Social Determinants of Health: Paying attention to them: 4 Additional Reasons Why


LEARN MORE, PRACTICE DIFFERENTLY, AND FEEL CONFIDENT

WORKING WITH CLIENTS

BY JOINING US FOR A SEMINAR ON, 

“NEW STRATEGIES FOR ADDRESSING THE NEEDS OF OUR PATIENTS AND CLIENTS:

THE SOCIAL DETERMINANTS OF HEALTH,”

ON JULY 6, 2018, 9AM - 1:00PM


client.jpg

“I almost did not make it here. I did not have any carfare. But my girlfriend helped me out with that,” Nathan said to Tara, the clinician who was seeing him for the first time, for an initial mental health assessment.

 

The World Health Organization (WHO) defines social determinants of health as the conditions in which people are born, grow, live, work, and continue to age.

 

In a previous article, entitled, Addressing the Social Determinants of Health, the Why and the How, I mention a total of fifteen such determinants of health, which include transportation barriers, and limitations in education, social support, and financial resources.

 

In the above article referenced, I outline four main reasons why it is crucial for us to help address the social determinants of health.  I mentioned the following:

  1. Enhancement of clinical outcomes;
  2. Achievement of full recovery;
  3. Promotion of career gratification; and
  4. Decrease of waste and cost.  
SWEET Institute social determinants of health
SWEET Institute social determinants of health
SWEET Institute social determinants of health
SWEET Institute social determinants of health

In this current article, I will outline four additional reasons why it is important for us to pay attention to the social determinants of health for our patients and clients.

 

To meet them where they are at and attend to their basic needs

Meeting our patients and clients where they are at will require that we know where they are at. It also means we should know their level of needs and necessities, following the principle of Maslow’s Hierarchy of Needs. With this knowledge, we will be able to, at least, attempt to attend to their basic needs.

SWEET Institute- Social Determinants of Health- Maslow’s Hierarchy of Needs

 

 

Informed expectations

Relationships entail mutual expectations, and the patient-clinician relationship is not exempt from this. As clinicians, we expect our patients and clients to attend clinic visits regularly, as scheduled and be on time; we expect them to take their medications as prescribed, to tell us of any adverse effects, and to let us know of any relapse in between visits.

SWEET Institute Social determinants

Our patients and clients also have their own expectations. They expect us to educate them about their conditions, their medications, the related side effects, and how to manage them. They also expect us to at least have a discussion about decisions and unhealthy coping mechanisms.

In the midst of all these, we may, at times, neglect the fact that some expectations may be unrealistic, due to specific barriers. For example, patients and clients with limited education may not fully understand how to complete the initial intake forms. Those with food insecurity or financial limitations may not be able to follow the dietary recommendations that will help mitigate their risk for metabolic syndrome.

Taking some time to pay attention to the social determinants of health will help us manage the expectations we have of our patients and clients, and look for ways to promote recommendations that are practical, realistic, and tailored.

 

 

To enhance trust, adherence, and the therapeutic relationship

SWEET Institute Social determinants

People are generally interested in those who first show interest in them, and they tend to also like those who like them or who are nice or kind to them. Our patients and clients will develop trust when they perceive that you care about them, and that care and concern often need to be demonstrated not only voiced. Asking our patients and clients about the neighborhoods in which they live, their possible ongoing experience at a shelter, their social support and level of functioning, and their commute to and from the clinic or the agency or the hospital all show that we, as clinicians care about them. And this can help instill trust. The trust we instill lays the groundwork for a healthy, therapeutic relationship, which helps with adherence for clinic visits and treatment recommendations.

 

 

To help prevent decompensation, relapse, recidivism and fragmented care

Related to trust, adherence, and the therapeutic relationship, paying attention to the social determinants of our patients and clients will also help prevent decompensation, relapse, recidivism, and exposure to fragmented care.

SWEET Institute-Social Determinants of Health

“He did not make it to the clinic. When I called his mom, she told me she had just received a call that Alain was arrested on his way to meet with me. The most shocking part was hearing that Alain was arrested for jumping the turnstile,” explained Lynn. Alain had been given a round trip metro card to return to the clinic, for his follow up appointment. However, he decided to walk home and save his metro card for travel to school the following day. On the day of his appointment, Alain was running late, and since he was tired, instead of walking, he took the risk to jump the turnstile, and he did not make it to the clinic.

 

Paying attention to the social determinants of health will also help prevent fragmented care, because it entails a conversation among all members of the team, whether internal or external; it helps prevent relapse, because clinicians can help strengthen the social support, shown to be a contributing factor to relapse prevention.

 

SWEET Institute-Social Determinants of Health:
“I almost did not make it here. I did not have any carfare. But my girlfriend helped me out with that,” Nathan said to Tara, the clinician who was seeing him for the first time, for an initial mental health assessment.

 

In summary, there are four additional reasons why all clinicians need to pay attention to addressing the Social Determinants of Health:

1) To meet our patients and clients where they are at and attend to their basic needs;

2) Informed expectations;

3) To enhance trust, adherence, and the therapeutic relationship; and

4) To help prevent decompensation, relapse, recidivism and fragmented care.

 

Only 10% of our overall care and wellness depend on direct care from a doctor. And 90% of our care and wellness depend on these social determinants of health. Have you been guiding your patients and clients toward recovery in the most effective and efficient way?

 

Your colleague,

Mardoche


LEARN MORE, PRACTICE DIFFERENTLY, AND FEEL CONFIDENT

WORKING WITH CLIENTS

BY JOINING US FOR A SEMINAR ON, 

“NEW STRATEGIES FOR ADDRESSING THE NEEDS OF OUR PATIENTS AND CLIENTS:

THE SOCIAL DETERMINANTS OF HEALTH,”

ON JULY 6, 2018, 9AM - 1:00PM


For more in this series of articles, check below!


SWEET Institute- Mardoche Sidor, MD

Dr. Sidor is quadruple board certified in psychiatry, with board certification in General adult, Child and adolescent, Addiction, and Forensic, psychiatry. He also has additional training in public psychiatry, in several treatment modalities, in addition to his teaching, supervision, mentorship, coaching, and management, experience. Some of his passions are public speaking, leadership, entrepreneurship, and research, in addition to program development and project management. His overall goal is to empower all health care professionals throughout the United States and globally, towards ensuring the continuity of excellent patient care, while balancing the need to take care of themselves. Dr. Sidor is the main instructor for the SWEET Institute, and he is currently an Assistant Professor of Psychiatry at Columbia University. He is also the past-Medical Director for CASES (Center for Alternative Sentencing and employment Services), and he speaks and writes fluently in six (4) languages—French, English, Spanish, Creole, and has intermediate proficiency in Portuguese and Italian.


References:

  1. Braveman, P. and Gottlieb, L., 2014. The social determinants of health: it's time to consider the causes of the causes. Public health reports, 129(1_suppl2), pp.19-31.
  2. Simandan, D., 2018. Rethinking the health consequences of social class and social mobility. Social Science & Medicine.
  3. Bryant, Toba; Raphael, Dennis; Schrecker, Ted; Labonte, Ronald (2011). "Canada: A land of missed opportunity for addressing the social determinants of health". Health Policy. 101 (1): 44–58.
  4. Townsend, P., Davidson, N., & Whitehead, M. (Eds.). (1992). Inequalities in Health: The Black Report and the Health Divide. New York: Penguin.
  5. Marmot, Michael; Wilkinson, Richard G. (2005). "Social patterning of individual health behaviours: The case of cigarette smoking". In Marmot, Michael; Wilkinson, Richard. Social Determinants of Health. pp. 224–37.
  6. Raphael, D. (2001). Inequality is Bad for our Hearts: Why Low Income and Social Exclusion are Major Causes of Heart Disease in Canada.