It’s not just you: community psychology and the social determinants of health

Four days before Christmas, a crisis text line in the UK took over 4,000 conversations. Demand for the service soared in the context of a new strain of Covid, new restrictions on movement and a markedly different Christmas than the one promised. It retrospect, it seems obvious to say that our mental health is linked to the wider social context.

Photo by Tegan Mierle on Unsplash

And yet, research on the impact of our environment, circumstances and social determinants of health lag hugely behind research on the biology of mental health. This week’s speaker, Sally Zlotowitz, spoke about about her passion which is taking mental health out of the ‘brains’ of individuals and instead thinking about it in terms of people’s wider context, including the health of our communities, inequality and economic policy, social inclusion and our connection to nature.

Next week 👉 Is age just a number? Exploring the link between mental health and life stages

If you just landed here — this article is part of a ten-part series providing bite-sized expert insights on mental health topics (from world-class speakers via Zinc) and my thoughts on the role tech can play in addressing these themes. All smart ideas come from the speakers and my peers — all poor phrasings and misunderstandings are my own.

What you’ll learn from this article 🧠

This week’s speaker was Sally Zlotowitz, Director of Public Health & Prevention at MAC-UK and part of the Digital & Social Health team at Nesta. The big ideas were understanding community psychology and co-producing services with the communities they serve. Our discussion focused on a case study of co-production and the profile of community psychology. Technology thoughts include the role of data justice and how technology can encourage civic participation for the benefit of all.

The big ideas 💡

• Community psychology considers the roots of distress at a systemic level. People don’t develop in a vacuum, and there are positive preventive actions we can take to protect our wellbeing (including the role of nature). There is a bias to action, often linked with collective action: addressing systems of oppression and recognising the impact of marginalisation on how people see themselves
• In practice, this often involves reimagining services together with users. This combines community psychology with narrative therapy (making sense of and positively influencing the narrative and meaning we give to our lives) and adaptive mentalisation-based integrative treatment. MAC-UK uses a youth-led approach to make mental health accessible to young people, by putting mental health workers at the heart of activities activities led by young people themselves.

Discussion points 🗪

• What does true co-production look like? There are varying levels of co-production, as seen in Arnstein’s Ladder of Participation: from tokenistic involvement amounting to manipulation all the way up to citizen control. Key features of co-production include seeing peoples’ skills and capacities to co-produce a service, breaking down the barriers between service users and professionals, the presence of reciprocity and services become agents for change. A key benefit is that this model is inherently scalable and whilst some support may be needed to set up co-production, it should eventually be fully sustainable and owned by the community
• Why isn’t community psychology better known and utilised? There’s a few answers — the main one is our idea of what constitutes evidence and evidence-based practices and service. Clinical psychology is young and committed to being perceived as a science whilst community psychology has its own methods and ideas about evidence which do not sit within the frameworks of clinical psychology. As a clinical psychologist your training is focused on individual therapy rather than the bigger picture around policy, how the NHS words, co-production and the social determinants of health

Technology thoughts 💻

• As services increasingly generate data — from financial transactions, communications and movement — this is being used to profile and sort groups. These processes can affect individuals as well as entire communities via denial of services, access to opportunity or wrongful targeting — all of which can impact mental and physical health. For example, a Huawei patent was recently discovered to contain AI which can identify people who appear to be of Uighur origin, whilst the Cambridge Analytica scandal shows the impact of weaponising data for political benefit. The Data Justice Lab, in their own words, “advances a research agenda that examines the intricate relationship between datafication and social justice by foregrounding and highlighting the politics and impacts of data-driven processes and big data”
• Technology can play a role in driving better civic participation: for example Hello Lamp Post allows people to communicate with objects in their community (like a lamp post!). This playful approach to participation acts as two-way communication, bringing together community engagement, cultural storytelling, public consultation and tourism / wayfinding. More broadly, it’s a more personable approach to getting feedback and guiding people toward their desired destination and a clear contrast to traditional systems of triage and feedback which usually take the form of ranking scales. What could a supportive and well-guided healthcare pathway look like, and how could service users help us design this?

Reading list 📚

• https://organizingengagement.org/models/ladder-of-childrens-participation
• https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwjC2_ao18HtAhXnWRUIHTzpBcsQFjACegQIAxAC&url=https%3A%2F%2Fyoungminds.org.uk%2Fmedia%2F2008%2Fwhat-is-participation.pptx&usg=AOvVaw3z6p8NsHekZZqguKE6JsA-
• https://ec.europa.eu/info/sites/info/files/lundy_model_of_participation.pdf
• https://mac-uk.org/

Speaker bio 🔈

• Dr Sally Zlotowitz is a Programme Manager in the Social Health team of Nesta and has spent over ten years working in the field of mental health innovation, clinical and community psychology, co-production of services and the social determinants of mental health through various roles, including at the mental health charity for excluded young people, MAC-UK, as Clinical Director, where she continues one day a week as the Director of Public Health and Prevention. She is Chair of the British Psychological Society’s Community Psychology Section, co-founder of Psychologists for Social Change and founding member of the Housing and Mental Health Network.