IPH action areas in health inequalities - mental health and wellbeing

How does mental health and wellbeing affect health inequalities?

“Mental health is paramount to personal well-being, family relationships, and successful contributions to society... Mental ill-health and poverty interact in a negative cycle: mental ill-health impedes people’s ability to learn and to engage productively in their economies, and poverty in turn increases the risk for developing mental disorders, and reduces people’s ability to gain access to health services.”

Dr Ala Alwan, mhGAP : Mental Health Gap Action Programme : scaling up care for mental, neurological and substance use disorders, WHO, 2008

mental health

Health inequalities are particularly evident in mental health. As stated in Inequalities in mortality 1989-1998 on the island of Ireland inequalities in mental health are evident in relation to:

  • Social class (Northern Ireland and the Republic of Ireland both show clear occupational class gradients in mortality from mental and behavioural disorders, with the lowest occupational class having 360% higher rates than the highest occupational class)
  • Gender (i.e. Drug dependence, toxicomania mortality rates were 244% for males than females) 
  • Social groups (i.e. Suicide rates for male Travellers are 6.6 times higher than in the general population)

The social determinants of health framework applies to mental as well as physical health. Mental health can be protected or threatened by social, economic and environmental factors. Equally, mental ill-health has societal impacts on social inclusion, employment and the economy. Together, poor mental health and unfavorable social conditions have the potential to exaggerate inequalities.

Good mental health is important for individuals and society because it promotes healthier lifestyles; better physical health; improved recovery from illness; fewer limitations in daily living; higher educational attainment; greater productivity, employment and earnings; better relationships with adults and with children; more social cohesion and engagement and improved quality of life.  Given the wider health and social benefits from good mental health, addressing inequalities in mental health is important for creating healthy and strong communities.

Mental health is a growing health, social and economic issue. WHO’s Commission on Social Determinants of Health stated that depressive mental illnesses will be the leading cause of disease in high income countries by 2030. In the UK, mental illnesses accounted for 20% of the burden of disease in 2002, which was higher than cardiovascular disease (17.2%) and cancer (15.5%). The economic costs of mental health problems are substantial because mental health has direct health costs as well as indirect costs such as loss of productivity, premature death, disability, and additional costs to social, educational and justice systems. The Northern Ireland Association for Mental Health (NIAMH) estimated that mental illness costs around £2.7 billion per year in Northern Ireland. The A Vision for Change press briefing stated that when this rate is translated to the Republic of Ireland’s population the economic cost of mental health in Ireland is €11 billion per year.  

Mental health inequalities are especially evident when looking at gender, drug and alcohol use, and social inclusion, and these issues can also contribute to greater health inequalities in the population.


Gender is a social determinant of health and it has a big impact mental health because it reflects the control people have of their social position, their socioeconomic opportunities, what their roles are in society, and their exposure to risks. There are great inequalities in mental health problems between genders.

Alcohol and Substance Misuse

Alcohol and substance (legal drug and illegal drug) use are used unequally in society. Alcohol and drug misuse is more common in the lowest socio-economic group, unemployed people, younger people, and men. Additionally, people with mental health problems are likely to misuse substances to cope with their mental illness.

Alcohol and substance misuse are important issues to address because they often worsen social and psychological conditions, lead to other mental health problems, and negatively impact physical health.  For example, addiction to alcohol and drugs is associated with homeless and suicide. In respect to physical health, WHO estimates that alcohol influences more than 60 different types of disease and injuries, and it accounts for 20% of motor vehicle deaths and  30% of deaths from cancer.  Alcohol and substance misuse not only impacts the individual, it also has wider negative effects on families and communities.

Social Exclusion

Social exclusion plays an important role in health because if people are discriminated, excluded or marginalized from society, their ability to access the goods and services they need to live a healthy life is compromised and the control they have over their lives diminishes. Social exclusion can result from a number of social determinants of health such as poverty, poor living conditions, transportation, and social groups. Social inclusion can promote mental well-being because it reduces barriers to health services, encourages supportive social networks and relationships, and addresses social determinants that negatively impact health.

IPH has recognised 'mental health and wellbeing as an action area with in it Corporate Plan 2010-2013. In this regards IPH will contribute to meeting DHSSPS targets set out in Protect Life, Investing for Health and Mental Health Promotion Strategy.

Mental health, wellbeing and health inequalities: IPH Portfolio

How can I learn more about mental health, wellbeing and health inequalities?


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