As is true of other health conditions, social factors that shape the environment in which people live can have an impact on the state of a person’s mental health.1 To assess the role that social determinants of health have on community mental health, the VHHA Analytics team examined diagnosis groups linked to mental health and substance abuse hospitalizations. Given that a considerable amount of mental health care is provided on an outpatient basis, mental health hospitalizations can be seen as something of a failure of the ambulatory care system. For patients, social determinants of health can play an influential role in whether or not treatment is successful. Our analysis (see Figure 1 below) identified the 10 most comment social determinant codes associated with patients hospitalized for a mental health or substance abuse diagnosis. The most common is homelessness, followed by childhood abuse, and then unemployment. The connections between diagnoses that indicate instability in one’s personal life and mental illness are evident. A person who lacks a permanent address, or is homeless, may have difficulty accessing mental health care or following through with necessary treatment, and may prioritize basic needs like food and shelter ahead of therapy appointments. These circumstances in a patient’s life can also be challenging for caregivers when they need to locate patients for follow-up care. Similarly, unemployment, which may result in homelessness, can complicate a patient’s ability to access care and maintain a prescribed treatment regimen. Unemployment typically means a loss of income, which can substantially alter a person’s financial situation and their view of what is a necessary expense. And because many people have coverage through employers, unemployment can also mean a loss of health benefits, making it more difficult for people to access care or pay for treatment and medication. Patients who were abused as children may exhibit lifelong challenges associated with that abuse, including serious trust issues and destructive behavior such as substance abuse or self-harm. Community health efforts that account for housing and employment needs, as well as adverse childhood experiences, are long-term strategies that over time may help alleviate inpatient care demand. Of course, health care providers alone aren’t equipped to solve entrenched societal challenges that require sustained investment and a multi-disciplinary response. However, helping providers identify options for linking patients with resources outside hospital walls is one potential approach to responding to the ways in which social determinants impact the delivery of mental health treatment. (3/1)
1 World Health Organizations and Calouste Gulbenkian Foundataion. Social Determinants of Mental Health. Geneva, World Health Organization, 2014.
Figure 1: Top 10 Codes in Patients Hospitalized for Mental Health or Substance Abuse