It is hard to be OK
Reflections on R U Ok day and Mental Health
In Australia, two in five people aged 16-85 have received a mental health diagnosis during their lifetime, with anxiety and mood disorders the most prevalent conditions (Australian Bureau of Statistics, 2021). On this “R U OK Day,” I am reflecting on the causes of mental health issues. Here I explore mental health difficulties not as a personal failing, but driven by systemic issues. My hope is that if you aren’t okay that perhaps this can lighten the self-blame for your poor mental health. More broadly, as with much of the work I do, my hope is that this perspective will allow more of us to understand the complexity of being human and deepen our compassion.
And that people who are struggling face barriers that be may not even be able to see in their recovery. Struggling with one’s mental health is not a personal failure. Mental health disorders aren’t just personal experiences; they’re entwined with broader social, cultural, and economic systems that may contribute to or exacerbate them. So how does mental (and physical) health relate to structural issues? Or aka why your depression, anxiety, or other health issues are not completely your fault!
For one, risk factors for mental health disorders and physical-mental multimorbidity are strongly correlated with social inequalities (Allen et al., 2014; Skou et al., 2022). These social determinants of health include (but are not limited to), race and ethnicity, gender, disability, sexual orientation, access to housing, social support, and income, which in turn compounds inequity because of the reciprocal effect of poorer health on social and economic opportunities (Jenkins et al., 2021). While these social determinants of health are extrapsychic (outside of the individual) factors, they are important to understand when it comes to mental health. Yet treatment orientations are commonly intrapsychic (within the individual). Why is this the case?
Neoliberalism, a political and economic ideology that promotes a free economy, individual liberty, and market competition, underlies this treatment paradox. Some argue that neoliberalism is a direct cause of mental ill health, for example through fiscal policy (Becker et al., 2021a). Beyond policy.
Recent research indicates that neoliberalism can reduce well-being by fostering social disconnection (Becker et al., 2021a). In Australia, even with extensive Federal Government funding for mental health treatment via the ‘Better Access scheme’, many Australians report mental (and physical) healthcare is not available and affordable to them (Australian Bureau of Statistics, 2022). Recent health policy research indicates that in Australia there is pro-rich inequity in health care utilisation (Pulok et al., 2020). Consumers report not being able to afford the mental health care they need.
With nearly 47% of people reported not seeing a Psychologist due to financial barriers (Australian Bureau of Statistics, 2022). Pro-free market neoliberalism, deregulation, and individualism underpin, or at the very least compound health inequities (Fox et al., 2009; Teo, 2009). This highlights an insidious feature of the mental health paradox: most treatment options are targeted at the individual (intrapsychic) level and do not address the social determinants of mental health, while these same social factors often render individualised treatment options inaccessible.
Treatment models primarily focused on the intrapsychic can be blind to the intersections of social factors like race, class, gender, education level, sexuality, and disability (Fox et al., 2009). These social determinants of health often compound mental health disparities (Allen et al., 2014; Ingram et al., 2021; Skou et al., 2022). Moreover, intrapsychic solutions to systemic problems are not merely disempowering. They entrench social determinants of health and may engender a perpetuating cycle, as individuals may begin to perceive their inability to heal as a personal failing.
There is a pressing need for effective and accessible treatments for mental health at both a social and individual level. But this is not a quick fix. It requires structural change. There is no easy solution. But Yoga, which anyone reading this likely loves, shows potential as a ‘transdiagnostic’ practice that can target some of the intrapsychic drivers of mental health. Yet yoga is also influenced by these same structural and systemic issues. How can we ensure the same systemic issues do not plague the world of yoga as well?
We have made it our mission since we opened 17 years ago to help yoga be widely available. Not just in the variety of classes on our timetable, or through having a diverse team of teachers and trainers. But through our community work in hospitals, domestic violence shelters, and partnerships with a number of community organisations. (Read our Impact statement here). Sunday afternoons are dedicated to free Community Yoga. If you ever wonder why I (Jean) am not teaching the 10+ classes that your average yoga school owner teaches, it is because I am busy behind the scenes, developing programs and actively involved in Yoga research to help bring back private health rebates for yoga and eventually with a strong evidence base to advocate for yoga under Medicare.
Change can happen. But it is slow. My wish here is that you can lift a little of the self-blame when it comes to your mental health, or understand that when people you love struggle – this is not their personal failing. R U Ok day can remind us to start the conversation and it could be life-saving. It is essential to remember though that the answer to not being okay, is not simple.