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Question: Identify one health challenge and explain why it might be considered a wicked problem. Examine at least three characteristics of wicked problems in relation to the identified health challenge (e.g. difficult to define) and explain what actions (e.g. policy formation) have been undertaken to address the challenge. Answer: Wicked Problems are multidimensional and have numerous causes, symptoms, and potential solutions. They cannot be definitively delineated or demarcated because many stakeholders frame the problems within different world-views. I believed that Toxic stress is one of wicked problem in several health challenges. It is referring to chronic, traumatic life events that occur in the child's life without the care of an adult for an extended period of time. Examples of toxic stress may include abuse (physical , sexual, emotional), neglect (physical, emotional), and instability in the family (parental mental illness, domestic violence, parental incarceration) (1).In response to this prolonged exposure to toxic events, the child’s body produces a severe stress response that lasts for an extended period of time. The toxic reaction to stress involves the neuroendocrine-immune network, and the reaction contributes to a prolonged and pathological response to cortisol. The associated immune dysregulation, including a chronic inflammatory condition, raises infection risk and incidence in infants (3). It is thought that the toxic stress response plays a role in the pathophysiology of depressive disorders, behavioral dysregulation, PTSD, and psychosis. Adults who endured early childhood adversity also experience more physical illness and poor health outcomes. These poor health outcomes are varied and include alcoholism, chronic obstructive pulmonary disease, depression, cancer, obesity, increase in suicide attempts, ischemic heart disease and myriad other disease processes (2). Low levels of maternal care and coercive behavior had the greatest multisystem health risk as adults. Inversely, high maternal warmth and love is correlated with lower health risk in adulthood during infancy (3). Maternal energy helps to shore up oxidative stressors, for example in deep poverty. Maternal help may have a preventive impact on childhood trauma and it also tends to be a predictor that defines an effective therapy outcome. It has been found that continuing family

involvement including maternal care and parental safety impacts recovery intervention in abuse circumstances and is more indicative of progress than the amount of violence encountered (2). References: 1. Bucci, M., Marques, S.S., Oh, D. and Harris, N.B., 2016. Toxic stress in children and adolescents. Advances in Pediatrics , 63 (1), pp.403-428. 2. Franke, H.A., 2014. Toxic stress: effects, prevention and treatment. Children , 1 (3), pp.390-402. 3. Kuehn, B.M., 2014. AAP: toxic stress threatens kids’ long-term health. Jama , 312 (6), pp.585-586. Post: Wicked problems have evolving requirements and complex interconnections related to the local environment of the problem (Periyakoil 2007). The affected parties usually have vastly different opinions with respect to comprehending and solving the problem (Coyne 2005). According to Henderson and Gronholm 2018, mental health wellbeing is a collection of subjective personal experiences, perceptions, thoughts, and emotions that are related to our social and physical surroundings. Unfortunately, mental illness is widely viewed as an individual’s problem rather than a systemic and cultural problem (Henderson and Gronholm 2018). Furthermore, people with mental illness frequently face stigma and derogatory culminating in social isolation, loss of friends, loneliness (Henderson and Gronholm 2018). The nature and solutions to mental health illness stigma vary in interpretation with no consensus on one definition or solution. This aligns with the disagreement about problem definition characteristic for wicked problems. There is no stopping rule for wicked problems. Society stops trying to fight stigma because of reduced funding or a belief that the point has been made rather than stopping because they found a concrete solution. Some anti-stigma interventions are effective, however, the essence of their design and unintended outcomes are open to judgment. Wicked problem solutions are weighed as good or bad rather than true or false.

Australia has had anti-stigma campaigns that have been achieved some success regarding improving people’s knowledge and attitudes towards mental illness through Beyond Blue programme (Jorm et al, 2005). The Fair work Act 2009 is the government’s effort to reduce discrimination and stigma at the workplace. People with mental illness are protected under the category of those with a disability. Reply: Yes, I also believed that mental health illness is wicked problem. Maternal help may have a preventive impact on childhood trauma and it also tends to be a predictor that defines an effective therapy outcome. It has been found that continuing family involvement including maternal care and parental safety impacts recovery intervention in abuse circumstances and is more indicative of progress than the amount of violence encountered (2). This hyper-individual fixation is both a symptom and source of most mental health problems, particularly general Mental Health system deficits. Getting a binocular vision that involves both machine and person, forest and oak, is crucial when attempting to create permanent progress (3). The Wicked Problems of COVID-19 and our Mental Health issues are mutually constituting. For much of Western culture the way of living was not psychologically stable to begin with until COVID-19, with various variables determining mental health including suicide rates, antidepressant and antipsychotic prescribing rates, income disparities, ambient pollution levels, etc. (1). People with pre-existing medical problems are the most susceptible to the COVID-19 effects and the most susceptible to the macrosystemic effects of this pandemic are societies and nation states with the least amount of resistance and wellbeing (3). And so, the way of life in our community has led to our susceptibility to COVID-19 as a population, while our response to COVID-19 is exacerbating our pre-existing Mental Health issues. Wicked Problems such as COVID-19 and Mental Health tend to get oversimplified, but if we can calmly engage the complexity of the topic, we often see that the solutions are hidden in plain sight within the problems themselves (1). References

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1. https://psychedelic.support/resources/mental-health-and-covid-19-intersecting-wicked- problems/ 2. Keyes, C.L., 2005. Mental illness and/or mental health? Investigating axioms of the complete state model of health. Journal of consulting and clinical psychology , 73 (3), p.539. 3. Westerhof, G.J. and Keyes, C.L., 2010. Mental illness and mental health: The two continua model across the lifespan. Journal of adult development , 17 (2), pp.110-119.

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