New Group Seeks to Make Management of Social Determinants a Reality in Health Care

Jeste, who chaired the Presidential Task Force on Social Determinants of Mental Health appointed by then-APA President Vivian Pender, M.D., in 2022, serves as director of the network. Charles Reynolds III, M.D., emeritus professor of psychiatry at the University of Pittsburgh School of Medicine, is secretary general; Eric Rafla-Yuan, M.D., chair of the APA Assembly Caucus on Social Determinants of Mental Health, is treasurer; and Heather Leutwiler, R.N., Ph.D., professor of physiological nursing at the University of California, San Francisco, is newsletter editor.

The leadership team is supported by a 21-member multidisciplinary advisory board. Jeste said APA will be a major partner, possibly supporting pilot projects and training courses on addressing SDoH in practice.

“I am delighted that Dr. Jeste has carried the torch and with others has established a permanent network to study the effects of social determinants on mental health,” Pender said. “For a significant part of my clinical experience, I witnessed individuals who were sometimes irreparably impacted by systemic structures, such as poverty, racism, and violence.

“Rethinking traditional approaches to mental illness is clearly warranted,” Pender said. “It has the potential to redirect our attention to causes rather than consequences. Shifting the psychiatric paradigm from individual fault and responsibility to societal policies can lead to improving large swathes of population health. This network is just the kind of vehicle to achieve that result.”

Jeste said the network will approach the subject on two fronts—promoting tools that practitioners can use right now to help address the social determinants that affect patients’ health and seeking changes in health systems that will enable and encourage practitioners to focus on social determinants.

The latter, in particular, will be a heavy lift and a long-term challenge for the network. “The problem is not that the medical or psychiatric community is resistant to addressing social determinants,” Jeste said. “The problem lies with the health care system. For example, physicians are tied to an electronic health record that focuses on diagnosis and treatment but does not enable or encourage assessment of or response to social determinants. The clinicians are not getting reimbursed for addressing social determinants.

“People in practice say, ‘We agree that we should do this. But our hands are tied.’ And they are correct,” Jeste said.

Michael Compton, M.D., M.P.H., a member of the network’s advisory board, said that the organization can help make assessment and management of SDoH an everyday reality in health care. “Dr. Jeste has brought together a diverse group of researchers interested in this area to promote collaboration and scholarly work on the ways in which the social determinants impact the mental health and physical health of our patients,” Compton told Psychiatric News.

“All of the social determinants can be considered societal problems that impact both individuals and the population at large, have major impacts on mental health, risk for mental illnesses, and course and outcomes among those living with a mental illness.” ■