization, 2005). The SEM believes health is affected by the interaction between the individual, relationship, community and society (Figure 1).  The SEM of health explains how all levels of the model influence each other and for the model to be success all levels of it need to be targeted at the same time (Reupert, 2017).  Wind & komproe (2018) explain there is a dominant argument that multilevel interventions have a much greater impact on multiple aspects of health compared to single level models.  Health professionals, and researchers use this model to identify factors, at different levels, that contribute to poor health.  The finding of these factors then can be used to assist in deciding on an approach to help a person or population.   Watson & MacDonald (2016) explain the first level of the SEM model as looking at an individual’s biology and other personal characteristics, such as age, education, income, and health history. The individual level of the SEM involves assisting people with making decisions that can aid them with making wise choices.  An example of how assistance can be given, could be through an educational program to make positive changes in one’s lifestyle, like healthy food choices and exercise programs.    The second level, which is relationship, includes a person’s close social circle of friends, partners, and family members.  This social circle influences a person’s behavior and contributes to his or her life experiences.    Community is the third level and explores the various settings in which people have social relationships, such as employment, neighbours and schools.  It seeks to find the characteristics of these settings that affect health.   The fourth level of the SEM looks at a wide range of societal factors that are beneficial or negative to one’s health.  Examples of the fourth level of SEM include cultural and social norms and the health, economic, educational, and social policies.  Golden & Earp (2012) state the SEM of health recognizes individuals as fixed within larger social systems and describes the interaction of individuals and environments as that of shaping their health. Long-term attention to all levels of the social ecological model creates the changes needed to support sustainable improvements in health (McClosky et al., 2004).  

      Mental health involves a state in which one “realizes his or her abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community” (Watson & MacDonald, 2016, p. 2).   Mental health is also defined as “the capacity of each and all of us to feel, think, and act in ways that enhance our ability to enjoy life and deal with the challenges we face. It is a positive sense of emotional and spiritual well-being that respects the importance of culture, equity, social justice, interconnections and personal dignity” (Hidayat, 2014, p. 5).   Mental health is explained by Wind & Komproe (2018) as being apart of all a person’s dimensions of their overall life and well being and not isolated from these dimensions or sheltered from political, economic, and social conditions around them.  Multiple factors across those dimensions have a bearing on mental health and cause one to experience mental illness. Mental illness is defined by Wind & Kromproe (2018) as being a feeling and experience of ill health which is personal and entwined in all areas of one’s life.  Goldie, Elliot, Regan, Bernal, & Makwah (2016) states mental health problems are the largest-global cause of years lived with a disability (p. 2).  They also state one quarter of adults and one in 10 children are likely to have a mental health illness at any given time (p. 2).  Watson & MacDonald (2016) explain the absence of mental illness does not mean a person is experiencing good mental health and those suffering from mental illness can experience wellbeing and live a satisfying life. 

          Hidayat (2014) explains human behavior is hard to change especially when in an environment that does not support this change.  To achieve a better mental health focus needs to not only be on a person’s behavior choices but also on the factors that influence these choices. The SEM of health assists in identifying and recognizing various factors that identify and influence an individual’s behavior (Hidayat, 2014).   Watson & MacDonald (2016) explain that factors such as biological, genetic, and demographic are determinants of mental health and illness.  The SEM also looks to modifiable factors that can be changed to enhance mental health and decrease the chances of developing mental illness.  Various modifiable factors include protective and risk factors that are apart of the levels in the Social Ecological model.  Protective factors assist to increase a person’s capacity to cope with life and risk factors are ones that may cause one to not cope with life and create mental illness (Cramer, & Kapusta, 2017).  Examples of risk factors, SEM observes, is weak problem-solving skills, inability to tolerate everyday life stressors, low self esteem, isolation, a lack of or weak social skills and alcohol and drug abuse.  These factors are apart of the Individual level of the model.  Risk factors present in the relationship level of the model include poor attachment in childhood, a lack of affectionate parenting and positive relationships throughout childhood, isolation and abuse and violence.  Risk factors for the community and societal levels of the model can include social and economic disadvantages, a lack of education, inadequate housing, homelessness, unemployment, discrimination, war and poverty (Watson & MacDonald).  The Social Ecological model organizes risk factors at the various levels and creates strategies to reduce the risk factors to assist in improving positive mental health.  Strategies include interventions to address positive and negative influences on mental health (Reupert, 2017).

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References

Canadian Institute for Substance use Research. (2018). Promoting positive mental health

through a socio-ecological approach.  Canadian Institute for Substance use   Research.  Retrieved from https://www.heretohelp.bc.ca/infosheet/promoting-positive-mental-health-through-a-socio-ecological-approach

Cramer, R. J., & Kapusta, N. D. (2017). A social-ecological framework of theory assessment,

& prevention of suicide. Frontiers of Psychology. Retrieved from    https://doi.org/10.3389/fpsyg.2017.01756

Goldie, I., Elliott, I., Regan, M., Bernal, L., & Makwah, L. (2016). Mental health & prevention:

 taking local action for mental health. Mental Health Foundation Policy Report.

Hidayat, M. T. (2014).  Socio-ecological model of mental health problem; interactions

            between the social, biological, economics & environmental determinants. School of

            Public Health Faculty of Medicine.

Lainsbury, D. W., & Mitchell, S. O. (2009).  Introduction to special issues on social ecological

approaches to community health research and action.  American Journal of Community Psychology, 44, 213-214.  Retrieved from https://doi.org/10.1007/s10464-009-9266-4

Lakhan, R. (2013).  Application of the ecological framework in depression: an approach

 when time has come.  Indian Journal of Psychological Medicine, 14(2), 103-109.

Reupert, A. (2017). A socio-ecological framework for mental health and well-being.

 Advances in Mental Health, 15(2), 105-107. Retrieved from

https://doi.org/10.1080/18387357.2017.1342902

Watson, S., & MacDonald, K. (2016). Mental health promotion:  let’s start speaking the same

language. Waterloo, ON: Region of Waterloo Public Health & Emergency Services.

Wind, T. R., & Kompoe. (2018).  Closing the gap between disaster mental health research

and practice: evident for socio-ecological mental health interventions through multilevel research. Journal of Mental Health and Psychological Support in Conflict Affected Areas, 16(1), 5-13.

World Health Organization. (2005). Promoting Mental Health; concepts emerging evidence

and practice.  Retrieved from https://www.Who.Int/mental_health/evidence/MH_Promotion _Book.pdf.