For a More Holistic SDoH Picture, Look at Social Determinants of Mental Health


By Daniel A. Schulte

As members of the broader healthcare community, we have been reviewing the many facets of the general healthcare delivery environment: from the old-school “diagnosis and treatment plan” strategy to understanding more about the patient’s real-world constraints on the path to wellness.

In addition to the often-discussed social determinants of health (SDoH)—such as income, food insecurity, housing instability, utility needs, transportation needs, and interpersonal violence—I believe we will see real value returned when we look at the specific needs of patients whose care focuses on their mental health as well as their physical health. The mental health scenario in America today is complex beyond measure, with 18 years of PTSD warriors, 19 years of terror, 20 years and more of growing dependencies on opioids and crystal meth, and so on. The mass media also plays a role in shaping public discourse in mental health. The whole-person wellness experience must include addressing mental health in equal measure to other disease processes.


Following are some key social determinants of mental health (SDoMH) for the US healthcare community worth discussing in this context:

  • Insecurity. Our society has been at war in varying degrees for a generation. Our ability to move about the world has radically changed in the past 20 years, with heightened security at nearly every large gathering. We have to develop stronger tools to help heal this broken society. We can’t eliminate the fear, but we have to learn to cope better.
  • Loneliness. We need to help individuals, groups, and communities to battle loneliness. This means rebuilding the social organizations that help nurture the individual’s well-being, with a strong sense of respecting the individual’s “safe space.” Unfortunately, we may have lost the skills needed to develop friendships, partly from issues of security in the city and partly from the distance in the suburbs and rural areas of the country. We’ve lost the sense of common goals and we need to enrich how we can build community in small ways. This path to self-empowerment may give just enough initiative to move away from the lost-ness of the estranged soul. This is not a call for square dances or knitting socials as much as it is a call to build community, engage with others, volunteer to help, or join groups that have specific social goals in mind.
  • Basic health needs of the mentally ill. Beyond January resolutions, we need to develop ways for the mentally ill to access the right kinds of sleeping arrangements, food, and physical activities. This is a direct intersection with SDoH and cannot be overlooked in addressing the path to mental health.
  • Therapy as an essential element. Clinicians of all types need to understand the issues associated with patients who suffer from mental illness. We need to specifically address the results of family trauma, social trauma, war, social malaise, etc. And when we look for ways to help clinically, we need to be culturally and racially sensitive to our patients’ needs. Careful attention to gender issues is critical as well.

Anger, compulsion, fear, and inattention fire up the primitive lizard brain (fight or flight) within us. Although the concept of lizard brain is an easy excuse, or shift of responsibility away from me to the other, those engaged in addressing SDoMH need to carefully watch for these triggers.

As healthcare community members, we need to address the co-morbidities associated with mental health—and they abound! Working within the simple structure below, when we discuss SDoH, we need to think through the key issues that affect mental health as well. When we link SDoH and SDoMH together, the tendency to address mental health crises of any kind as legal issues, or jailable offenses, will be much more clearly understood as immoral and ineffective ways of dealing with critical health issues.

HGS Healthcare works with a client base of national and regional health plans, hospital systems, diagnostic labs, and durable medical equipment companies. Our team of more than 20,000 healthcare professionals, including physicians, nurses, and clinical resources, actively support utilization management, health risk assessments, and case management. Working across the healthcare industry enables us to gather unique insights into the US healthcare system. If you would like to explore these topics with us, we would welcome the discussion.

Dan Schulte is the leader of HGS’s Provider Revenue Cycle Practice. He has more than 40 years’ experience in the healthcare industry. Defining the business of hospitals, he has helped large and small organizations find their weak spots, change processes, and realize immediate returns in bottom-line cash.

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