In the years since the World Health Organization released its pivotal report in 2008, the concept of social determinants of health (SDOH) has thankfully expanded beyond the public health sector and into the lexicon of the broader healthcare community. 

Social Determinants of Health (SDOH) are now understood to influence as much as 80% of a person’s modifiable health factors and 50% of their overall health outcomes. Every major U.S. health organization is actively evaluating SDOH to improve outcomes, including the Centers for Disease Control (CDC) with its six-pillar framework for addressing social determinants and the U.S. Department of Health and Human Services (HHS) as part of the Health People 2030 initiative. 

However, such programs are almost universally focused on using SDOH data to promote health equity and expand access to care. It’s time we started using social and experiential data to improve the quality of that care.

Expanding the Framework

Recognizing that the world has changed significantly since 2008, global researchers and organizations began calling for an updated approach to social determinants of health. A 2020 paper published in the International Journal of Environmental Research and Public Health noted several emerging challenges to the WHO’s SDOH framework, including disrupters caused by climate change, complex health issues such as obesity and the pandemic, and the continually evolving political and social landscape. In 2021, the World Health Assembly asked WHO for a revised World Report to set the agenda for the next 10 years of action on social determinants of health. 

In the U.S., the mental health care crisis would most certainly qualify as an emerging challenge to the SDOH framework. U.S. Surgeon General Dr. Vivek Murthy released an advisory about the devastating epidemic of loneliness and isolation, and also famously called mental health “the defining public health crisis of our time.” 

Within this context, we must first expand the framework to include social determinants of mental health (SDOMH), which build upon traditional SDOH but are different. More importantly, we must collect SDOHM data and use it to do more than promote equity and access to treatment. We must make it available to clinicians to reference as part of day-to-day care.  

What are SDOMH?

Where traditional social determinants of health are broad building blocks that may impact mental health, the social determinants of mental health include the granular non-medical drivers of health that are unique to individuals. 

Using traditional SDOH, everyone in a particular neighborhood will be experiencing the same broad social determinants of health, and a ZIP code-based intervention—such as adding bus routes or expanding food pantry hours—may improve physical health for all residents in the same manner. 

However, the brain is much more complicated. To make a meaningful impact on an individual’s mental health, we must understand all the additional factors that combine to create the individual’s unique experience. 

Collecting this type of historical and environmental data has proven elusive to the behavioral health community. Environmental observations typically exist only in unstructured physician notes or paper forms, where they cannot be easily accessed or integrated into diagnoses and treatment plans.

The Trayt platform was built to collect this type of data and integrate it into day-to-day care as structured data. The platform tracks and measures 750 different factors that all influence mental health, including physical symptoms, behavioral symptoms, broad social determinants of health, granular environmental factors, and Adverse Childhood Experiences (ACEs). Clinical data from providers is assimilated with critical between-visit data—symptom data, environmental data, and real-life experiences—which is collected through a patient- and caregiver-facing application from the people who know the individual the best. Together, the data develops a 360-degree personalized view of the patient.

Providing Better Care

This 360-degree view is extremely powerful. It takes into account a person’s entire experience rather than treating one symptom at a time. It also enables providers to collaborate with caregivers and social services agencies in putting individualized support systems in place—not broad band-aids—to ensure treatment success. 

How will we use this powerful information? If we look only to identify people who need care and expand access at the community level, we are not going far enough. We must make SDOMH data available to clinicians who are treating individual patients. Understanding SDOMH not only improves assessments and treatments, but it also allows clinicians to better predict how patients will respond to treatment. There’s no more direct way to improve patient outcomes than to improve the effectiveness of their individualized treatment. The technology exists. It’s time to use it more broadly.