Mental health inequalities and mental health nursing

Accessible summary Current research clearly shows that mental health problems occur more frequently in some social groups than others. These inequalities in mental health affect people in many developed countries. For example, depression and anxiety are more common among poorer people than richer people. Depression is more common among women while suicide is more common among men. There are higher rates of certain mental health problems among ethnic minorities. People with long-term mental health problems also have poorer physical health compared with those in the general population. These differences are thought to be determined by a person's economic, social and cultural position in society. There is additional evidence that mental health inequalities can be made worse by poor service provision or by people not using the existing services. This paper examines what mental health nurses might do to address inequalities in mental health. It concludes that mental health nurses have a key role to play in helping to shape existing physical and mental health services so that these services are more accessible and helpful for those who use them. However, we also conclude that health services, including nursing, may not be powerful enough to tackle some of the underlying causes of mental health inequalities. One such cause is poverty, which needs extensive government action. We also think that these limitations are not clearly stated in current policy for mental health nurses and should be set out more clearly in policy and indeed training initiatives. Abstract Reducing inequalities in health, including mental health, is of high priority in many national policies. However, it is not yet known how mental health nurses might respond to these policies. Using examples from the available evidence, we argue that the causes of mental health inequalities are complex and thought to arise from fundamental divisions in society. These divisions are formed by social relationships, which areinfluenced by deep social structures, such as the economy or culture. The extensive range of social determinants means that there is no single explanation of why inequalities in mental health might occur. It also suggests that these determinants may act synergistically to create pockets of inequity where health needs are most complex. This poses difficult challenges for mental health nurses who undoubtedly have a key role in addressing mental health inequalities, although their role is likely to be restricted to service redesign and delivery. Mental health nurses are unlikely to address some of the deeper structural determinants of mental health inequalities, such as poverty, which can only be tackled through government-led reforms. Furthermore, we must be mindful of the possibility that services offered by mental nurses may have an uneven uptake across social classes, which in turn could serve to maintain or worsen mental health inequalities. Therefore, a key question for mental health nursing, policy and training is whether these limitations are clearly recognized.