Two parents walking along a creek, each with a child on their back.

Traditional social determinants are a starting point. But for significant improvement in mental health, they don’t go far enough. Achieving equity in behavioral health care requires that we define the social determinants of mental health (SDOMH).

Social determinants of health (SDOH) account for as much as 80% of person’s modifiable health factors and 50% of their overall health outcomes. Thankfully, the healthcare community now understands that access to quality food, primary care services, safe housing, and transportation all significantly impact health outcomes. Those societal challenges are rightly now the focus of large-scale government programs and community-based efforts.

But what about mental health? 

Traditional social determinants such as housing and food are certainly critical to consider. However, we also know this: Two children with the exact same health and demographic profiles could respond very differently to behavioral health treatment. Why? One of them may be impacted by a more challenging home environment—an unsupportive parent, a stressful relationship with a sibling, a cultural difference in attitudes toward mental health treatment.

In this context, the traditional social determinants are a starting point. But for significant improvement in mental health, they don’t go far enough. Achieving equity in behavioral health care requires that we define the social determinants of mental health (SDOMH).

What are SDOMH?

Where traditional social determinants of health are broad building blocks that may impact mental health, the social determinants of mental health include the granular non-medical drivers of health that are unique to individuals. 

In other words, everyone in a particular neighborhood will be experiencing the same broad social determinants of health, and a ZIP code-based intervention—such as adding bus routes or expanding food pantry hours—may improve physical health for all residents in the same manner. 

However, the brain is much more complicated. To make a meaningful impact on an individual’s mental health, we must understand all the additional factors that combine to create the individual’s unique experience. 

Some examples:

  • Do cultural factors make food insecurity particularly traumatic for this person? 
  • Is a teen tasked with caring for a disabled sibling in a community that lacks social services? 
  • Did this child’s mother suffer from perinatal or postpartum depression?

These are questions not only to ask, but also to measure, track, and incorporate into day-to-day care.

Trauma-Informed Care

This approach to social determinants of mental health enables clinicians to provide what Roshni Koli, MD, refers to as trauma-informed care. I shared a stage at HLTH 2023 with Dr. Koli, Chief Medical Officer of the Meadows Institute, to discuss how incorporating SDOMH data could change the way patients are managed in the clinic. As she explained: To understand a patient’s clinical presentation, we must consider two things—what happened to them, and what their environment looks like.

Collecting this type of historical and environmental data has proven elusive to the behavioral health community, however. Environmental observations typically exist only in unstructured physician notes or paper forms, where they cannot be easily accessed or integrated into diagnoses and treatment plans.

The Trayt platform was built to bring this type of data into day-to-day care. The platform tracks and measures 750 different factors that all influence mental health, including physical symptoms, behavioral symptoms, broad social determinants of health, granular environmental factors, and Adverse Childhood Experiences (ACEs). Clinical data from providers is assimilated with critical between-visit symptom and environment data, which is collected through a patient- and caregiver-facing application from the people who know the individual the best. Together, the data develops a 360-degree personalized view of the patient.

The New Paradigm

Behavioral health treatment looks very different through a 360-degree lens. It takes into account a person’s entire experience rather than treating one symptom at a time. It enables providers to collaborate with caregivers and social services agencies in putting individualized support systems in place—not broad band-aids—to ensure treatment success. And, it empowers patients with respectful, holistic care.

Going forward, the challenge for all of us in the behavioral health care community is to ensure we are using SDOMH data in ways that contribute to care rather than hinder it. 

From a clinical perspective, Dr. Koli reminds us to approach patients with cultural humility to avoid implicit bias in the ways we treat patients. From a technological standpoint, Trayt is focused on making the data meaningful by tracking patient outcomes. It is not enough just to collect SDOMH data. We must be able to demonstrate that we’re using it to help patients get better.

Article written by Malekeh Amini, Founder and CEO, Trayt Health.