[COMM-ORG] Spring Newsletter from Tom Wolff & Associates

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Thu May 24 19:54:56 CDT 2012


From: "Tom Wolff & Associates" <Tom_Wolff__Associates at mail.vresp.com>





Dear Friends and Colleagues,

The Newsletter is Back!

Welcome to the Spring 2012 Issue of the “Collaborative Solutions 
Newsletter” from Tom Wolff & Associates. This issue is on “The Social 
Determinants of Health and Mental Health; Why not?”

This newsletter issue and earlier issues are available online at 
www.tomwolff.com. You may find that the web versions to be the easiest 
to read and download. A text version can be found below.

We encourage you to distribute this information. Please feel free to 
download this issue at www.tomwolff.com and circulate it to your friends 
and colleagues. You can subscribe for free or unsubscribe at the end of 
the newsletter. Let us know what you think and what else you would like 
to see in the newsletter.

Thanks,
Tom Wolff
Tom Wolff & Associates
Contents of Spring 2012 Collaborative Solutions Newsletter:

In this issue:

Social Determinants of Health and Mental Health: Why Not?
If we all embraced a SDOH perspective on mental health, what would that 
look like?
What is new at Tom Wolff & Associates
The Power of Collaborative Solutions
New clients
Quote of the month:”life ia a fundamentally cooperative, locally rooted, 
self-organizing enterprise in which each individual organism is 
continually balancing individual and group interests”

Social Determinants of Health and Mental Health: Why Not?

The concept of Social Determinants of Health (SDOH) is widely used and 
accepted as a way of understanding health, especially in the world of 
Public Health. Social Determinants of Health are the “conditions and 
environments in which people are born, grow, live, eat work and age as 
well as their access to the care system” (CDC). The premise behind 
Social Determinants of Health is that our health is determined by much 
more than our access to health care and our health behaviors but also by 
the powerful forces in our environment such as:

Socio economic status
Environmental exposure
Education
Employment
Housing
Access to food,
Transportation
Social capital, and
Public safety.

Social Determinants of Health account for almost 80% of our health. 
Access to health care actually only accounts for around 10% of our 
health. There is solid research to back up the impact on health in each 
of these arenas. The punch line is that our zip code may be more 
important than our genetic code for our health. A social determinants of 
health approach allows for a broad, ecological, community wide, 
understanding of our health and an equally broad approach to 
interventions to modify these numerous systems to improve health.

So, the question for this Newsletter is, “ why isn’t this simple common 
sense framework being applied as broadly to mental health as it is to 
physical health?” There was a conference at the Adler School of 
Professional Psychology in 2010 that was focused on this topic.(See The 
Social Determinants of Mental Health: From Awareness to Action June 3-4, 
2010 
http://www.amazon.com/The-Social-Determinants-Mental-Health/dp/1456324160). 
But, short of this, the literature on this topic is minimal. This is 
puzzling since on the face of it mental health seems even more amenable 
to a SDOH understanding than physical health.

One of the first things I learned in Psychology 101 was that behavior is 
a function of the organism and the environment. However, as I proceeded 
in my undergraduate and graduate training, the focus was more and more 
on the person/organism side of the equation and less on the environment. 
In spite of this, in my early work as a psychotherapist on a university 
campus the link was actually quite obvious. Life stresses had an impact 
on the well being of my clients. The Viet Nam veterans returning to 
college brought their war experiences to the campus (in the form of what 
would later be labeled Post Tramautic Stress Disorders). Mothers of 
young children living in graduate student housing found managing their 
lives and their children with very little money to be quite stressful. 
In these cases we went beyond providing psychotherapy but to building 
community prevention programs for these groups and modifying their 
physical environment (i.e. building a playground for the children in the 
married student housing).

After I left the campus, I worked in Consultation, Education and 
Prevention in a Community Mental Health Center (CMHC) -remember them?. 
Here again the approach was a SDOH approach (even though we did not know 
the language then). For me it was an approach deeply embedded in my 
training and experience as a community psychologist with a premise that 
behaviors needed to be understood in their context and the eco-system of 
the individuals. The community psychology approach empowers populations 
to solve their own problems. Community psychology is committed to 
developing prevention approaches that include structural and systems change

With all this background in the community mental health movement in the 
60s and 70s, you would think that the field of mental health would have 
been ripe for embracing and championing the SDOH approach to mental 
health that is the present hot trend in public health. But no!

Along the way, something interesting and distressing happened. Mental 
health issues became the business of mental illness, and mental illness 
became conceptualized as a biological illness cured by powerful and 
profitable medications. A SDOH approach to mental health and mental 
illness is a direct threat to the model that declares mental illness a 
biological disorder cured by drugs.

I can hear the echo of one of my mentor’s, George Albee’s words, 
predicting the biologization of mental health. First, President Reagan 
turned the national community mental health system that was federally 
funded into state mental health block grants. What the states knew about 
was dealing with the chronically mentally ill, so there was no place for 
prevention, consultation and education in the mental health system and 
those services disappeared very rapidly under block grants. That is the 
equivalent of a comprehensive health system eliminating public health. 
Then, the National Institute of Mental Health shifted from support of 
CMHCs to funding for research on the biological origins of mental 
illness. At that point the drug companies moved in and supported these 
efforts. The Alliance for the Mentally Ill (AMI), mainly composed of the 
families of the mentally ill, became a strong voice for the chronically 
mentally ill. Interestingly, their major funding source was the 
pharmaceutical companies. So, all the stars aligned to move the mental 
health system away from a SDOH community mental health perspective and 
towards a biological perspective. And, there has been no turning back.

The widespread endorsement of SDOH by public health may be a chance to 
bring the pendulum back a bit and to start addressing alternative ways 
of understanding emotional well being and other ways of intervening and 
preventing disorders.

Page Top
If we all embraced a SDOH perspective on mental health, what would that 
look like?

First, researchers would have to lay the ground work by gathering the 
studies
on each of the social determinants of health and its relationship to 
mental health. For example: What is the impact on unemployment or 
underemployment to one’s emotional well being? How does nutrition and 
fitness affect one’s mental health?

In the arena of health, an early British publication entitled “ The 
Solid Facts”
http://www.euro.who.int/__data/assets/pdf_file/0005/98438/e81384.pdf 
laid out the research to back up each social determinant of health in a 
clear and concise manner – very readable for stakeholders and policy 
makers. This is what is needed now for SDOH and mental health.

Second, for each SDOH we would need to present approaches that can 
modify these social determinants in such a way that it can improve the 
mental health of the population. These can be programs, policies or 
structural changes. Two recent issues that touch on major social 
determinants of health come to mind: At the moment there is a 
significant amount of focus on Food and Fitness policy . What has been 
found about improving food and fitness and its impact on mental health? 
Another hot issue at the moment regards housing; we could look at 
various foreclosure interventions and their impact on mental health.

So, we need a sophisticated look at how to create changes in each social 
determinant of health that can improve mental well being.

Finally, we need settings which can address mental health from a SDOH 
perspective.

Where can this work be carried out and supported? Who will step up to 
the plate? Mental Health agencies? Public Health agencies? Academia? 
Healthy Community initiatives? Or, will we need to create new settings. 
Without settings to support SDOH and mental health, we will make little 
progress.
A story that summarizes the issue well:

Early in my career, I went to do a focus group with some community 
elders. I asked them “What are the major issues they face in their 
lives?” They responded: money (not enough), access to affordable health 
care, and lack of transportation. Then, I explained that I was from a 
mental health agency and asked what issues in their life most affected 
their mental health. They said : ‘Doc weren’t you listening : money (not 
enough), access to affordable health care, and lack of transportation.’

Even back then, they understood the relationship of SDOH to their mental 
well being. Now, we need to catch up with them.

Page Top
What’s new at Tom Wolff & Associates?
“The Power of Collaborative Solutions”

In November of 2011 my new book was reviewed in Health Promotion 
Practice by Sara Olsen.

She wrote:
“… is a practical easy-to-use new resource for building effective 
collaboration and partnerships….The book is compact, easy to read and 
covers a lot of ground, outlining six proposed principles for healthy 
communities. Wolff illustrates his facts and show successes with stories 
and examples of collaboration and coalition building on any level.”

The book continues to be used in core academic courses at many different 
universities. Practitioners from many fields such as public health, 
urban planning, etc are often telling me how useful and readable they 
have found the book.
Comments from a reader:

“As a person who initially reacts not positively to the word 
spirituality, I really like, Tom, how you described it with words I 
associate with community-building all the time – acceptance, 
appreciation, deep compassion and interdependence. I think those words 
conjure up some of the beautiful and meaningful work in community 
development that also unites non-religious spirituality with traditional 
religious meanings of spirituality – and this allows me to imagine new 
ways of community members working together from different spiritual 
staring points.”
Recognition:

In June of 2011 I was honored and very grateful to be given the “John 
Kalafat Award in Applied Community Psychology” awarded at the SCRA 
Biennial in Chicago. The award is presented to someone who exemplifies 
John Kalafat’s “unique characteristics as mentor, teacher, and advocate 
and especially his passion for making the benefits of community 
psychology accessible to all”
New Clients:

Over the last year I have been pleased to work with new groups across 
the country including Chicago, Los Angeles, Wichita, Omaha, Worcester 
and others:

The Coalition of Hospice and Palliative Care Organizations
The Southside Healthcare Collaborative of the U Chicago Medical Center
Boston Connect To Protect (C2P) at Fenway Institute, Boston
Leadership Metro Richmond
CitiMatch webinars for:
Nebraska Health Policy Program, and The Plaza Partnership, Omaha, Nebraska
Pacifica Graduate Institute
Antioch University Community Psychology Program Los Angeles, CA
Wichita State University, Community Psychology Program
Molly Bish Center , Worcester County District Attorney’s Elder Abuse Seminar
Oklahoma Health Department – Health Leadership Institute
Quote of the month:

David Korten in The Great Turning: From Empire to Earth Community 2006
“…. Real change would depend on articulation of a compelling alternative 
to the existing profit-driven, corporate- planned and corporate-managed 
global economy. It seemed that living systems might offer helpful 
insights. Yet conventional biology, which seeks to explain life in terms 
of material mechanisms and assumes that a competition for survival by 
the most fit is the key to evolutionary progress, offered little of 
evident use.

Then I met two extraordinary women- microbiologist Mae-Won Ho and 
evolution biologist Elisabet Sahtouris. Both were taking the study of 
life to a profound level that reveals life to be a fundamentally 
cooperative, locally rooted, self-organizing enterprise in which each 
individual organism is continually balancing individual and group 
interests. Here was the natural model for which I had been searching. 
Life has learned over billions of years the advantages of cooperative, 
locally- rooted self-organization. Perhaps humans might be capable of 
doing the same.”

This is what I describe as “interdependence” in The Power of 
Collaborative Solutions.

Page Top









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