HEALTH INEQUALITIES

ISSUE OF HEALTH INEQUALITIES AND ITS IMPACT ON YOUNG PEOPLE’S MENTAL HEALTH

Introduction       

Mental health is a health risk which is found to exist in the society at the risk of the progress and development of the community. The stigma involved with mental health often results in people to not seek health services. Moreover, the lack of awareness of the available services results in health inequalities in the UK society when it comes to mental health issues as compared to other health risks in society.

The aim of this study is to evaluate the issue of health inequalities and its impact on the mental health of young people. This was done with the help of definition and models, along with promotion strategies and legislations reviewed to analyse its application in youth and community work. Moreover, a reflection was done to understand the importance of this issue with respect to youth and community work practices.

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Section 1 – Definition and Models  

1.1 Definitions        

Task 1.1 Definition   

The term madness may be defined as a state of wild or chaotic behaviour patterns exhibited by the individual which is not usually done in the society. On the other hand, mental illness is a condition in which a person shows deviation from normal behavioural pattern expected from the community over a long period of time.

Moreover, mental health is said to be a condition which indicates the overall behavioural and cognitive health and wellbeing of the individual.

One of the major factors which have led to forming such a concept of these three terminologies is growing up with a sibling who suffered from a mental health issue of anxiety disorder. The interaction with such a person led me to have direct exposure to the issues faced by an individual with mental health issues and led me to develop an open mind to this concept, accepting mental well being as a matter of concern.

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The word “madness” would often be said by the layman relatives leading me to take up this study and understand the issue on a social concern platform.

Task 1.2 Severities in Mental Health   

According to Pilgrim (2017, p.46), mental health may be divided into the following categories depending on the severity of the issue.  A mental health issue may be mild in nature and perceived as a mental illness by society. Such mental illnesses include grief and anger which can be channelized in a positive mannerism.

Then it is of severe degree as found in health issues like eating problems such as anorexia nervosa and bulimia nervosa in people. Moreover, the mental health issue can even be chronic to profound in nature. This mental health issue is then referred to as a psychiatric disorder.

The definition provided by the Cambridge dictionary for mental health falls under the category of chronic and profound criteria where there is a risk of mortality in the person such as in cases of suicidal and self-harm behaviour. It is in these cases that the guardian involvement has to be involved for the betterment of the patient.

Task 1.3 PMI of Cambridge dictionary definition of Mental Handicap 

As provided in the above definition provided in the Cambridge dictionary, a mental handicap is said to be a condition in which people have less than 70 IQ score. This definition specifically demarcates a person who would fall under mental handicap criteria as compared to one who would be segregated to be mentally ill.

However, the definition creates a negative attitude of society towards such individuals. As pointed out by Knapp et al. (2018, p.70), such a definition highlights the weak points of people with special needs and can lead such people to experience stigma. Despite such negative points it helps to show the potential causes of “mental handicap” among people.

One of the interesting points detected in this definition is that mental handicap like Down syndrome can be caused by genetics or even accident, pointing towards the principle of nature vs. nurture. This principle highlighted indicates that a person with an IQ score of 70 or above can even become mentally handicapped due to events in one’s lifetime.

1.2 Issues regarding Power and Culture in Mental Illness

Task 1.4 Comparison of definitions      

According to Kendall (1995, p.36), physical and mental health are separated. this is rightly agreed up as physical and mental health do not show the same symptoms, making it more realistic and factual in nature.

Moreover, the duration and type of treatment involved in physical and mental illness are different, making it justified to separate physical and mental health and wellbeing. However, it would be correct to give up the term “mental” altogether since it associates with “madness” among laypeople.

Moreover, it is against the ethics of mental health treatment of labelling an individual thereby providing the patient with an equal platform. As provided in the above definition of Carter, it is correct that health issues such as polygenic disorders are associated with the brain.

However, Kendall seeks to promote health equality among people with mental and physical health risks, thereby, promoting positive wellbeing of the individual by taking every illness seriously.

Task 1.5 Arguments on Fernando’s approach to Mental Illness 

The aspect of racism in psychiatry is studied since the last 300 years (Fernando, 2017, p.50), According to Fernando (2010, p.65) indicated that earlier studies revealed that people of indigenous race and belonging to slave criteria were less intelligent in nature as compared to Europeans and the environment of slavery increased the risk of mental health issues among these people.

This was further supported by the army cognitive test data to show that people of non-European origin had lower intelligence and due to the same engaged in rote learning as compared to the abstract reasoning among the Europeans.

However post-war it was found that, as per a psychiatry study was done in a hospital in Kenya, people of non-European origin had lesser chances of suffering from mental illness due to lack of environmental factors which contributed to the problem.

Moreover, psychiatric diagnosis revealed that people of African origin had lesser mental distress and chances of suffering from depression as compared to other races. Therefore, it is clearly understood from the arguments in Fernando’s study that chances of mental illness in various races depended on the environment to which the person was exposed to (Fernando, 2010, p.64).

It would be best to promote a cross-cultural setup in care to establish a common culture in healthcare. This would help to promote the elimination of racism in psychiatry practices in mental health promotion.

Task 1.6 relationship between power and mental illness  

The research study of Perkins (1999, p.6) has highlighted the power of language in the treatment of various mental illnesses in society. The new element which is found in this research is that of the concept of the line of division between distress and psychological illness.

This line of demarcation as used in various languages reveal that illusion is often present as an illusion known as gymnastics in languages. However, the researcher has not delved much into terminologies in language showing racism in mental health promotion and treatment. This is due to the lack of much political power prior to the Second World War.

However, post-war the influence of political power led to the application of various legislations in the use of language leading to “denial of differences” in the approach of diagnosis and evaluation in mental health practices.

1.3 Mental Health  

Task 1.7 Warr’s model of mental health    

Warr’s model of mental health is based on more on deprivation theory of health in which the principles of valued social position, the opportunity for control, availability of money, the opportunity of skill use and externally generated goal influence the mental health and wellbeing of an individual (Haworth, 1997, p.58).

For example, I wished to enhance my career skills which led me to seek funding. However, lack of access to money led to the rejection of potential offers which led me to sadness. Furthermore, when overcoming the grief of death in my family, I used the opportunity of the upcoming examinations to control my emotions from going to the extremes.

This led me to use my skills to overcome any scope of low self-esteem by displacing the locus of control from family melancholy to academic performance. This shows that the components of Warr’s model were used in a positive manner to promote mental health. However, in certain instances, people encounter a lack of access to money and lack of friendship (Bech, 2016, p.43).

One such example of a challenge was noted in the case of two of my colleagues. This resulted in them to become anxious due to the development of low self-esteem subjecting them to increased risk of mental health issues.

Task 1.8 Difficulties faced in mental health   

The most rising challenge in mental health is that of no faith in treatment and care. This lack of trust is due to the fact that people believe more in evidence-based health plans as compared to any promotion action plan carried out in mental health awareness.

Article in the Independent UK revealed that only 43% of British people were Christian and had a former religious father (Sharman, 2017). The community I worked in had 1 British family out of 10 families present in the community.

Most of the people were non-religious and believe in evidence than trust in the healthcare provider. This rose to be a major challenge in daily health promotion work carried out by my team and me in the community.

1.4 Conclusion     

It was therefore understood from the above definitions that the concept and definitions of mental health have evolved from those leading to a negative attitude to people with mental illness to that of the definitions in the present.

The psychiatric studies and diagnosis carried out prior to world wars show a high rate of racism, which reduced to a considerable degree post the war as seen in the arguments of Fernando.

Moreover, various models implemented in mental healthcare highlight the severity and distinguish mentally handicap people from mental illness. Despite this argument by Kendall seek to provide a platform for equality in the treatment of people by denying such individuals as ill in the community.

Section 2- Approaches to intervention     

Task 2.1 Medication of Children and young people with a mental health issue

The balance of benefits and risks of medication should always involve informed consent in treatment of people (Brownlee et al. 2017, p.158). In my opinion, the mental healthcare professional should specialise in the field of Child and Adolescent Mental Health Service (CAMHS) so as to listen to the reasons for anxiety undergone by the young patient.

The aspect screening involved prior to the provision of medication drugs often raises questions in the mind of the youth leading to self-doubt within the conscious. However, the evidence derived from the screening should be conveyed to the individual youth before taking in all the evidence to provide with medication or therapy or both as a means of treatment of the mental health issue.

This opinion is further supported through the study of Diamond et al. (2004, p.2) and research of Nieman and McGorry (2015, p.827) where the elements and requirements of the CAMHS should be promoted to ensure a balance between medication and therapy in overcoming mental health risks in the young individual.

People can engage in use of talk therapy to understand these requirements as well as indulge in the use of communication to justify the prescribed medication in order to overcome the exploitation of medication in mental health issues such as the dosage of antidepressants provided to a depressed individual (Dogra et al. 2017, p.45; NHS.uk, 2019).

One such example was noted in case of a school going girl suffering from depression and anorexia nervosa where the depression developed from bullying at school resulted in the development of the eating disorder. The prescription of antidepressant 10mg of Escitalopram was given which led the 15 years old girl to experience confusion and at times unusual dizziness.

These complaints were considered by the teachers and my team of youth workers who reported the same to the mental health specialist, thereby leading to the prescription of another antidepressant altogether.

Task 2.2 Therapies in Mental Health in Youth Work     

As highlighted in the research of McDonald and Thompson (2016, p.72) several young people in the UK were found to work beyond their occupational skill boundaries.

This type of work could risk the individual to do work which is beyond the competency skills of the young person. The result is an increase in self-doubt, which is further increased due to judgement by peers at the workplace.

This judgement from peers often results in individuals to experience lack of motivation at work leading to a low level of self-esteem and this results in the development of anxiety, distress and depression within the individual.

One of the places which an individual youth can go to to talk out his or her anxieties is in the family. As highlighted in works of Westaby et al. (2016, p.115), the family is the immediate contact within the range of the individual which can be sought by the adolescent or young person when venting out about the self-esteem issues and conflicts at work.

Here, the youth is assured of facing no judgement as he or she faced from people at work. Moreover, young people can go to a teacher or even to youth centres to overcome their dilemma. This takes about a free of cost from informal sources to about 1% of the total national cost in case of youth centres and can vary in time, depending on the duration and severity of the distress (Vandewalle et al. 2016, p.240).

Here, the young people are provided with information about their skills and provided with esteem development therapy via talking to the counsellor or youth worker. The person has to be trained for at least a year to become a specialist in talking therapy and practise in the society of the UK.

Task 2.3 what political, institutional and societal influences  on health inequalities in mental health  

It was understood from the Mental Health Strategy of 2011 that lack of political reforms pre-2011 led to disparities in healthcare. Moreover, there was no such issue regarding conditions for detection of treatment of the individual or the choice of the caregiver in the health strategy (gov.uk, 2011).

This lack of social support and evidence-based treatment from institutions led to health inequalities for people suffering from mental health issues. The involvement of young people in voluntary activities of various health organisations such as that in NHS Confederation of Mental Health framework led to a rise in social volunteers who provided relevant support helping to overcome the inequalities in mental health care services.

Moreover, the application of government policies of Mental Health strategy of 2011 and the No Health without Mental Health scheme as well as the initiative of Closing the gap: priorities for essential change in Mental Health of 2014 led me to work as a mental health care social support for the young people by raising awareness about mental illness and the issues such as stigma associated with it (Gov.uk, 2011).

This coalition of government policies led me and my team of youth workers to speak about human rights and equality in mental health aiming to bring a change in social outlook towards the issue.

Section 3- Different Groups and Different Experiences

Task 3.1 Race and Mental Health

The studies of Pilgrim show that the connection between race and mental health lies in the mannerism of lifestyle and the environment of the person. The people of Caribbean origin are often found to live in a congested neighbourhood.

This lack of proper housing environment and distance from health centres increases the risk to mental health issues (Gould, 2016, p.34). Pilgrim and Rogers argued that this was especially seen in the case of schizophrenia which was due to increased distress experienced due to lack of access to mental healthcare facilities.

Task 3.2 Key issues in understanding the mental health impact of socioeconomic inequalities:        

As per the works of Friedli (2009, p.4), the key issue of social division in a society based on racism and socio-economic division in the community increases the chances of psychological distress in young people.

This social division often results in exposure to bullying which leads to increased chances of depression, self-harm and suicidal tendencies having an ill effect on the mental health of the person.

Task 3.3 Youth and community work with reference to BALBERNIE’s article          

The article of Balbernie clearly indicates that exposure to racism and discretion due to racial background often results in the rise of anger and aggression in people.

This develops the mental health issue of psychosis in the person making the individual a danger to the community. As a youth worker, it is essential to counsel and channelize the anger of such individuals in a positive direction, helping them to overcome such discriminations and fight for equality through legal manner, thereby helping them gain equality in treatment.

Task 3.4 Practice of Youth work for different groups of people with Mental Health  

Carr (2005, p.170) clearly points out that people from the LGBT category still face mental health issues and the already present stigma and social discrepancy lead them to not gain equal access to the facilities provided by the government. Even though social and youth workers have progressed in letting this community gain access to mental health care schemes, the lack of preparation of the actual requirements has not led to much success in bringing change to overcome health inequality in mental health services.

Youth workers can be careful with the language used and not make any racial references such as Mongolian for Asian, black for African and Caribbean origin people, or even any other racial symbolic language when communicating with such a community. This would lead to a gain of trust between the people and the youth worker, leading to move to the successful practice of youth work with people with mental health issues.

SECTION 4: Working with mental health issues

Task 4.1: Evaluation of Listen Up! Project

The word ‘Crisis’ can be determined in various ways and its definition varies from person to person. Mental health issues can create a health inequality and it is also able to lead an intense impact on mental health of young peoples.

Listen Up! Project provides an understandable definition of the word crisis and it also focuses on a person-centred treatment to eliminate health inequality issues (Mentalhealth.org.uk, 2019).  Maintenance of some strategies can be helpful to make health inequalities an obsolete one; some of such strategies are mentioned below:

  • Increasing socializing activities (42ndstreet.org.uk, 2019)
  • Enhancing communication level with others
  • Emotional wellbeing
  • Motivational aspect (Centreformentalhealth.org.uk, 2019)
  • Higher level of engagement

Listen Up! Project has shed light on mental issues in various young peoples and in this connection, lots of case studies has been taken under consideration (Glasgowcpp.org.uk, 2019). As per this project, some service can be offered to put a control over health inequality issues within youths and these are such as a person-centred therapy process, advocacy towards engagement, complementary therapies, referral of signposting and so on.

As for evidence, a case study can be analyzed in which an 18 years old youth is doing some work but willing to complete higher studies. Though there is no scope for doing so and this is ending up on creation of distress within that individual. I this context, signposting has been chosen to gather information about other options to fulfil own dream.

Major principles of primary care in mental health consist of the following:

  • A higher quality service related to mental health is to be constructed to monitor all possible areas of scope and this can reflect on local needs to identify mental health issues.
  • A revolution is to campaign is to be revolutionized to promote wellbeing and mental health (HM GOVERNMENT, 2011)
  • A understandable waiting-time limit is to be incorporated within mental health services.
  • Present inequalities are to be eliminated out from periphery of health services (HM GOVERNMENT, 2014).
  • Psychological therapy is to be provided for around 900,000 individuals every year

Implementation of these principles can be helpful to omit inequalities related to mental health conditions. These principles can be carried out by person-centred service care provider units or health workers and these are helpful to decrease the impact of mental issues on youths.

Task 5.2: Mental health promotion and youth policy

Present condition that reflects on mental health promotion and youth policy provides some examples by which promotion of mental health of youths can be determined.

For example, responsible authority of UK government is focusing on development of mental health and wellbeing among the youths of age group among 15 to 24 and in this context, care pathways, health professionals and social workers of UK is involved.

Furthermore, an example of an incident of the year 2017 in UK can be taken under consideration to inspect the enhanced activities of resilience of youths who have experienced some life risk due to lack of mental health (HM GOVERNMENT, 2014).

In this context, incorporation of a proper mental health care strategy such as motivational aspect or emotional wellbeing can be beneficial (HM GOVERNMENT, 2011). These actions can be represented as positive factors and a de-motivational speech given by closed one can be considered as limit6ing factor in this regard.

Thus, a psychometric treatment can be advantageous for such an individual to overcome such ill mental health situation.

Reflection

Statement evidenced:

  • Promotion of mental health enables me to work with youths of UK and various communities of this country
  • In order to promote mental health and well being, I have to work with various agencies that provide health care support to youths of UK
  • Implementation of this module into real-life practice helps me to cultivate a leadership attitude and management capacity within me. This is because of performing group dependent tasks.

Example

For performing self-reflection, evidence can be chosen based on a situation that has been discussed in this report in previous portions. As per this example, a school going girl has been suffering from anorexia nervosa and depression and this depression resulted for facing some incidents of bullying in school.

In this example, a situation of eating disorder has occurred for that girl and to control health issues some medicines have also been prescribed for that girl by medical professionals.

Point

The main reason behind the above-mentioned situation is bullying in school. Thus, it can be stated that bullying can cause mental damage and it leads to mental inequality (Elgar et al. 2016, p. 1169). As per my opinion, school governing authorities must be very careful for its students to decrease incidents of bullying.

Interpret/Reflection

Mental health can be disturbed by various factors and the major one of this list is bullying (Veale et al. 2017, p. 45). Incident of bullying can be reported in any sectors such as education or professional. The mentioned situation makes me feel about the problem faced by that particular girl.

As cited by Patel et al. (2018, p. 1555), a crisis can be dominated only when a real situation is evaluated perfectly. Based on this statement it can be stated that, by evaluating the present situation of that affected girl, issue of bullying can be diminished and in this respect, I can identify those individuals who have been involved in the bullying situation.

I spread awareness for anti-bullying approach within a school to decrease such indicants in future. Differently, I can contact with school governing bodies to decrease down such incidents and to incorporate some punishment for those who are involved in such incidents. In this connection, a link can be established towards Warr’s model and theory.

This theory can be implemented in that educational periphery to decrease down such matters and to spread anti-bullying awareness among all students. In this connection, I am also considering anti-oppressive perspectives to bet a better understanding of situation. Moreover, this perspective is also helpful to have a better understanding related to anti-bullying activities.

Consider

Form the above-mentioned event, it is to be learnt that, bullying incidents can cause some mental health-related problems for youths in UK. Moreover, it is also to be noted that, mental health issues can cause inequalities in professional and education sector.

As per this example, the girl has been suffering from eating disorder and as per my suggestion; this can lead to an inequality in respective school of that girl. In this connection, an anti-oppressive perspective is to be considered to mitigate such issues from education sectors or professional fields.

Reference List /For Assignment

42ndstreet.org.uk, 2019, 42nd Street: supporting young people with their emotional wellbeing and mental health, accessed on: http://42ndstreet.org.uk/, Accessed form: 27th August, 2019

Bech, P., 2016. Positive Mental Health. In Measurement-Based Care in Mental Disorders (pp. 43-47). Cham: Springer,

Brownlee, S., Chalkidou, K., Doust, J., Elshaug, A.G., Glasziou, P., Heath, I., Nagpal, S., Saini, V., Srivastava, D., Chalmers, K. and Korenstein, D., 2017. Evidence for overuse of medical services around the world. The Lancet, 390(10090), pp.156-168.

Carr, S., 2005. The sickness label infected everything we said’: Lesbian and gay perspectives on mental distress. Social perspectives in mental health: Developing social models to understand and work with mental distress, pp.168-184.

Centreformentalhealth.org.uk, 2019, Commission for Equality in Mental Health: Call for Evidence, accessed on: https://www.centreformentalhealth.org.uk/commission-equality-call-evidence-january-2019, Accessed form: 27th August, 2019

Diamond, C., Floyd, A. and Misch, P., 2004. Key elements of effective practice–Mental health source document.

Dogra, N., Parkin, A., Warner-Gale, F. and Frake, C., 2017. A multidisciplinary handbook of child and adolescent mental health for front-line professionals. London: Jessica Kingsley Publishers.

Fernando, S., 2010. Mental health, race and culture. Basingstoke: Macmillan International Higher Education.

Fernando, S., 2017. Institutional racism in psychiatry and clinical psychology. London: Palgrave Macmillan.

Friedli, L., 2009. Mental health, resilience and inequalities–a report for WHO Europe and the Mental Health Foundation. London, Copenhagen: Mental Health Foundation and WHO.

Glasgowcpp.org.uk, 2019, Meeting the Needs of the LGBTI+ Community in Glasgow: A Review of Services Provided and Identified Needs, accessed on: https://www.glasgowcpp.org.uk/CHttpHandler.ashx?id=42287&p=0, Accessed form: 27th August, 2019

Gould, N., 2016. Mental health social work in context. Abingdon: Routledge.

Gov.uk 2011. The Mental Health Strategy of England. [Online]. HM Department. Available at: https://www.gov.uk/government/publications/the-mental-health-strategy-for-england [Accessed on 28 August 2019].

Gov.uk 2014. Closing the Gap: Priorities for essential change in Mental Health. [Online]. HM Department. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/281250/Closing_the_gap_V2_-_17_Feb_2014.pdf [Accessed on 28 August 2019].

Haworth, J. T. 1997. Chapter 5, ‘Principle Environmental Influences and Mental Health.’  In Work, Leisure and Wellbeing, Abingdon: Routledge, pp. 57-68.

HM GOVERNMENT (2011). No health without mental health. A cross-government mental health outcomes strategy for people of all age, accessed on: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/213760/dh_123990.pdf, Accessed form: 27th August, 2019

HM GOVERNMENT (2014) Closing the gap: priorities for essential change in mental Health. Accessed on: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/281250/Closing_the_gap_V2_-_17_Feb_2014.pdf, Accessed form: 27th August, 2019

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Knapp, M., Cambridge, P., Thomason, C., Beecham, J., Allen, C. and Darton, R.O.B.I.N., 2018. Care in the community: Challenge and demonstration. Abingdon: Routledge.

McDonald, P. and Thompson, P., 2016. Social media (tion) and the reshaping of public/private boundaries in employment relations. International Journal of Management Reviews, 18(1), pp.69-84.

Mentalhealth.org.uk, 2019, listenup!, accessed on: https://www.mentalhealth.org.uk/sites/default/files/Listen_up_web_version_0.pdf, Accessed form: 27th August, 2019

Nhs.uk, 2019. CAMHS information for children and young people. [Online]. Available at: https://www.nhs.uk/using-the-nhs/nhs-services/mental-health-services/camhs-information-for-children-and-young-people/ [Accessed on 28 August 2019].

Nhs.uk, 2019. Child and Adolescent Mental Health Services (CAMHS). [Online]. Available at: https://www.nhs.uk/using-the-nhs/nhs-services/mental-health-services/child-and-adolescent-mental-health-services-camhs/ [Accessed on 28 August 2019].

Nieman, D.H. and McGorry, P.D., 2015. Detection and treatment of at-risk mental state for developing a first psychosis: making up the balance. The Lancet Psychiatry, 2(9), pp.825-834.

Perkins, R., 1999. Madness, Distress & The Language of Inclusion. OPENMIND-LONDON-, p. 6.

Pilgrim, D., 2017. Key concepts in mental health. London: Sage.

Sharman, J. 2017. More British People identify as non-religious than Christian, finds report. [Online]. Independent UK. Available at: https://www.independent.co.uk/news/uk/home-news/british-people-christian-more-non-religious-faith-agnostic-atheism-report-a7737856.html [Accessed on 28 August 2019].

Vandewalle, J., Debyser, B., Beeckman, D., Vandecasteele, T., Van Hecke, A. and Verhaeghe, S., 2016. Peer workers’ perceptions and experiences of barriers to implementation of peer worker roles in mental health services: A literature review. International Journal of Nursing Studies, 60, pp.234-250.

Westaby, C., Phillips, J. and Fowler, A., 2016. Spillover and work–family conflict in probation practice: Managing the boundary between work and home life. European journal of probation, 8(3), pp.113-127.

(For reflection)

Elgar, F.J., McKinnon, B., Torsheim, T., Schnohr, C.W., Mazur, J., Cavallo, F. and Currie, C., 2016. Patterns of socioeconomic inequality in adolescent health differ according to the measure of socioeconomic position. Social indicators research127(3), pp.1169-1180.

Patel, V., Saxena, S., Lund, C., Thornicroft, G., Baingana, F., Bolton, P., Chisholm, D., Collins, P.Y., Cooper, J.L., Eaton, J. and Herrman, H., 2018. The Lancet Commission on global mental health and sustainable development. The Lancet392(10157), pp.1553-1598.

Veale, J.F., Watson, R.J., Peter, T. and Saewyc, E.M., 2017. Mental health disparities among Canadian transgender youth. Journal of Adolescent Health60(1), pp.44-49. Accessed from: https://europepmc.org/articles/pmc5630273, accessed on: 27th August 2019

 

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