When Dr. Amy Barnhorst treats patients for mental illness in county jails, emergency rooms, and psychiatric hospitals, she sees more than the person standing before her. She takes in their life circumstances, too. That can include childhood trauma, food insecurity, neighborhood violence, unemployment, and personal and institutional racism.

These experiences, among others, influence a person's emotional and psychological well-being. Yet mental health is typically cast as a biological condition shaped by genes and character traits. While that's true, ending the story there is misleading, says Barnhorst, vice chair of community mental health in the department of psychiatry at the University of California, Davis.

Nothing could've proven that more than the COVID-19 pandemic. The threat of death, along with the economic and social costs of lockdown, brought a heightened sense of anxiety and fear into most people's lives. Suddenly, they were thrust into shared trauma and grief. They laid awake at night, waiting for dawn to come. Few endured what came next without some form of suffering.

COVID-19 demonstrated in painful ways how personal mental health is a reflection of what's happening in the world. This doesn't mean one should give up on emotional and psychological wellness, but that awareness can put into perspective why healing may feel out of reach. The pandemic holds numerous such lessons, but three defining experiences from the past year uniquely illuminate the connection between one's circumstances and their mental health: racism, financial strain, and weight stigma.

Research shows that such external factors, which exist well beyond a person's body and mind, can play an important role in worsening mental health. While personal behavior is critical for positive well-being, a person can only adopt so many new habits to counter powerful forces over which they have little say.

Barnhorst argues that treating mental health should involve addressing and reducing inequality.

"When someone loses their ability to pay rent or buy food for their family because of our government's failure to manage a pandemic, psychiatric care will have a minimal impact," Barnhorst recently wrote in Slate. "Suggesting an antidepressant for them is like offering someone aspirin for their headache while repeatedly hitting them in the head."

For critics, identifying and describing outside factors that contribute to poorer mental health is akin to complaining or surrendering instead of rising up to change one's circumstances. Barnhorst looks at it differently.

"Sometimes I think it's helpful to have the perspective that you weren't dealt the same hand as everyone else," says Barnhorst, "You are doing the best with what you have."

Read the full article about inequality worsening mental health by Rebecca Ruiz at Mashable.