Social psychiatry faces a challenging relationship with pop culture. Understanding pop culture portrayals of mental health culture could be valuable to public mental health. ‘ Top Boy ‘ is a fictional show touching upon the experience of individuals living in the grip of a mental health syndemic in inner-city London.

AS & WQ had structured discussions to analysing themes, social determinants and psychiatric correlations in Top Boy.

Top Boy touches on aspects of mental health including immigration, the impact of violence, the impacts of urbanicity and deprivation syndemics, domestic abuse and PTSD.

Violence as a trigger for PTSD is illustrated in the story of Jason, a young child who is exposed to domestic violence, resulting in avoidance of this environment and association with gangster Sully. Jason becomes desensitised to violence. Greater PTSD is linked with violence in a dose-dependent fashion (Abram et al., 2004).

Sully watches Jason die after a racially motivated attack, illustrating the nested nature of such trauma as Sully develops PTSD; he is seen re-experiencing the fire. Sully can later be seen to be hyperaroused to perceived threat. Exposure to violence, particularly in the context of gang membership, is strongly associated with anxiety disorders. (Coid et al 2011)

Impacts on relationships and childhood neglect are explored through Ra'Nell and Lisa. Lisa is a single mother who's survived an abusive relationship. She becomes severely depressed resulting in her being sectioned and an extended psychiatric admission. Ra'nell, her son, falls into the narcotic trade, leading to truancy and violence. His friend Gem is seen to try drugs when forced to act as a mule. Involvement in the drug economy leads to drug dependence among gang members (Coid et al 2011).

These come together in the estate syndemic; psychiatric morbidity is exacerbated synergistically with health inequalities caused by poverty, stress, structural violence and racial discrimination. This leads to educational disadvantage through truancy in the cases of Ra'nell and Ats, who's mother suffers from the mental health effects of unemployment and deportation threat. Individuals are then more likely to interact with gangs in this syndemic environment and so the cycle of illegal activity, violence and ill health perpetuate.

Gang members currently will make a large contribution to mental health disability and service burden in syndemic areas. Top Boy illustrates the challenge and opportunity for public mental health in the context of such syndemics.