Why Health Systems are Getting Involved with Mental Health and the SDOH


It shouldn’t be surprising that the human mind and body are interconnected—the brain is, after all, a part of the body, and what affects the one will affect the other. And it is well known that poor mental or behavioral health can lead to poor health outcomes. For instance, anxiety and depression are linked to a shorter lifespan, as well as a greater risk of health complications, such as loss of sleep or an excessively sedentary lifestyle.

And mental health across the United States is not improving, says Dr. Robert Copeland, senior vice president of Kaiser Permanente, in an interview with DiversityInc. According to WHO, approximately 350 million people suffer from depression, and it is predicted that by 2020, depression will be the world’s second-leading cause of disease. And ultimately, in the working world, mental health issues impact productivity.

And, Dr. Copeland laments, part of the problem is that there is still a significant stigma surrounding mental health. Mental health problems are often conflated with negative personality traits or just negative feelings that sufferers can simply buck up and overcome, or even suggest that mentally ill people are abnormal or dangerous, when in fact the vast majority of mentally ill individuals are no threat to those around them. At any given time, as many as 20% of people are suffering from a mental health condition, making those who do suffer mental health conditions not uncommon.

Because of this stigma, it isn’t always adequately addressed by healthcare providers, even with the increased push to address the social determinants of health. In fact, untreated common mental health conditions such as depression contribute greatly to unemployment, excess use of healthcare services, and risk of heart disease, diabetes, and stroke.

But this is not to diminish the importance of social determinants of health like education, job security, food security, shelter, and access to reliable transportation. All of these are crucial to achieving positive outcomes for a health system. Keeping patients out of the hospital is key, and the solution is to address these issues at their root. Across the country, health systems are trying to find new ways to accomplish this.

For the last two decades, the New York City-based Montefiore Health System has made population health management a part of its business model. By leaning into risk-based contracting for patient care, the health system now has the significant financial incentive to help keep patients out of the hospital, which entails forming strong relationships with community partners to address aspects of health that primary care providers simply aren’t equipped or staffed for.

Nicole Hollingsworth, assistant vice president of Montefiore, stressed that this relationship must be a committed one integrated into the health system’s business model, because any collaborative efforts that are some form of charity of simple goodwill-building will have no staying power. “It has to be something you’re invested in and something you’re in invested in over the long haul,” she added. By forging and diligently reinforcing these long-term ties with the community, the Montefiore Health System is much better able to tackle the social determinants of health.

LifePoint Health, a health system based in Brentwood, Tennessee, has found success collaborating with community services and stakeholders, even when sometimes these collaborations took extra effort to get off the ground. For instance, Dr. Rusty Holman, the system’s chief medical officer, said that it may be that the aims of the health system may actually be in competition with community stakeholders. In such cases, being upfront has proven effective, he says: “defining the problem and making it clear is an important initial step.” Establishing right off the bat what the objectives are of the health system’s programs and initiatives and seeking common ground are essential to moving forward.

Sometimes it can be even more difficult to make these collaborations work than just competition. Perhaps a health system has no existing relationships with community organizations and services, or the relationship may be too superficial to affect a real coordinated effort, or the organizations in question may even feel slighted or injured by the health system in some way. Hillary Heishman, senior program officer at the Robert Wood Johnson foundations, stresses that productive, long-term partnership requires solid, authentic interpersonal relationships, not just business network contacts or formal treaties. Health systems need to take the time to research the organizations they wish to partner with and understand how that organization sees them—and not to fight these characterizations, however unfair or wrong they may seem, but to acknowledge that this is how the group perceives things and seek to make reparations.

Alternatively, addressing these SDOH can be challenging in areas where services are not available in the community. In some rural areas, there simply may not be sufficient services to address determinants like mental health. In such situations, health systems may have to get creative. For instance, when transportation is difficult for residents to reliably or feasibly be able to keep appointments at remote clinics, telemedicine may be an option to bring counselors and psychiatrists to young individuals who have no one else to turn to. Alternatively, providing more mental health training to primary care providers and teachers in local schools in remote rural communities can help alleviate some of these unmet needs.

In sum, addressing the social determinants of health is essential to any strategy to improve health outcomes for patients of health systems. Health systems that aim to resolve the socio-economic barriers to their patients’ wellbeing, the same factors that disproportionately put them in emergency departments and require costly prescriptions, must find ways to make inroads with the nonmedical social services and organizations in their communities. Long-term partnerships with such groups must be integrated into any business model hoping to make this more Whole Person Care-centric a reality, and barriers to access to such services must be overcome in remote and rural parts of America. All of which can seem daunting at first, but with the aid of the right resources, including a solid community care coordination platform such as Eccovia Solutions’ ClientTrack, health systems can accomplish all this and more, lifting overall community health, mental and physical.

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