Mental health & women

This past Friday (October 10th) was Hat Day, a fundraising initiative run by Australian Rotary Health to support mental health research in Australia. I have a scholarship from both this organisation and the National Health & Medical Research Council (NHMRC); my research would not be possible without these. You can find out more about Hat Day and/or donate at www.hatday.com.au. 

As part of my support for this day I wrote a guest post for the Monash University Medical Student Undergraduate's Society (MUMUS) about mental health. It's a piece that I'm really proud of so I thought I would share it with you all (to see it in its original form click here). While this post is aimed at medical students I think we can all take something away from it in terms how we perceive women and the illnesses they experience.

A comprehensive approach to mental health care research and practice

This Friday on October 10 is Hat Day where Australian Rotary Health—the largest non-government funder of mental health research in Australia—has asked people throughout Australia to wear a hat and donate to mental health research. I personally am very grateful for the hard work of Rotarians to raise such funds; I have been awarded an Ian Scott scholarship. My own research would not be possible without it.

The aim of my PhD project is to understand women’s experiences of endometriosis, particularly the effect that living with this condition has on their mental health. Throughout my research I have seen evidence of the need to approach all aspects of health, particularly mental health, in a comprehensive manner. I use ‘comprehensive’ to mean an approach that takes into account the person in their social context, not just the biological aspects of their illness. In this blog post I explain why such an approach is important in mental health research and practice, and why it is an essential topic for the next generation of doctors in Australia to understand and consider.

People do not experience illness in a vacuum, void of social, cultural and political influences, nor is medical practice immune to such influences.  A well-known example is the entry of homosexuality as a disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM; version: DSM-I)—the US diagnostic reference for mental health—despite the lack of empirical data. It was removed in 1986 because of changing social norms and the emergence of a politically active lesbian, gay, bisexual, and transsexual (LGBT) community.

The impact of sociocultural influences on people’s experience of illness is most evident when we consider women and their mental health. While both women and men experience mental illness, women in general are more often diagnosed and each is more prone to certain diagnoses. For example, mood disorders (such as depression) and anxiety disorders (such as generalised anxiety, post-traumatic stress) are more likely to be experienced by women than by men (mood: 18% vs 12%; anxiety: 32% vs 20%).

There are many factors that contribute to such gendered differences, one of which is women’s social context. The 1997 United Nations Human Development Report concluded that “no society treats its women as well as its men.” Although this report was published over 10 years ago little has changed. Gendered inequalities within society have been reported to be a significant factor in increased rates of mental illness among women.

Ignoring social factors has led many to attribute poor mental health among women to personal deficits rather than identifying it as an understandable reaction to adverse social circumstances. (It is ironic that this oppression—which is enacted by men who predominantly benefit from it—also adversely affects the ability of men and boys to seek care for mental health problems because of fear that it is not masculine to do so.) By not acknowledging social circumstances and their relationship to mental illness within health research and practice, we not only overlook significant determinants of women’s health but also perpetuate inequality.

Failure to consider all aspects of mental health also contributes to the unnecessary pathologisation of people’s distress, much of which is understandable given their circumstances. This pathologisation can result in the misallocation of resources, for example, funding pharmaceutical interventions rather than psychosocial interventions such as domestic violence campaigns and improved social support for women experiencing endometriosis. It can also lead to increased pressure on medical professionals, including general practitioners (GPs), to ‘treat’ problems for which they have received little or no training, when this burden could be distributed across the community.

It can be difficult to incorporate these concepts of a comprehensive approach into medical practice, given the restraints inherent in the modern medical environment, such as short consultation times and minimal training for non-specialist mental health professionals. As the future of Australian medicine, you are well placed to revolutionise the system to ensure that all women receive the best possible care. You may choose to take time now to become informed about how your service will contribute to people’s experience of illness. I hope this blog post contributes at least in a small way to your conversation with your peers.

For more information on the topics mentioned in this post I recommend the following:

o   Gender and sex, and its relevance to medical practice: http://www.med.monash.edu.au/gendermed/sexandgender.html

o   A review of the evidence of the psychosocial effects of living with endometriosis: Young K, Fisher J, Kirkman M. (2014). Women’s experiences of endometriosis: A systematic review and synthesis of qualitative research. Journal of Family Planning and Reproductive Health Care. http://www.ncbi.nlm.nih.gov/pubmed/25183531; doi: 10.1136/jfprhc-2013-100853

o   The risks of ‘too much medicine’: http://www.bmj.com/too-much-medicine