David Satcher, M.D., Ph.D.

Behavior, largely driven by mental health factors, accounts for 40 percent of the difference in health outcomes, compared to biology at 15-20 percent and environment at 25 percent.

Adding mental health and environment factors together to create a combination that profoundly affects physical health outcomes was the topic of the July 27 Satcher Health Leadership Institute session, "Mental Health and the Environment: An Interactive Impact," at the NMA's Annual Convention and Scientific Assembly. The Satcher Health Leadership Institute is part of the Morehouse School of Medicine in Atlanta.

"Mental health is something we all take for granted, and we can't take our mental health for granted," said David Satcher, M.D., Ph.D., director, the Satcher Health Leadership Institute and the former U.S. surgeon general.

Behavior ranks among the top four determinants of overall good health, with other determinants including good social and physical environment, genetic/biologic factors and quality health care.

"What we have not talked enough about are social determinants and how they affect all health determinants," Dr. Satcher said. "The social environment has a tremendous impact on health."

For example, studies of children who witness violence at an early age, including murder, showed they were twice as likely to be victims of perpetrators or the same kind of violence before they became adults, he said. At the National Institute of Mental Health, researchers are studying how the brain changes from what humans experience in the environment.

"The brain changes in terms of chemicals that it secretes, even in terms of the wiring," Dr. Satcher said. "That's the new frontier in mental health and mental illness, and that is understanding how the brain is affected by the environment. I don't believe we consider mental health enough."

To address social factors affecting mental health, he emphasized the importance of writing policies, developing interventions and making laws to drive change, all of which require leadership. The Satcher Health Leadership Institute offers an assortment of programs that foster development of leadership styles and approaches.

A particularly important Satcher Health Leadership Institute initiative involves parenting education. Another session presenter — Martha Okafor, Ph.D., MPA, director of the Division of Behavioral Health, the Satcher Health Leadership Institute — discussed the institute's Smart and Secure Child (SSC) Parenting Program. To help young parents become more effective, the program educates and engages them on issues and skills involving child social development, community resources, social support and coping. SSC program leaders develop and organize parent groups, listen and learn from patients about the realities of their experiences, and then develop educational programs that will work for those parents, Dr. Okafor said.

"We recognize and empower parents as the primary mentors and leaders of their children's development," she said. "We get the right information into parents' hands, show them how to use it and show them opportunities for transforming and preparing that child for a productive future."

Those most at risk for inadequate parenting skills are parents who are poor with low coping and adaptive abilities, unemployed and isolated single individuals with children, persons whose stressful conditions affect their functional levels and relationships, and families with unstable housing, she said.

Poor parenting results in an insecure child with little or no parental attachment who is deprived of physical and emotional health. The outcome, Dr. Okafor noted, is neglected brain development and low functioning, as well as chronic stress, poor coping skills and lack of essential problem-solving capabilities.

"Quality parenting leads to security and attachment for the child," she said. "Attachment is so fundamental in the ability of the child to develop emotional well-being and to be able to love and care about someone. Research has shown that a stimulating environment is also important to reading and language development."

In addressing prison issues, Brian McGregor, Ph.D., clinical instructor in the Department of Psychiatry Behavioral Health Research, Community Voices Division at the Satcher Health Leadership Institute, called for action to stop the revolving door from incarceration to release to incarceration again.

"The criminal justice system disproportionately impacts individuals with mental illness, particularly in communities of color, due to harmful policies and practices," he said. "Law enforcement, sentencing, incarceration and release to the community intersect. The cycling in and out of these environments by all accounts appears to inhibit and interrupt the healing necessary to repair and restore the lives of our mothers, brothers, fathers, sisters, sons and daughters. It places an enormous stress and strain on individuals, families and communities."

Some studies have found that 43 percent of prisoners released in 2004 had returned to prison by 2007, and 64-80 percent of those had mental illness, Dr. McGregor said. Still other studies found that prisoners are two to four times as likely to be diagnosed with schizophrenia, depression, bipolar disorder or PTSD than the general population. Additionally, data shows that 73 percent of mentally ill inmates have also been diagnosed with a co-occurring substance abuse disorder. Mortality rates two weeks after release from prison are 12 times higher than the rate in the general population.

The Satcher Health Leadership Institute's Community Voices is committed to stopping the revolving door and being part of the solution. Community Voices works to identify challenges to successful re-entry pathways and to promote development of model re-entry projects in Georgia for released prisoners.

"We have recently partnered with the U.S. Attorney's Office, Department of Corrections, Board of Pardons and Paroles, to provide re-entry forms where individuals are able to come to a church where we have gathered service providers who are capable and committed to providing services to this population," Dr. McGregor said. "Our role is that of evaluator, so it will be important to demonstrate that this is effective and working."