Providing mental health services should be more than addressing the mental health needs of your client. Providing services should also include reviewing the social determinants of health that affect their lives, from food to housing to safety to education.
The World Health Organization (WHO) recognizes social determinants of health (SDOH) as: “The non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age and the wider set of forces and systems shaping the conditions of daily life.” Understanding the SDOH and their impact on mental health outcomes helps society better examine—and act upon—the inequity within cities, states, and countries worldwide.
There are five distinct categories of SDOH:
- Economic Stability
- Education Access and Quality
- Health Care Access and Quality
- Neighborhood and Built Environment
- Social and Community Context
(Social Determinants of Health, n.d.).
- Income and social protection
- Unemployment and job insecurity
- Working life conditions
- Food insecurity
- Housing, basic amenities, and the environment
- Early childhood development
- Social inclusion and non-discrimination
- Structural conflict
- Access to affordable and quality health services
It is correct to say that health and disease follow a social gradient: the lower a country’s socioeconomic position, the worse the physical and mental health statuses of those who live there. In other words, the more disadvantaged a community is, the harder it can be to stay in good health and access quality services. In contrast, a country with a higher socioeconomic position often experiences better health and increased access to quality services (World Health Organization and Calouste Gulbenkian Foundation, 2014).
The WHO elaborates on the power imbalances of socioeconomic status further, stating: “…Inequity in health is socially determined, preventing poorer populations from moving up in society and making the most of their potential.” To achieve health equity universally, we must first become aware of the disproportionate policies, social norms, and structures governing us—limiting far too many communities—and change them together. We must concentrate our attention on the people and places who need our help now and then diffuse our attention to surrounding areas accordingly.
We can take steps to spread awareness about the importance of SDOH and begin improving health outcomes today.
Our efforts must include:
- Educating communities about SDOH and the impact they have on health and well-being
- Improving living conditions through the use of micro and macro efforts
- Dismantling the unjust distribution of power, money, and resources
- The use of measurable objectives to evaluate and assess progress towards health equity
How Social Determinants Specifically Impact Access to Mental Health Services
Now that we are more familiar with the SDOH, we can better address how these determinants impact mental health outcomes. It is fair to say that lack of addressing social determinants of health impacts mental health outcomes negatively. (Social Determinants of Health, n.d).
The most severe mental health concerns often go untreated due to the lack of education on the importance of mental health, the lack of availability of services in a designated area, and limited funds or sliding-scale options for payment. In addition, individuals struggling to meet the basic needs of their families may be less likely to prioritize their mental health (World Health Organization and Calouste Gulbenkian Foundation, 2014). Frequently so, circumstances of fighting racial injustices, locating daily child-care services to maintain employment, or keeping a family safe from hazardous environmental exposures, commonly take precedence.
At the same time, because mental health symptoms are not visible, they are often the first to be placed on the backburner. Mental health can affect every aspect of one’s life. It creates either a positive or negative feedback loop between the other social determinants of health. For example, poor mental health can cause unemployment and, in turn, can cause food insecurity for an entire family. Likewise, poor physical health can cause poor mental health and, as a result, can cause lapses in education or work responsibilities. Addressing the social determinants of health and encouraging or discouraging society from seeking mental health services makes it feasible for mental health outcomes to improve.
How Social Determinants Specifically Impact the Delivery of Mental Health Services
When providing mental health services to an individual, family, or group, it is vital to keep in mind the social determinants of health and their impact on an individual’s level of functioning. Using a biopsychosocial model to understand the biological, psychological, and social components which exist for a person is central to providing quality care.
When beginning services with a client, a mental health clinician should refer to Maslow’s Hierarchy of Needs discussed by Dr. Mcleod. The first task starts with basic needs (food, water, safety, shelter). We should then move upward to psychological needs from basic needs (building friendships, increasing confidence, sense of accomplishment). And lastly, addressing self-fulfillment needs (setting goals, achieving one’s full potential, contentment with relationships). While providing mental health services, a clinician should continue to tune into the social determinants of health and how they affect all areas of life.
How to Increase Mental Health Outcomes by Way of Social Determinants
To increase mental health outcomes across the board, we must acknowledge the obstacles that exist for many because of the SDOH. We must then work to begin a positive feedback loop among the SDOH, targeting mental health by way of the following:
- Educate and spread awareness about the importance of mental health
- Increase funding for mental health services and quality child-care
- Meet the basic needs of all individuals (food, water, safety, shelter, warmth).
- Incorporate job training and employment programs
- Increase affordable housing and temporary housing efforts
- Increase government assistance and support
- Support and encourage one another at the community-level
Despite the challenges of addressing unfair inequalities resulting from the SDOH, there are ways to implement action in all sectors and across all levels of government to create change—and achieve better mental health outcomes. We must take universal action and create universal policies that are proportionate to the need determined by today’s advantages and disadvantages. If we choose to ignore the impact of social determinants on our livelihood and others, we only endorse and contribute to the unfairness that persists.
Mcleod, S. (2020, December 29). Maslow’s Hierarchy of Needs. Simply Psychology. https://www.simplypsychology.org/maslow.html.
Social Determinants of Health. Social Determinants of Health – Healthy People 2030. (n.d.). https://health.gov/healthypeople/objectives-and-data/social-determinants-health.
World Health Organization and Calouste Gulbenkian Foundation. Social determinants of mental health. Geneva, World Health Organization, 2014. https://apps.who.int/iris/bitstream/handle/10665/112828/9789241506809_eng.pdf;jsessionid=99BFB066D8FAFA6B37D4E69DBFDE3F3B?sequence=1
World Health Organization. (n.d.). Social determinants of health. World Health Organization. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_3.