The Impact of Social Determinants of Health in Behavioral Healthcare

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In the healthcare ecosystem, finding ways to predict health risks is a key component of healthcare distribution and service. The social determinants of health (SDOH) — which relate to factors like race, ethnicity, geographic location, and socioeconomic status — are as important (or more important) to determining health outcomes than actual clinical factors.

For behavioral health institutions, uncovering the value of social determinants isn’t always easy. It’s a grand project. But the implications for onboarding social determinant strategies are immense. They can help patients, hospitals, and communities by improving health and minimizing the long-term behaviors that negatively impact millions of American’s lives.

Understanding Social Determinants of Health

As we embrace the big and beautiful world of “big data,” healthcare providers are constantly looking for ways to predict health issues and improve the quality of care. But trying to analyze clinical data doesn’t paint a clear picture. It’s evident that non-clinical factors have a significant impact on people’s well-being, and these factors can help us better understand the healthcare ecosystem at large.

Social determinants of health (SDOH) are the environmental conditions that impact peoples’ health. These include factors such as:

  • Social status and income levels
  • Employment, working conditions, and working environments
  • Literacy
  • Education
  • Access to healthcare
  • Past experiences
  • Social support
  • Behavioral mechanisms
  • Physical environments (e.g., house, neighborhood, geographic location, etc.)

In other words, social determinants of health are all of the magical metrics that make up peoples’ incredibly complex lives. Where do they live, work, play, eat, sleep, and socialize? What kind of healthcare access have they had in the past? What types of transportation systems do they use? What are their coping mechanisms bred by childhood experiences?

These clusters of very real experiences are the so-called “makeup” of peoples’ health DNA. But there’s a problem. Most healthcare groups don’t have the resources or data collection methods to fully utilize these hyper-complex and always expanding data sets. Without SDOH, healthcare organizations are working with incomplete puzzles, but successfully ingesting and utilizing this type of data requires sophisticated systems, policies, and procedures that many behavioral health organizations simply don’t have.

The Value of Social Determinants

As the age-old homage goes: treat the cause, not the symptom. Trying to directly address health issues without uncovering the underlying web of factors that went into creating those issues is like shoveling water out of a lake. You may see that it’s working — but it likely isn’t making a dent.

While major organizations like the CDC and various health insurers are investigating SDOH data to advance health equality and uncover new financial models for broad healthcare funds, individual practices and hospital networks have plenty to gain by diving deep into SDOH. The United States spends more on healthcare than any other developed nation, yet, according to the 2017 Commonwealth Fund, we rank last in overall health outcomes.

Part of this is due to the medicalized approach to medicine. We don’t look for a holistic picture. Instead, we simply treat symptoms while ignoring the larger factors that created those symptoms, to begin with. A great example is an individual with asthma. You can treat asthma with inhaled corticosteroids. But if the person with asthma lives in a cigarette smoke-filled house, you’re not solving the issue — you’re prolonging the problem.

According to the New England Journal of Medicine, 40 percent of premature deaths occur due to individual behaviors. Finding ways to identify the core social determinants that produce these outcomes will improve the quality-of-care, efficiency, equity and equality of your healthcare services — especially when it comes to behavioral health.

The Role of Social Determinants in Behavioral Healthcare

While many healthcare providers emphasize physical health when exploring the complexities of social determinants, mental well-being is also strongly correlated with SDOH. As WHO puts it:

“A person’s mental health and many common mental disorders are shaped by various social, economic, and physical environments operating at different stages of life.” —Social determinants of mental health, WHO

The various actions, behaviors, and experiences that happen between birth and the moment a patient walks into a hospital are crucial health clues that may be the instigator for their behavioral issues or mental unwellness. But making sense of all of those social determinants isn’t always easy.

Healthcare institutions generally understand the value of societal determinants, but most can’t figure out how to leverage them. According to surveys, 88 percent of hospitals have committed to addressing social determinants — yet 72 percent of those hadn’t actually made any monetary investment towards establishing frameworks for social determinants. In other words, health systems know social determinants matter, but they’re not at the point where they’re ready to invest.

This is the biggest barrier for healthcare systems. Measuring and analyzing social determinants doesn’t show immediate ROI. It doesn’t immediately impact care. It’s a long game. It requires breaking down the walls that separate healthcare institutions from social life, and it certainly requires a complete overhaul of both the intake process as well as the overall data analysis capabilities of healthcare providers. But you don’t have to start with scale.

Simply encouraging physicians to ask more questions, dig deeper and think about the holistic picture of people’s lives is a start. Of course, racial, ethnic, and socioeconomic barriers are equations in this jigsaw puzzle of mental health — but those are best handled at a larger scale by massive health institutions and community outreach programs.

How Behavioral Health Institutions Can Begin the Social Determinant Journey

For most hospitals, the social determinants of health journey doesn’t have to begin with a significant monetary investment. But you do have to be committed to holistic healthcare. The initial action starts with information gathering and screening at intake. The Center for Medicare and Medicaid offers a 10 question screening tool that helps identify food insecurity, interpersonal safety, housing instability, utility needs and transportation needs. The National Association of Community Health Centers also has a Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences tool, which can help you gather more social determinant data. Of course, it’s valuable to create additional data collection methodologies and each additional data point helps demystify the societal factors that surround each patient.

It’s important to combine societal determinants with medical records. This will follow the patient across healthcare settings — providing crucial information to future healthcare providers. A good example of this is the California San Mateo County Health System. They combine societal determinants of health with electronic medical records to help reduce repetitive healthcare needs among the vulnerable homeless population.  

While Deloitte’s survey shows that the majority of hospitals are collecting social determinant information at intake, many aren’t adequately distributing that information to healthcare providers and critical staff that could actually leverage that information to make actionable decisions.

Another way hospitals can immediately (and without significant investment) begin implementing social determinant strategies is to connect with stakeholders at major community outreach programs. Bridging the gap between medical and non-medical initiatives can help hospitals begin to approach mental health more holistically.

Of course, to scale analysis of social determinants of health, healthcare systems need to invest in data analysis tools layered on top of policies and procedures. According to Deloitte, healthcare providers should be looking to accomplish three primary goals with their social determinants of health strategy:

  • Resource consolidation empowered by breaking down silos between healthcare departments
  • Creating value-based models of healthcare that incorporate social needs
  • Improve health tracking, modeling, and cost outcomes

While the immediate financial impact of societally-geared strategies may not be visible, incorporating these strategies will put hospitals ahead of the curve and well-positioned to provide a greater level of value-based care to all of its patients. After all, the mental health of patients often isn’t cured with drugs — it’s cured with compassion, understanding and deep visibility into that patient’s overall history.

Final Thoughts

Establishing fully-holistic social determinants of health strategy won’t happen overnight. On a larger scale, hospitals and healthcare providers will need to engage with stakeholders in the health insurance space as well as local, state and Federal bodies. But that doesn’t mean that behavioral healthcare providers can’t take immediate action.

Behavioral healthcare providers that want to push towards value-based care while improving the quality-of-life of their patients should consider immediately incorporating baseline strategies to collect and analyze social determinants of health. This starts with intake. You want to gather as much information as possible, and there are plenty of resources to help you accomplish just that. Healthcare providers should also begin breaking down silos between departments that prevent adequate and accurate data spread. Finally, behavioral healthcare providers should forge meaningful relationships with community outreach programs beyond the mental space. Low-income housing communities, addiction programs and food assistance bodies can help bridge the gap between clinical and societal.

Change won’t happen overnight. But once the results start to take shape, larger investments in data analysis tools can help make the most out of all of that social determinants of health data. For now, behavioral healthcare institutions have a path forward — though it may not be a paved one.



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