Mental health, youth and racism Kwame McKenzie MD

*Mental capital the new frontierIf we are to prosper and thrive in our changing society and in an increasingly interconnected and competitive world, both our mental and material resources will be vital. Encouraging and enabling everyone to realise their potential throughout their lives will be crucial for our future prosperity and wellbeing.

Mental capital = IQ + EQ + mental health

*EQ = social skillsEmotional intelligence (EQ) is not a new concept;Around since Socrates: Know Thyself. Studies show that EQ is the best predictor of a child's future achievement; better than any other single factor. EQ is a better predictor of success than IQ and technical skills combined Robin Stern NYU

*Mental illness is costly 4 of the top 10 leading causes of disability30% of disability claims and 70% of the total costs estimated cost of mental illness to the Canadian economy is $51 billionAt least 50% starts before age of 14

*Mental illness preventionEvidence based, cost-effective strategies documented Ontario legislature concluded for every $1 spent on mental health promotion you get $7 returnBut we do not do this very well.

*Mental health in IRER groupsCanadian literature tagcloud

Rates*

*Clusters of researchRates

Social determinants

Barriers and facilitators of care

*Canadian-Born Population and Immigrants Reporting "Fair" or "Poor" Health,

Source: Newbold KB. Self-rated health within the Canadian immigrant population: Risk and the healthy immigrant effect. Social Science and Medicine, 2005.16

*More likely to develop poor health if you are non-European* Significantly different from estimate for Canadian-born (p

2011 schools data CAMH*

Chart1

15

14

9

13

17

19

16

20

11

poor health %

Sheet1

poor health %Column1Column2

White15

Chinese14

South Asian9

Black13

Aboriginal17

Filipino19

Latin American16

South East Asian20

West Asian / Arab11

Ontario Schools

Chart1

3

2

1

3

7

6

1.5

3.5

4

suicide attempt

Sheet1

suicide attemptSeries 2Series 3

white32.42

chinese24.42

south asian11.83

black32.85

aboriginal7

filipino6

latin american1.5

south east asian3.5

west asian / arab4

Social determinants*

*

*

*The problem is not just Bay Street

*% immigrant population by electoral wardIn Toronto

*Ratio of earnings of recent immigrants to Canadian people is decreasing over time

Chart4

0.770.590.840.86

0.630.630.670.77

0.580.520.650.66

0.480.430.610.56

Males w Univ. Deg

Females w Univ. Deg

Males w/o Univ. Deg

Females w/o Univ. Deg

Sheet1

With a university degreeWith no university degree

MalesFemalesMalesfemales

19800.770.590.840.86

19900.630.630.670.77

20000.580.520.650.66

20050.480.430.610.56

Sheet1

0000

0000

0000

0000

Males w Univ. Deg

Females w Univ. Deg

Males w/o Univ. Deg

Females w/o Univ. Deg

Recent Immigrants to Canadian Born earnings ratio

Sheet2

Sheet3

* City1 City2 City3 Most children in Toronto live in City 31/3 of people in City 3 live under low income cut off50% of the housing for families in City 3 is high risePoverty is color coded

*A problem in the future?City 3 is high poverty and high immigrantOur population growth is due to people in City 3If we are going to move forward and be competitive we need to invest in City 3Parents doing a good job buffering children from problemsBut what happens if we want to move forwards and integrate economies so that children can get access to resources and help build our future?

Racism

*Recorded racially aggravated crime England and Wales (data Home Office)

Chart3

3274696210758

3776788712468

4935862714975

4344884316696

4419885720584

4316898922669

Property crime

Assault and wounding

Harrassment

Sheet1

1999/002000/12001/22002/32003/42004/5

criminal damage590612822776836834

vehicle damage123213991885152416021638

dwellling damage145217652228204419811844

assault427547115164449140173677

harassment107581246814975166962058422669

wounding268731763463435248405312

Sheet1

criminal damage

vehicle damage

dwellling damage

assault

harassment

wounding

year

number

Sheet2

1999/002000/12001/22002/32003/42004/5

criminal damage590612822776836834

vehicle damage123213991885152416021638

dwellling damage145217652228204419811844

assault427547115164449140173677

wounding268731763463435248405312

harassment107581246814975166962058422669

Total209942413128537298833386035974

1999/002000/12001/22002/32003/42004/5

Property crime327437764935434444194316

Assault and wounding696278878627884388578989

Harrassment107581246814975166962058422669

Sheet2

Property crime

Assault and wounding

Harrassment

Sheet3

*Hate crimes in Canada in 2006

Models of pathways to health impact of racism

*Pathways to racisms health impact Socially inflicted trauma mental, physical, or sexual Economic and social inequality Decreased mobility due to racism (education, employment)Inadequate, inappropriate or degrading medical careTargeted marketing of commodities and lifestyles that can harm health: alcohol, tobacco, drugs

*US Surgeon general report mental health pathwaysInternalization of racial stereotypes & negative images which denigrate individuals self-worth and adversely affecting their social and psychological functioning; Institutional racism resulting in stressors that can affect mental health due to living conditions, crime, violence, poverty

*Racism effects getting under the skinAcute stressor (life events) Chronic stressor (micro-aggression) Body: adreno-corticoids t-cell changeearly agingweathering foetal growth Cognitive developmentLong term change in cognitive focus eg / increased vigilance Personality/ identity(resilience/ vulnerability)

*Racism stress is different 3 stage model: 1) Stress because of life event2) Stress because life event considered unfair 3) Stress because of inability to do anything about it

*Pascoe and Richman

*Pascoe and RichmanLinks between racism and health occur through the mechanisms of stress responses and health behaviors.Our synthesis of existing literature also suggests that social support, active coping styles, and group identification were most likely to serve a protective function in these pathways.

Racism and schizophrenia

*Stress of Migration increases risk of schizophrenia. Cantor Graae and Selten 2005

*Genetics

*Stress and daily hassles

*StressIncreased rates of schizophrenia if you:

live in neighborhoods that are stressful

have numerous daily hassles

*Racism psychosis risk factor cross sectional Odds of suffering from a psychosis:Verbal abuse victims 2.86 (1.69-4.83) Racist attack victims 4.77 (2.32-9.80) Thinking most employers racist 1.57 (1.02-2.42) Karlsenn & Nazroo Am J Public Health. 2002

*Racism psychosis risk factor cross sectional Karlsenn et al Psychological Medicine 2005

Estimated prevalence of psychosis

Racial harassment

British employers discriminate

*Racism ecological risk factor for psychosisSouth London: rates of psychosis in ethnic minorities by ward taking into account age, sex, deprivationEthnic minorities more likely to suffer from psychosis:in areas 28-60% ethnic minorities = 2.4in areas 13-28% ethnic minorities = 3.6in areas 8-12% ethnic minorities = 4.4Boydell et al BMJ 2001

*Discrimination psychosis risk factor - longitudinalThe Netherlands:4722 people asked about discrimination (age, sex, handicap, appearance, ethnic group and sexual orientation). Followed up for 3 year Rates of psychosis increased in ethnic groupsDiscrimination, not being an ethnic minority most important factor.Janssen et al British Journal of Psychiatry 2003

**Interaction of race and other risk factors

*conclusionWe know that there are difference sin healthWe know what keeps people in healthyWe know we have to integrate Toronto if we are going to move forwardWe know that this may be at a cost to the diverse population because of racismWhat are we going to help develop resilience?

Thank you