Applying the Social Determinants of Health in everyday practice: Lessons from the APS Congress

At the 2016 APS Congress held at the Melbourne Convention and Exhibition Centre from 13-16 September, the APS Public Interest team convened a forum to discuss and showcase the valuable application of a Social Determinants of Health (SDoH) approach in everyday psychological practice. The forum included a panel of practitioners who shared their experiences of using an SDoH approach across different areas of practice. Forum participants used the APS SDoH practice resource providing examples of their work across the seven SDoH domains outlined in the resource (see link on opposite page to access the full resource).

Referencing the pivotal work of Sir Michael Marmot, who recently delivered the 2016 Boyer lectures in Melbourne, APS Board member Tim Carey told the forum that two fundamental principles of the SDoH are control and autonomy: “Self-determination and sense of control in your life, along with social engagement, are directly related to health and wellbeing and have big implications for the work we do”. These principles were illustrated in the practice examples that followed in the forum.

Recognising the ‘social’ in individual practice

Brad Levingston FAPS highlighted the promise of an SDoH approach in professional practiceand psychology more generally. Brad emphasised that in all forms of psychological practice, it is important to accept that there are limitations to providing techniques directed solely at individuals, such as CBT, psychotherapy or even medication, without recognising the context within which clients live and work. Brad noted, “If we don’t address the social context in which psychological disorder occurs, we are ignoring a very powerful and obvious variable, which is not what a reasonable scientist-practitioner would do”. He went on to say that adopting a contextualised approach can promote health and reduce inequity in service provision.

Responding to individuals, couples and families impacted by the closure of the car industry, the downturn in mining and construction and other socio-economic changes occurring in Australia provides an obvious example of the need to recognise and respond to the social factors that underpin the extent to which people feel ready, willing and able to care for their health. Changes in the economy, job uncertainty and unemployment need to be foregrounded when addressing psychological problems that are so inextricably linked to individual and community health and wellbeing, in Brad’s experience.

Working with transgender young people

Briony Kercheval MAPS is a community psychologist in private practice who has worked with a number of transgender1 young people. Being aware of the alarming rates of self-harm and suicide within this population, Briony looked for local organisations and resources to help support her work. Her clients’ experiences have led Briony to take on board the APS Code of Ethics principle that psychologists assist clients to address unfair discrimination or prejudice. Briony shared a number of examples of such advocacy including:

• Liaison with local schools, university and Centrelink, as well as other professionals: endocrinologists, GPs and school counsellors
• Communication with family members providing broad information on transgender issues
• Referrals to specialist transgender services: The Royal Children's Hospital, The Gender Clinic (Monash)
• Offering bulk-billing to reduce financial burden
• Linking clients to safe social networks and supportive groups such as Minus 18, and online services that promote interactionand safe spaces for questions (Instagram, blogs, YouTube channels).

Briony has also taken the opportunity to discuss this work during peer supervision sessions, and to share the new APS information sheet ( Info-Sheet-Transgender-affirmation-extended-version.pdf) which recommends the use of mental health practices that affirm the experiences of transgender people.

Building relationships with professionals and community to enhance private practice

Jo Mitchell MAPS is co-director of The Mind Room, which is home to a team of psychologists from a range of specialist areas. Jo explained how The Mind Room works across the broad spectrum of mental health – from treatment of mental illness to performance coaching and ways to create meaning and wellbeing. From an SDoH perspective the work they do beyond individual therapy is particularly interesting.

Underlying The Mind Room team’s practice is the belief that connections are essential, creativity is important and acceptance is key. These values were clearly on display in the range of collaboration, consultation and engagement activities Jo described. Valuing such connections has resulted in informal collaborations with local businesses (e.g., local Allpress café), joint community initiatives with like-minded organisations (e.g., The School of Life and Movember Foundation), as well as more formal contract work with other institutions (e.g., AFL Players Association). Free weekly mindfulness drop-in classes also serve to forge links with the local community.

Training and education is at the forefront of The Mind Room, with Jo delivering guest lectures at universities, convening APS study groups, facilitating at Laneway Learning and other bespoke training events, and hosting a continuous stream of students onplacement.

The Mind Room also provides a great example of how to cultivate a healthy workforce. Such steps include creating consultation rooms with no computers or desks to encourage use of a shared staff area and a staff ‘Screw-up’ wall to document mistakes and promote an environment of disclosure and learning.

Researching women’s experiences during the perinatalperiod

Belinda Barnett MAPS is a psychologist who is conducting her PhD research at the University of Queensland about women’s experiences of decision making, wellbeing and empowerment during the perinatal period. Since the births of her two children Belinda has also worked voluntarily for a not-for-profit community organisation, Maternity Choices Australia (MCA), which advocates for increasing women’s access to high-quality continuity of midwifery care models that have been shown to improve physical and emotional health outcomes for mothers and babies, consistent with the key priorities of the Australian National Maternity Services Plan (NMSP, 2010-2015).

Belinda’s own experiences propelled her to investigate what influences women making choices not only around birth but in relation to their return to work. Her research drew attention to social determinants such as workplace policies, discrimination, social attitudes towards mothering and unpaid care. Belinda’s aim is that this study will inform future advocacy initiatives for policy that better supports women during this life stage. Belinda’sexample demonstrates how psychologists can incorporate an SDoH focus in their research, by their choice of research question, as well as the participatory and empowering processes theyemploy.

Practising in an SDoH framework

According to the World Health Organisation, the social conditions in which people are born, live and work are the most important determinants of good or ill health, beyond health behaviours and biomedical or genetic factors (AIHW, 2016). Adopting an SDoH approach expands our thinking about mental health to include how to help people keep it, not just how to get it back. The APS SDoH resource offers a number of ways for psychologists to embed this framework in everyday practice and improve outcomes for the clients and communities we serve.

More information and to access the APS SDoH resource

Photo L to R: Belinda Barnett, Tim Carey, Brad Levingston, Harriet Radermacher, Emma Sampson and Heather Gridley.

1. For some people the presumed relationship between assigned sex (at birth) and gender is incorrect. The term ‘transgender’ is now widely used to refer to this diverse group of people.