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From treatment to prevention in mental health: a socio-ecological model

In most areas of health care the social and environmental determinants of health are overlooked in favour of an individualistic approach to treating illness and disability.

Below, PhD student, Tassia Oswald, describes the complex and important role of ecological determinants for mental health and argues that our health system should adopt a socio-ecological model, in particular for young people.

This essay was submitted for the National Public Health Think Tank Competition and has been selected by Croakey for publication. The competition is an initiative of the Students and Young Professionals in Public Health (SYPPH) Committee of the Public Health Association of Australia.


Tassia Oswald writes:

During a 2019 ‘Listening Tour’ conducted by United Nations Youth Australia, young Australians reported that their top areas of concern were ‘climate change/the environment’ and ‘mental health’.

Unsurprisingly, the psychological burden of climate change has led to the emergence of new psychological phenomena which are uniquely related to feelings of distress around the state of the environment: namely, ‘eco-anxiety’ and ‘eco-grief’.

Climate change, natural disasters like bushfires, and the emergence of new viruses like COVID-19, all have human-induced ecological issues at their core.

Increasing global temperatures are the result of greenhouse gas pollution arising from the industrial revolution, and these elevated temperatures create environments which facilitate greater frequency and extremity of natural disasters.

Land clearing for agricultural purposes creates environmental pressures which displace wildlife and increase their proximity to other animal and human populations, ultimately increasing our risk of exposure to novel zoonotic viruses like COVID-19.

The events of 2020 have not only caused significant global disruption, they also reflect the environmental issues young people are most worried about and exacerbate the mental health issues which they already report to be “at a crisis point”.

These events are particularly challenging for young people who must bear the long-term social, ecological, and economic consequences, but have limited direct influence over decisions made or actions taken.

Youth mental health issues are a major public health impact of these events, with Kids Helpline reporting a 15% increase in calls during the bushfires, and a 40% spike in calls during COVID-19 restrictions.

From treatment to prevention

Clinical psychology is the dominant discipline addressing issues of youth mental health.  While incredibly important, most psychotherapies are individualistic and costly, placing the onus of mental wellbeing on the individual, and typically fail to consider wider ecological determinants of mental wellbeing.

This treatment-approach is problematic as experiences of depression and anxiety in childhood and adolescence are associated with an elevated risk of poor mental health in adulthood.

A shift is required from treatment to prevention of mental illness and promotion of mental wellbeing.  A socio-ecological model, which considers upstream ecological determinants of youth mental health, is needed. This presents a tremendous opportunity for public health.

Increasing the provision of urban greenspaces

In addressing the youth mental health consequences of climate change, bushfires, and COVID-19, the underpinning ecological issues must be considered.  The Ottawa Charter for Health Promotion highlights the inextricable links between human health and the environment and demonstrates the key role public health has to play in environmental protection, as well as the role of environmental management in ensuring youth mental health.

Figure 1 outlines a range of strategies which could be implemented to achieve this mutually beneficial collaboration.

Figure 1. Strategies to address youth mental health issues and ecological issues through (a) highlighting the dual human-environment benefits of protecting natural earth systems, (b) preventing environmental degradation to reduce eco-anxiety and eco-grief, and (c) promoting the mental health benefits of connecting with nature.

A key strategy

A key strategy involves increasing the provision of greenspaces in cities, as well as promoting the mental health benefits of connecting with nature.  Despite concerns young people display for the environment, their engagement with nature is relatively low due to urbanisation.

This absence of local nature is particularly pronounced for young people living in low socioeconomic areas due to inequitable distribution of greenspaces.  Competing activities can also limit nature engagement, with some children reporting higher daily “screen time” than weekly “green time”.

Environmental psychologists postulate that engagement with natural environments is crucial for wellbeing as humans are predisposed to resonate with nature.  Our evolutionary experience within natural environments means our bodily systems, physiological processes, cognitive functions, and mental states are regulated to function optimally in nature.

This suggests that young peoples’ detachment from nature may be deleterious for their mental health, and increasing their connection with nature is important to promote mental wellbeing.   A body of evidence points to a positive relationship between nature exposure and psychological outcomes, including increased attention and positive mood, alongside reduced depression and stress.

Aside from psychological theories which explain the benefits of nature, alternative underlying mechanisms are regularly proposed.  These include increased social connectivity, physical activity, and exposure to natural sunlight (regulating healthy sleep-wake cycles) experienced in greenspaces, as well as reduced crowding and air/noise pollution.

Solutions to ecological issues and youth mental health issues are symbiotic.  Protecting nature is crucial for reducing psychological distress, while connecting with nature is important for promoting youth mental health.

Tassia Oswald is a PhD Candidate in the School of Public Health at the University of Adelaide. Her background is in Psychology and Epidemiology, and she has a strong interest in youth mental health.  

Tassia is passionate about strategies which target both prevention of mental illness and promotion of mental wellbeing. She is particularly interested in links between the natural environment and population health, which is why she is involved with the Planetary Health Alliance as a Campus Ambassador.  Alongside her PhD, Tassia has worked on a range of projects which aim to increase access to psychological therapies for Australians. 

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