rē•framing Our View of Mental Health to Include Social and Environmental Factors

The traditional approach to mental health once viewed it strictly as biology. While this medical vantage point is a critical part of the equation, the fact is that social, environmental, and economic factors that are outside of the individual’s control also impact mental health outcomes. This means that poverty, employment, education, and food scarcity all have an essential role in the conversation. As a result, providers increasingly broaden their treatment plans to address these more comprehensive factors that play a role in well-being.

It is essential for our health and that of our loved ones and acquaintances that a more holistic approach is adopted. In addition to viewing mental health in a less pathologizing way, recognizing the myriad factors beyond individual physiology that lead to a diagnosis can also provide more opportunities to effect change and help. This is one of the driving philosophies behind the ecological framework used in clinical social work.

Leah Aguirre is a licensed clinical social worker and psychotherapist specializing in treating trauma using Eye Movement Desensitization and Reprocessing (EMDR). This modality helps clients move past trauma that impacts their mental health functioning in their day-to-day lives. This is one of the many modalities that has been adopted in addition to more traditional forms of talk-therapy, garnering an impressive array of evidence-based research to back it up.

Aguirre explains that earlier psychiatric treatment focused on using talk therapy to process and heal from past traumatic experiences stored in the unconscious, such as those emanating from childhood. But in the years since, many contemporary treatment models have developed that can be practiced along with, or instead of, the traditional Freudian session. “Action-oriented interventions, like cognitive behavioral therapy (CBT) or dialectical behavior therapy (DBT) [are popular today],” Aguirre tells rē•spin.

Psychotherapy is an umbrella term used to describe several techniques implemented between therapists and clients — talking about their lives, identifying issues, fostering self-awareness, and building rapport. Frequent forms of therapy include individual, couple’s, family, or supportive psychotherapy. For instance, CBT is a therapy model that seeks to help clients recognize the link between their thoughts and subsequent emotional states. Likewise, fostering self-awareness helps the client become more intentional and empowered in cultivating their states of well-being. DBT is another prevalent form of intervention involving individual sessions and group therapy where distinct tools modules — including mindfulness — are taught to clients as skills.

The therapist hopes to help the client develop self-awareness and become empowered to facilitate their wellness and pro-social steps. But it is increasingly understood that teaching an individual to cope with their specific symptoms and identify the stressors and triggers in their individual lives does not address the macro-and mezzo-level factors that contribute to mental illness.

Social, economic, and systemic factors also impact mental health. If you find yourself trying to take a side in the “nature versus nurture” debate, the reality is that both matter; people are both the products of their environments and their biology. Effective treatment of mental health and mental illness requires acknowledgment of external conditions and factors that take a toll on the wellness trajectories.

Systemic roadblocks have often existed for centuries, disproportionately marginalizing specific communities of people over time. Aguirre explains that some environmental factors that may impact our mental health could include, but are not limited to, family dynamics, generational trauma, socioeconomic status, one’s access to resources (including shelter, medical care, transportation, and food), as well as cultural values and beliefs related to religion, family of origin, or even just social constructs.

According to the American Psychological Association, studies have shown that unemployment, poverty, and housing unaffordability are all risk factors for mental illness. Parallels have also been drawn between parents’ education levels and their children’s mental health — with higher education levels corresponding to fewer mental health problems, even in the face of life stressors. Furthermore, social research confirms that issues like systemic racism impact outcomes related to health, education, and more, within marginalized populations like the BIPOC community.

“Many of these environmental factors are reinforced and a product of larger social systems and institutions that result in the disenfranchisement of certain groups of people like BIPOC, LGBTQIA+ — which exacerbates or contributes to mental health challenges,” Aguirre explains. “Because of the scale and complexity of these factors, many individuals tend to feel very helpless and hopeless about their circumstances. Like, ‘What’s the point?’ It is hard to believe that things can get better or truly be efficacious when one has encountered barrier after barrier. It can be incredibly overwhelming and difficult to have hope.”

Aguirre acknowledges that it can be discouraging to recognize these factors in our lives. Still, there is a therapeutic element to recognizing the impact these systemic issues have on us and how they can affect our emotions. “It’s important to hold space for and validate all our feelings, including anger, resentment, and sadness,” she says. “When we try to ignore or repress our feelings, this often fuels shame and can take an even greater toll on our mental health. The practice of self-compassion can also be a wonderful tool in responding to these factors.” Aguirre references Kristen Neff, Ph.D., who has identified three elements of self-compassion: self-kindness versus self-judgment, common humanity versus isolation, and mindfulness versus over-identification. This helps validate feelings and experiences, reminding us that we aren’t alone in our suffering and providing loving, nurturing words. “Self-compassion is a wonderful practice to help us cope with pain and circumstances that are beyond our control,” she says.

Yet there is also hope in learning to see the social and environmental factors linked to wellness; the fact is that taking away blame from the individual, and finding external means of effecting positive changes, can yield multi-pronged treatment plans with more significant impact. 

For instance, prioritizing the development of social supports can be an excellent way to tend to mental health proactively. Aguirre encourages her clients to develop robust social support systems to cope with the difficulty of external stressors. Whether this is through connecting with friends on a more regular basis, making new and meaningful connections with those who share similar backgrounds and experiences or even getting involved with your community through local politics, volunteer work, or community organizing, these connections can help reduce those feelings of loneliness and othering, replacing them with a sense of purpose and hope instead. 

Shifting the locus of control back to the individual is the key. Finding ways to empower individuals in their wellness — including their mental health — can be done through support and providing them with the tools to affect pro-social changes in their lives moving forward. Over time, self-awareness, discernment, and self-mastery improve, and clients can become their own greatest advocates in achieving their goals. “I also work with my clients to identify aspects of their life in which they do have control—like setting boundaries with family members, engaging in healthy outlets and activities like exercise, connecting with one’s faith or spirituality, and making more time for things that they value like relationships, nature, healthy lifestyle, etcetera,” she explains. “When you invest your time and energy into things that bring you joy and have meaning, it increases your resilience.” 

While the ecological framework, and acknowledgment of the social and environmental factors that impact mental health, emphasize non-biological factors that affect mental health trajectories, genetics and biology still matter. For many, the right combination of treatments does include medications or medical interventions — and there is no shame in that. But we hope to have broadened your lens to realize that these are not the only ways to treat mental health diagnoses and that your wellness can be improved in ways that go beyond the traditional health model’s original treatments. It all comes down to the individual’s needs and preferences and the perfect balance of modalities and treatments. Just as you can become an active co-creator in your wellness regimens, you can also become informed and empowered masters of protecting and improving your mental health.