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    Dr Matt Fisher

    Dear Jennifer, thanks for the article. Useful in many respects but unfortunately – speaking of skirting around issues – you manage to barely touch on THE most fundamental issues of concern, which do so much to explain Australia’s very poor performance on mental health compared to other OECD countries, and explain why all the enquiries and frenetic activity make little difference, and provide the framework for understanding what must be done instead. These issues are the social determinants of mental health, and chronic psychosocial stress as THE key mechanism that ‘translates’ exposure to certain social conditions into effects on mental health. Chronic stress is a generic risk factor acting across the whole population, and more intensely for those of lower SES, which serves to shift the whole population bell curve, to increase risk of illness for all, increase incidence for the ‘unlucky’ 20%, and produce a social gradient in illness. Until we begin to understand our social and economic conditions in terms of the ways that drive chronic stress (and undermine or under-develop peoples capabilities to cope with stressors) we WILL continue to fail – and in fact on our current social and environmental trajectory it is likely that things will get worse. We know this. However, this need not be a counsel of despair because by understanding the role of stress as a driver of mental illness we can in fact also move to better understand the basic social conditions required for mental health and wellbeing. To do this we need to get out of our comfort zone of ‘fixing’ the mental health system and face up to the challenge of social and economic change. This is not an inchoate cry from the barricades; there are many feasible actions that could be taken immediately, but they all need careful understanding of the nature and role of socially produced chronic stress as a generic risk factor for mental ill health.


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