Merged_Reversed_Presentation (1).pptx0000

PSYCHOSOCIAL FOUNDATION OF MENTAL
HEALTH

Introduction
● Mental health is significantly shaped by psychosocial factors including relationships,
societal roles, culture, community interactions which continuously influences mental
health and this dynamic state means that an individual's overall well-being depends
on psychological, social connection, support and the individual's environmental and
cultural or religious factors.
● Psychosocial environment refers to the intricate interplay between an individual's
psychological and social aspects, which includes social support, family dynamics,
socioeconomic status, and community engagement alongside individual
psychological characteristics such as self-efficacy, self-esteem, and coping
mechanisms.

Psychosocial Determinants
● Psychosocial determinants refer to elements connected to the social environment,
mental state, and wider societal conditions that impact mental health. Understanding
the role of psychosocial determinants is effesential as these factors frequently interact
with biological influences, shaping the development, progression, and outcomes of
mental health issues. Following are the psychosocial determinants:
Gender Ethnicity & Race Socioeconomic Status Education Employment/Occupation
Migration Access to Health Care Family Environment Family Dynamics Childhood Adversity
Cultural &
Religious Beliefs
Self Esteem, Coping &
Resilience
Marriage Community Stigma

Psychosocial Theories
Biopsychosocial Model (Plus)
● Developed by George Engel in 1997 posits that
mental health & illness are the result of interactions
between biological, psychological, & social factors.
● The Plus model focus on evaluating the 3 factors
along with individual cultural, spiritual &
environmental influences to understand the mental
health disorders as well as improve treatment efficacy,
understand the broader context in which individual
lives & enhance the Interprofessional education.

Social Cognitive Theory
● Developed by Albert Bandura, focus on how
individuals learn & adopt behaviours via
interaction with the environment, personal
experiences, & social influences.
● Understanding the intricate play between the
factors helps to design behavioural interventions
that aim to improve mental health outcomes
through enhancing self-efficacy, promoting
positive outcome expectations, and using
modelling to encourage the adoption of healthier
behaviours.

Social Causation Theory
● The concept of social causation can be traced back to Emile Durkheim, but the
formal use of social causation theory in contemporary studies, especially related to
socioeconomic status & mental health, was developed by Bruce Link and Jo Phelan
in the 1990s.
● Social environment & socio economic conditions directly influence mental health
problems where conditions such as poverty pose as a significant risk factor.
Individuals living in poverty face higher levels of stress, financial instability, and
limited access to resources, all of which contribute to mental health problems.

Social Selection Theory
● Social selection theory has its roots in Darwinian evolutionary theory and has been
explored in the context of mental health and socioeconomic status by Dohrenwend. It
is also known as social drift theory, which posits that individuals with mental health
problems are more likely to experience downward social mobility.
● Individuals with a genetic predisposition to mental illness are likely to experience
downward social mobility, regardless of their initial socioeconomic status because of
the psychosocial stressors leading to isolation & further downward mobility.

Social Capital Theory
● Popularised by Robert Putnam, the theory refers to the resources and benefits that an
individual gain from the social networks, relationships or through community
participation. These social ties provide individuals with emotional support, a sense
of belonging, access to information, and practical assistance.
● Individuals with higher social ties may experience better mental health outcomes due
to their ability to navigate & access institutional support, it influences attitudes
toward mental health & help-seeking behaviours (Woolcock, 2001).

Diathesis-Stress Theory
● Developed in late 1960s by Paul Meehl, Manfred
Bleuler, and David Rosenthal to understand risk
factors of Schizophrenia.
● Individuals with a higher diathesis which can be
biological, genetic, psychological, or cognitive in
nature are more susceptible to developing mental
health conditions when exposed to stress.

Labelling Theory
● First proposed by sociologist Howard S. Becker in his book Outsiders: Studies in the
Sociology of Deviance. Emphasises laid on understanding the process which
involves identifying behaviours that deviate from societal norms, categorising them
as symptoms of mental illness, and assigning the individual a label such as "mentally
ill".
● Once labelled, individuals may begin to see themselves primarily through the lens of
their diagnosis, treated differently by others, leading to social exclusion,
discrimination, & marginalisation, which significantly impact a person's social
identity & self-esteem (Phelan, 2001).

Modified Labelling Theory
● Proposed by Bruce G. Link, it explores the negative stereotypes and stigmas such as
assumptions that mentally ill individuals are dangerous, unpredictable, or incapable,
are deeply ingrained in cultural and social norms.
● Individuals under treatment or when diagnosed starts to internalise the negative
beliefs, anticipating that they will face discrimination and rejection, leading to
individuals to fear of being judged or marginalised based on their mental health status
further repeating the vicious cycle of isolation which indirectly worsen mental health
conditions.

Legislation and Mental Health Programmes
Acts/Policy/Programmes Objectives
Lunatic Asylums Act of 1858 Social control i.e., focusing on controlling behaviour that did not conform to
social norms. Reflected stigma & reinforcing isolation
Indian Lunacy Act of 1912 Establishment & regulation of mental asylums, addressing the treatment,
reinforced social stigma
The Mental Health Act of 1987 Licensing and regulation of mental health institutions, legal safeguards,
patient rights, establishment of licensing authorities & mental health review
boards,
The Mental Health Care Act , 2017 Promoting community-based treatment and rehabilitation, rights of persons
with mental illness, mental health review boards & prohibition of
discrimination.

Cont…
National Mental Health Programme 1982 Integration with general healthcare, equal access, prevention &
early detection, reduce stigma, & community based care.
National Mental Health Policy, 2014 Human rights & dignity, universal access to mental healthcare,
prevention & early detection, integration with other health &
social services
Persons with Disabilities Act, 1995 Equal opportunities in employment, education, & other sectors of
society, protection of rights, & full participation,
Rights of People with Disabilities Act, 2016 Equal right to education, employment, healthcare, political
participation, legal capacity & guardianship, protection from
abuse & violence

Indicator of Positive Mental Health
● Psychosocial determinants play a crucial role as indicators of positive mental health
because they encompass the social, psychological, and environmental factors that
influence an individual’s well-being and capacity to cope with life's challenges.
● Strong psychosocial foundations demonstrate better resilience when faced with
stressors which includes the ability to effectively manage and recover from life’s
challenges, which is a hallmark of positive mental health, achieved through robust
social connections and coping mechanisms (Freeman, 2022).

Indicators of Positive Mental Health
• Resilience
• Optimism
• Coping skills
• Education
• Religion and Spirituality
• Self esteem
• Problem solving Skill
• Access to Mental Health care
• Social Support
• Family Environment
• Healthy Habits

Conclusion
● A person's state of mind is shaped by a variety of social, economic, and
environmental factors throughout their life; the more social inequality there is, the
higher the chance that a person may experience mental health problems.
● To improve mental health outcomes and lower the frequency of mental diseases, it is
imperative to address these inequities at all stages of life. Perhaps the most important
predictors of poor mental health is psychosocial risk factors, that emphasises the need
for comprehensive preventive and intervention strategies.

PSYCHOSOCIAL FOUNDATIO
MENTAL HEALTH
Chairperson: Dr. Prashant Srivastava
Co-chairperson: Ms. Srbana Bhattacharjee
Presentee: Mr. Kilovi Swu
Discussant: Mr. Minhaz Khan

Introduction
• Beyond Symptom Management: Healthcare providers can offer more compassio
individualized care by addressing psychosocial factors (Sirey, 2008).
• The Role of Socio-cultural Factors: Socio-cultural issues are critical in understa
(Epidemiological evidence).
• Social Inequality: Direct correlation between social inequalities and increased m
• WHO (2014) Findings: The greater the inequality, the greater the mental health
with it.

• Cognitive Patterns: Influence mental
health through thought distortions (e.g.,
negative self-perception).
• Emotional Regulation: Managing
emotions is key to mental well-being.
• Trauma & Stress: Long-term stress or
Psychological Factors
• Family Dynamics: Supportive vs.
conflicting family environments.
• Socioeconomic Status (SES): Lower SES
linked to higher mental health risks.
• Social Support: Strong networks reduce
the risk of disorders.
• Community & Culture: Beliefs shape
Social Factors
Etiology of Psychosocial Foundations of Ment

Community and Cultural Influences
• Cultural beliefs and practices shape attitudes
towards mental illness, influence the types of
support available, and determine the stigma
associated with mental health issues
• Communities with high levels of social cohesion,
where residents feel connected and supported by
their neighbours, tend to have lower rates of mental
health problems (Kawachi & Berkman, 2001).
• Deteriorating physical environment can lead to
chronic stress
Developmental and Biological Interactio
Impact of Life Events:
• Positive & Negative
Events: Major life changes
(e.g., marriage,
parenthood, loss) can
trigger mental health
issues.
• Stress and Risk: Multiple
stressful life events
increase vulnerability to
Adoloscent and Adult
Transitions:
• Adolescence: A critical
period for mental health
vulnerability (Arnett,
2000).
• Adulthood Transitions:
Challenges like entering
the workforce, marriage,
and ageing impact mental
health.
• Support Systems: Family,
Contd.

Mental Illness and Psychosocial Relations
Mental Illness Risk Factors Maintaining Factors
Depression Genetic predisposition, Chronic
stress, Substance abuse, Trauma
Negative thought patterns,
Lack of social support, Poor
coping skills
Stron
Effe
Regu
Anxiety Disorders Family history of anxiety, High-
stress environments, Traumatic
events
Avoidance behaviour, Chronic
stress, Lack of treatment
Resi
relat
man
Schizophrenia Genetic factors, Prenatal
exposure to infections,
Substance abuse, Stressful life
events
Poor medication adherence,
Social isolation, Stressful life
circumstances
Stron
inter
men

Mental Illness Risk Factors Maintaining Factors
Obsessive Compulsive Disorder
(OCD)
Family history, High levels
of stress, Specific
personality traits
Ongoing compulsive
behaviours, Lack of
therapy, High stress
Co
the
sup
ma
Post-Traumatic Stress Disorder
(PTSD)
Exposure to trauma,
Previous mental health
issues, Lack of social
support
Ongoing exposure to
stressors, Avoidance of
therapy, Continued
substance abuse
So
the
Eating Disorder Genetic predisposition,
Sociocultural pressures,
History of trauma or abuse
Disordered eating patterns,
Low self-esteem, Social
isolation
He
Su
fri
spe
Contd.

Critical Appraisal of Theories of Psychosocial Fo
Theories Strengths L
Biopsychosocial Theory • Comprehensive Approach to Health
• Recognition of Psychological and
Social Factors
• Influence on Integrated Care Models
• Complexity a
Implementati
• Potential for O
Factors
• Challenges in
Quantifying N
• Potential for A
Specificity
Social-Cognitive Theory • Holistic and Integrative Approach
• Emphasis on Observational Learning
• Focus on Self-Efficacy
• Overemphasi
• Complexity in
• Potential for L

Contd.
Theories Strengths Lim
Social Causation • Focus on Social Determinants of Health
• Empirical Support
• Policy and Intervention Implications
• Challenges in Establ
• Potential Overempha
Neglect of Social Mo
Factors
• Potential Cultural Bi
Social Selection
Theory
• Insight into Reciprocal Relationships
• Support for Interventions Focused on Mental
Health
• Evidence of Impact on Social Mobility
• Challenges in Disting
from Social Causatio
• Potential Neglect of
• Limited Focus on Re
Mechanisms

Contd.
Theories Strengths
Diathesis- Stress Model • Integration of Biological and
Environmental Factors
• Empirical Support and Research
• Clinical Relevance
Complexity in
Stress
Potential for O
Factors
Cultural and C
Dynamic Inter
Modified Labelling Theory • Emphasis on the Social Construction of
Identity
• Focus on Stigmatization and Its
Consequences
• Application to Policy and Practice
• Challenges
of Labels
• Potential O
Outcomes
• Cultural an

ANDERSON’S BEHAVIOURAL MODEL
● Framework developed to understand & address health behaviours
● Key Components: Predisposing Factors, Enabling Factors, Reinforcing Factors,
● Applications: Health Promotion, Chronic disease management, Preventive healt

Example (Scenario)- Implementing a smoking cessation program
○ Predisposing Factors: Knowledge about the health risks of smoking, Attitu
smoking, Beliefs about personal ability to quit.
○ Enabling Factors: Availability of cessation aids (e.g., nicotine patches, cou
support services (e.g., quitlines, local support groups). Affordability of sm
resources.
○ Reinforcing Factors: Positive feedback from family and friends, Rewards
milestones (e.g., smoke-free days), Support from healthcare providers.
○ Behavioural Outcome: Reduced smoking rates among participants, Increas

Social Pathogenesis and Determinants of Psychosoc
● Social Pathogenesis refers to the social factors that contribute to the onset, prog
outcomes of mental health disorders
● Determinants of psychosocial foundations encompass a wide array of social, ec
influences that shape mental health across the lifespan

Social Determinants of Health
(SDOH) Framework
● is a comprehensive approach to understanding how various social factors impa
● framework recognizes that health is not solely determined by individual behav
healthcare
● health is significantly influenced by a wide range of social, economic, and env

Key components of SDOH Framework
● Economic Stability
● Education Access and Quality
● Health Care Access and Quality
● Neighbourhood and Built Environment
● Social and Community Context
● Policy and Governance

Strengths and Limitations of SDOH
Strengths Limitatio
• Comprehensive Approach: The SDOH framework
provides a broad, holistic approach, emphasizing how
social, economic, and environmental factors shape
mental health outcomes.
• Complexity and Implementat
across sectors are difficult to
the outcomes of interventions
• Empirical Support: Strong empirical evidence links
social determinants (e.g., poverty, education, housing,
employment) to mental health outcomes, influencing
interventions.
• Potential for Deterministic Vi
social determinants may over
resilience and coping mechan
the effects of adverse conditio
• Policy Relevance: Supports multi-sectoral public • Cultural Considerations: Assu

Changes in Rights-Based Perspective Over the Ye
Year Key Act/Policy/Program Impact on Psychosocial f
1858 Indian Lunatic
Asylum Act
Established initial framework for mental health care but
communityfocused elements
1912 Indian Lunacy
Act
Improved care within institutions but did not address br
care issues.
1982 National Mental Health Program
(NMHP)
Marked a shift towards decentralising mental health ser
communitybased care.
1987 Mental Health
Act
Introduced significant rights-based provisions, improvin
outlining clearer safeguards.
1996 District Mental Health Program (DMHP) Strengthened communitybased mental health services a

Contd.
Year Key Act/Policy/Program Impact on Psychosocia
2003 National Mental Health Program (NMHP) -
Revised
Modernization of State mental hospitals and the up
of Medical colleges/General Hospitals
2014 National Mental Health Policy Emphasised a comprehensive approach to mental
health care and focusing on accessibility
2016 Rights of Persons with Disabilities Act
(RPWD)
Broadened the rights-based perspective, integratin
broader disability rights framework

Community Psychiatry
● Psychiatry focused on delivering mental health services in community settings
● Address mental health issues within the community context.
● Key Focus Areas:
○ Social Factors- Impact of community and social conditions on mental heal
○ Cultural Factors- Influence of cultural norms and practices.
● Environmental Factors: Role of the environment in mental well-being.

Principles of Community Psychiatry
● Holistic Approach
● Prevention and Early Intervention
● Empowerment and Participation

Models of Community Psychiatry in India
Community Based Rehabilitation
(CBR) Model
Highlights
MHAT model (Kerala) Volunteer delivered mental health services to a wide spread
Shifa Project (Madhya Pradesh) Camp approach in delivering mental health treatment and us
Mental Health Support Program
(MHSP), Gujarat
Pilot project integrating mental disability with other disabili
areas of the CBR matrix.
COPSI Providing treatment and rehabilitation in the community and
workers. Build tools and manuals based on their experience.
Ashagram CBR model in Madhya
Pradesh
Three-tier system of service delivery. Systematically proven
rehabilitation is feasible and effective for persons with sever

Therapeutic Community
Aspect Description
Definition A therapeutic community is a structured environment where individuals with
behavioural problems live and work together, supporting each other's recove
Origins The concept originated in the mid-20th century, influenced by psychoanalyt
humanitarian approaches to mental health.
Key Principles 1. Community as Method: Uses the community itself as a primary tool for th
2. Participatory Approach: Residents actively participate in their own treatm
management.
3. Holistic Care: Focuses on the overall well-being of residents, including ps
sometimes vocational aspects
Structure Typically involves a hierarchical yet flexible structure where residents
have roles and responsibilities, contributing to the community's daily

Intervention towards future directions
● to focus on housing facilities.
● to strengthen trust within the community and improving access to health care syst
● use of Community Health Workers(CHWs) for patient outreach, navigation, and c
● to provide proper training and supervision to the primary and CHWs.
● to focus on voccational rehabilitation.
● to engage people in volunteer activities.

Conclusion
● Emphasizes the crucial interaction between psychological, social, and
environmental factors in shaping mental well-being.
● Highlights that mental health is not just the result of biological processes but
is significantly influenced by social conditions and community support.
● Underlines the impact of individual psychosocial experiences and social
conditions on mental health.
● Addressing these dimensions enhances the ability to offer care that is both
empathetic and well-rounded, considering all aspects of an individual's

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