Report on the Distribution of the Social Determinants of Health and Health Equity in a Forensic Psychiatry Program
Keywords:forensic mental health, health equality, social determinants of health
The social determinants of health are important factors that shape a person’s well-
being, life expectancy, and quality of life. The environments in which people live, work, and play are paramount in determining their overall health. As such, viewing health as an outcome, not only of individual choices and biomedical factors but also of socioenvironmental influences, can be an important lens to guide health-care practice. This report examined the social determinants of health of people admitted to inpatient units in a forensic psychiatry program in a major Canadian urban centre. Twenty health variables were collected from the Resident Assessment Instrument–
Mental Health form. A deprivation scale was created to understand social and material inequality on a gradient. Findings showed that those surveyed had high rates of poor social determinant of health factors, such as low educational attainment, insecure housing, and lack of secure employment before their admission to the program. Chi-square tests showed associations between material deprivation, race, and comorbidity status. The findings may influence a multisectorial approach to mental illness prevention, management, and recovery practices.
Andermann A. Taking action on the social determinants of health in clinical practice: a framework for health professionals. Canadian Medical Association Journal. 2016.;188(17-18):E474-E483. https://doi.org/10.1503/cmaj.160177.
Wilkinson R, Marmot M (eds.) Social determinants of health: The solid facts (2nd ed.). Denmark: World Health Organization; 2003. https://www.euro.who.int/__data/assets/pdf_file/0005/98438/e81384.pdf
World Health Organization. Social determinants of health. 2020. https://www.who.int/social_determinants/sdh_definition/en/.
Canadian Public Health Association. What are the social determinants of health? n.d. https://www.cpha.ca/what-are-social-determinants-health.
Pickett KE, Wilkinson RG. Inequality: An underacknowledged source of mental illness and distress. British Journal of Psychiatry. 2010;197(6):426-428. https://doi.org/10.1192/bjp.bp.109.072066.
Hilton NZ, Ham E, Lang C, Harris, GT. Weight gain and its correlates among forensic inpatients. Canadian Journal of Psychiatry. 2015;60(5):232-238. https://doi.org/10.1177/070674371506000505.
Scerri A, Innes A, Scerri C. Person-centred dementia care in acute hospital wards—The influence of staff knowledge and attitudes. Geriatric Nursing. 2020;41(3):215-221. https://doi.org/10.1016/j.gerinurse.2019.09.001.
Andresen R, Oades LG, Caputi P. Psychological recovery: Beyond mental illness. Chichester, West Sussex: Wiley-Blackwell; 2011.
Oliver ME. The psychology of criminal conduct (fifth edition) edited by D.A. Andrews and J. Bonta [book review]. British Journal of Psychology. 2011;102(3):689-690.https://doi.org/10.1111/j.2044-8295.2011.02057.x.
MacPhail A, Verdun-Jones S. Mental illness and the criminal justice system. Vancouver, British Columbia: International Centre for Criminal Law Reform and Criminal Justice Policy; 2013. https://icclr.org/wp-content/uploads/2019/06/Mental-Illness-and-the-Criminal-Justice-System-Final-VS.pdf?x96127.
Hiday VA. Putting community risk in perspective: A look at correlations, causes and controls. International Journal of Law and Psychiatry. 2006;29(4):316-331. https://doi.org/10.1016/j.ijlp.2004.08.010.
Trotter RT, Lininger MR, Camplain R, Fofanov VY, Camplain C, Baldwin JA. A survey of health disparities, social determinants of health, and converging morbidities in a county jail: A cultural-ecological assessment of health conditions in jail populations. International Journal of Environmental Research and Public Health. 2018;15(11):2500. https://doi.org/10.3390/ijerph15112500.
Stewart LA, Nolan A, Thompson J, Power J. Social determinants of health among Canadian inmates. International Journal of Prisoner Health. 2018;14(1):4-15. https://doi.org/10.1108/IJPH-08-2016-0038.
Kouyoumdjian F, Schuler A, Matheson FI, Hwang, SW. Health status of prisoners in Canada: Narrative review. Canadian Family Physician. 2016;62(3):215-222. https://www.cfp.ca/content/62/3/215.
Canadian Institute for Health Information. Ontario mental health reporting system metadata. 2019. https://www.cihi.ca/en/ontario-mental-health-reporting-system-metadata.
Institut national de santé publique du Québec. Material and social deprivation index. 2019. https://www.inspq.qc.ca/en/deprivation/material-and-social-deprivation-index.
Pearson C, Janz T, Ali J. Mental and substance use disorders in Canada. Statistics Canada Catalogue no. 82-624-X. 2013. https://www150.statcan.gc.ca/n1/pub/82-624-x/2013001/article/11855-eng.pdf.
Statistics Canada. Table 13-10-0394-01 Leading causes of death, total population, by age group. https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310039401.
Heger D. Decomposing differences in health and inequality using quasi-objective health indices. Applied Economics. 2018;50(26):2844-2859. https://doi.org/10.1080/00036846.2017.1412073.
Zinger I. Office of the Correctional Investigator annual report 2018-2019. 2019. https://oci-bec.gc.ca/cnt/rpt/annrpt/annrpt20182019-eng.aspx.
Hajizadeh M, Mitnitski A, Rockwood K. Socioeconomic gradient in health in Canada: Is the gap widening or narrowing? Health Policy. 2016;120(9):1040-1050. https://doi.org/10.1016/j.healthpol.2016.07.019.
Ontario Ministry of Health and Long-Term Care. HEIA: Health equity impact assessment. 2020. https://www.health.gov.on.ca/en/pro/programs/heia/.
Chesney E, Goodwin GM, Fazel S. Risks of all-cause and suicide mortality in mental disorders: A meta-review. World Psychiatry. 2014;13:153-160. https://doi.org/10.1002/wps.20128.
Mawani FN, Gilmour H. Validation of self-rated mental health. Statistics Canada Catalogue no. 82-003-X. 2010. https://www150.statcan.gc.ca/n1/en/catalogue/82-003-X201000311288.
How to Cite
Copyright (c) 2021 Samantha Perrotta, Bruno Losier
This work is licensed under a Creative Commons Attribution 3.0 Unported License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright of their work and grant the International Journal of Risk and Recovery the right of first publication with the work simultaneously licensed under a Creative Commons Attribution License. This allows others to share the work with an acknowledgement of the work’s authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal’s published version of the work (e.g., post it to an institutional repository or publish it in a book) with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their websites) before and during the submission process as it can lead to productive exchanges, as well as earlier and greater citation of published work. (See The Effect of Open Access.)