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    Social Determinants of Mental Health

    APA believes in promoting equitable access to high-quality mental health care for all individuals, and aims to equip its member psychiatrists and other stakeholders with the tools to address the societal, economic, and environmental factors that influence mental health outcomes.

    Social determinants of mental health (SDoMH) refer to the conditions in which people are born, grow, live, work, and age, which significantly impact mental health outcomes. These determinants include factors such as economic stability, education, healthcare, housing, social relationships, and physical environments.1

    Psychiatrists must consider these factors during diagnosis and treatment planning to ensure holistic care, including:

    • Social determinants significantly impact physical, cognitive, and mental health, influencing quality of life, daily functioning, and longevity.2
    • Coexisting SDoMH act synergistically, worsening health outcomes for individuals with serious mental illnesses (SMIs) from marginalized communities.2
    • Research shows that adverse SDoMH are linked to higher rates of depression, anxiety, and other psychiatric disorders.3
    • SDoMH can contribute to the development, course, and outcomes of schizophrenia-spectrum disorders (SSPD), as well as to greater medical comorbidity and premature mortality.2
    • Social isolation and economic hardship are major contributors to the severity of mental illness.4
    • Studies show that Black (15.3%) and Latino (13.6%) Americans have higher rates of psychotic risk factors compared to White Americans.5

    To document SDoMH during a healthcare encounter, V and Z codes (utilized in the DSM and ICD) can help facilitate reporting of these factors. Using V and Z codes allows for more accurate diagnosis of patients through identifying individual social needs, aggregate data, trends, and the guidance of policy and services. The importance of addressing these factors continues to gain attention due to their profound influence on both the prevalence and management of psychiatric conditions.

    Economic Impact

    • The economic burden of untreated mental health issues linked to SDoMH is immense.
    • In the U.S., mental illness results in lost productivity and increased healthcare costs, with estimates exceeding $280 billion annually.6,7
    • Additionally, conditions like unemployment, food insecurity, and housing instability exacerbate these costs by prolonging or worsening psychiatric conditions.8,9

    Policy and Programs

    • Recent initiatives, such as the APA’s Presidential Task Force on Social Determinants of Mental Health, aim to raise awareness of these factors in clinical practice.9
    • The Healthy People 2030 framework also addresses these factors by setting goals to reduce disparities in mental health outcomes related to SDoMH.10

    Avenues of Intervention

    • For Psychiatrists: Incorporate screenings for social risks (e.g., food insecurity, housing instability) during assessments.11
    • For Individuals: Engage in community support networks to enhance social connectedness.12
    • For Organizations: Educate and advocate for policy changes to address social disparities, such as improved access to housing and healthcare.9,13

    Telehealth

    Telehealth is an effective tool that expands access, continuity of care, patient privacy, and convenience while reducing barriers to care, including fears of stigma.

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