Social determinants of mental health — structured clinical viva

Slide 1. Walk structural (policy, racism, welfare) → intermediate material/psychosocial → individual/health-system pathways. Name protective factors as well as risks. Link to Lund SDG map for multi-sector action.[1][2][3]

Slide 2 (gradient). Interpret as population social gradient: stepwise higher CMD in lower income groups. Avoid claiming every low-income person is ill (ecological fallacy about individuals) while still using data for service equity.[3]

ACE follow-up. Graded dose–response of childhood adversity categories with adult health and mental health risk — selective prevention and trauma-informed care follow.[4]

Prevention follow-up. High-risk clinics help the tail; Rose reminds that many cases arise from average-risk groups, so structural population strategies (housing, education, anti-discrimination) are required for incidence impact.[5]

Migration follow-up. Elevated schizophrenia risk in migrant groups is meta-analytically supported; discuss social defeat/discrimination hypotheses without ethnic essentialism.[6]

Stigma follow-up. Stigma as fundamental cause restricts resources and amplifies inequalities; contact-based anti-stigma has better evidence than pure biogenetic messaging alone.[7]

Poverty follow-up. Bidirectional poverty–depression mechanisms justify concurrent material and clinical interventions.[8]

Homeless discharge. Medical and risk stabilisation plus Housing First-style pathways, follow-up, and means restriction — not discharge to street. Name scarcity–inequity–inefficiency when systems lack capacity.[9]

ANZ equity. Indigenous mental health requires cultural safety, recognition of colonisation and racism as determinants, and co-designed services — principles without invented statute numbers.[2][3]