Navigating Social Determinants of Mental Health During COVID-19

As we enter our 3rd month of the COVID-19 pandemic, the impact on disadvantaged communities nationally is becoming increasingly clear. Comorbidities, lack of insurance, fear of hospital visitation, and underlying conditions are all contributing to a sickening disparate impact of the disease against our most vulnerable populations. Of course, this disparate impact is just the most recent, and painfully clear, manifestation of something we in the behavioral health, mental health, developmental disability, and homeless communities have known for a long time: inequalities in our healthcare system lead to detrimental outcomes for vulnerable communities. Prior to the pandemic, our industry was just beginning to grapple with this fact in a more rigorous way than we have before. Back then (we’re talking about February of this year), the work was referred to as Social Determinants of Mental Health, and it addressed the idea that insurance status, poverty, housing status, disability and mental health status and whole host of non-medical variables, have a profound impact on the physical and mental health of people. Our software, AWARDS, was further developed to be able to track these new data sets. Mold can cause asthma, black people are statistically less likely to be believed by doctors when describing physical pain (and receive less aggressive treatment for various maladies), substance users face bias in their communities and places of work, a lack of permanent housing is correlated with dozens of mental and physical ailments; Million Dollar Murray lives! What’s interesting about a disease as transmissible as COVID-19 is that we are now faced with the reality – one we work mightily to ignore – that each of us is directly responsible for the health and well-being of the people with whom we share our communities and lives. And unfortunately, just as the work our customers do is becoming increasingly important to the health and well-being of all of us, the virus itself makes many modes of counseling and service provision much more dangerous.

How Agencies Can Adapt to Telehealth

However, where there is challenge, there is also opportunity. Increasing reliance on telehealth services may allow some providers to permanently downsize their office footprint and save money on rent, overhead and other expenses associated with physical space. As well, the need to be able to gather and report out data at a distance, means many of our clients are expanding their use of our EHR and paying renewed attention to the quality of the data that is entered. Moving services into the virtual world also requires additional focus on cybersecurity, a topic often given short shrift in normal circumstances. Creating systems and protocols for serving people virtually also means that many people who were resistant to physically going to a provider can be reached where they are. Finding ways of increasing the size of your serviceable market without increasing the physical size of your catchment area can be a boon to your organization and the health of our communities. All of these will result in operations that are leaner and more efficient, and enable our customers to do more good in their communities.

COVID-19 Can Grow Awareness Around Social Determinants of Mental Health

Lastly, there is an opportunity here to change the way people understand the work our customers do. The economic crisis that has followed the pandemic means that many people who have never experienced the nonprofit human service sector are suddenly doing so for the first time. Food banks, free medical services, inexpensive counseling, and subsidized housing are now being used by people who have never needed those services before, and may not need them for long. This is a once-in-a-lifetime opportunity to create bonds with these individuals that will outlast the pandemic; to create a new class of supporters and donors and political allies that can be with us after things return to normal. Moreover, there is a marketing opportunity to let your community know that you are there for them; That you have their backs and they can only fall so far because you are there like a backstop to catch them. This kind of communication will never be so readily and deeply internalized as it will be now. This pandemic has been terrible for all of us, and none have had it as hard as our disadvantaged communities and the organizations that serve them. However, we have seen incredible resilience and creativity from providers and the communities they serve. Despite the crisis, there are ways to continue doing the work that is needed now more than ever before.