Social and mental health care integration: The leading edge

It is now well recognized that many factors beyond medical care access and quality drive health outcomes, including social and economic risks (social risk factors) associated with neighborhood safety, educational attainment, housing stability, and food security. The association of social risk factors with health can be direct (eg, lead ingestion in substandard housing leads to poorer cognitive functioning) and indirect (eg, neighborhood exposure to violence in adolescence can increase chronic stress, which contributes to the development of mental illness). Whether via direct or indirect mechanisms, social risk factors shape health, health behaviors, and health care use and costs.

Psychiatry has been a disciplinary leader in recognizing the specific ways in which social risk factors affect health, including psychopathology. Research in the field has underscored that these risk factors play a key role in the development, severity, and chronicity of mental illness and substance use disorders, in part because they make engagement with evidence-based interventions for mental illness more difficult and living with mental illness more challenging. A more pressing question than whether social risk factors affect health is what health care professionals can do about them. In psychiatry, it is time to articulate how and when mental health care professionals should act on identified social risks. There is not yet a clear consensus on specific strategies to address either how social risks should be addressed (ie, how should health care professionals change care based on patients’ social risk factors?) or when (ie, when should mental health or social risks be prioritized in care delivery?).