Commentary
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Pharmacists can address social determinants to improve patient well-being and treatment.
In an interview with Pharmacy Times, Shari Allen PharmD, BCPP, Associate Professor of Pharmacy Practice Philadelphia College of Osteopathic Medicine, School of Pharmacy Atlanta, GA, discussed her presentation at the 2024 American Association of Psychiatric (AAPP) Conference. Allen shared how social determinants of health like economic stability and access to healthcare can impact mental health outcomes. She emphasized that untreated mental illness due to lack of access to care can lead to worse patient outcomes. Strategies for pharmacists to address social determinants were discussed, including taking time to talk to patients and understand their lives and goals. Allen also highlighted that understanding social determinants is essential for pharmacists to effectively treat patients with mental illness.
Pharmacy Times
What are social determinants of health, and why are they crucial considerations in patient care, particularly for those with mental illness?
Shari Allen PharmD, BCPP
Social Determinants of Health are the non-medical factors that play a role in our health. So, they are the economic, the social, the physical environments where we live, we work, we play, we worship, we grow up in. It's important with regards to mental health, because 80% to 90% of your health — not just mental health, but overall health, we say that it's made up or influenced by the social determinants of health.
Pharmacy Times
How do social determinants of health impact mental health outcomes and influence patient care in psychiatric settings?
0:00:13 - Introduction to social determinants of health and how they influence health outcomes.
0:00:42 - Discussion of how economic stability and access to healthcare can impact mental health and utilization of psychiatric resources.
0:01:20 - Question about specific social determinants that commonly affect patients with mental illness.
0:01:24 - Example given of how access to healthcare can impact treatment through untreated mental illness.
0:01:46 - Strategies discussed for how pharmacists can address social determinants in patient care.
Shari Allen PharmD, BCPP
Social Determinants of Health can be broken down into 5 different domains. For example, one of those domains is economic stability. What we see with people that have a low economic stability or low economic status, is that can result in poor mental health care, particularly depression. We also see that people that have a low economic status, they also utilize psychiatric resources less so than then people that do not have a low economic status. We can look at certain domains, the economic status access to health care in either directly or indirectly, they can affect people's mental health.
Pharmacy Times
Can you provide examples of specific social determinants that commonly affect patients with mental illness, and how these factors may manifest in their treatment?
Shari Allen PharmD, BCPP
The biggest one that you'll see is access to health care. Think about how long it might take you to get in to see a psychiatrist or to see a psychologist or to see any mental health specialist. Access to health care, especially after the pandemic — access to mental health care is probably one of our biggest barriers to getting treatment is the access. The reason why that's important is because when we do not have access to health care, to mental health care, then that means we have untreated mental illness. Untreated mental illness can then result in what— worse outcomes for the patient and maybe worse outcomes for people around them, or for their family units as well. I think access to health care and food insecurity is something that you may not think about either. There are certain psychotropic medications that we have to take with food. Food insecurity means I have a patient who's deciding I have to eat, or I have to take my medications. That's another way that kind of indirectly how the social determinants can affect mental health care. I was talking to a student after the presentation the other day, and he was telling me it's such a good presentation, there are things that I didn't think of. I think that's the thing. The social determinants are things that occur in our everyday lives, they're the way that we live. So you don't necessarily think of them. But I think the challenge is, we need to think about them.
Pharmacy Times
What strategies can psychiatric pharmacists employ to address the social determinants of health in patient care while ensuring effective treatment outcomes?
Shari Allen PharmD, BCPP
This is going to sound very cliche, maybe I don't know if that's the word, but talk to your patients, you have to talk to patients. I was telling a couple of people after the presentation the other day that asked me, what are some ways that we can incorporate the social determinants of health? And I said, it sounds very simple, but talk to your patients. Whenever I have patients that come to me in the clinic, I always ask them first, what are your goals? We sometimes spend the first 10 minutes of our conversation talking about just their lives. What's going on at home? How did you get here today at the clinic? What's your family life like? Tell me about something that's going on important in your life. You would think that those things don't necessarily matter to me as a pharmacist, but actually they do, because that's when I learned, somebody has a newborn baby at home, maybe they're a little bit stressed. Maybe they were late for appointments, because they are sharing a car with everyone else in their family. I think in order to incorporate the social determinants of health, the easiest thing that you can do is put aside the time to talk to your patients. That's when you're going to find out the most about them that's going to be able to affect their care going forward. Realizing that patients are not a number but looking at them as people and I think from a mental health standpoint, that's what my patients appreciate the most about me. I don't treat them like come in here's a checklist like let's be done. I talked to them like people because they are people.
Pharmacy Times
Why is it essential for pharmacists to understand and address social determinants of health in the treatment of patients with mental illness, and how can this improve overall patient well-being?
Shari Allen PharmD, BCPP
Circling back to what we talked about earlier is you don't realize that 80% to 90% of your health is affected by social factors. It's really important for pharmacists to consider that because it doesn't matter — it does matter, but it doesn't matter what you do regarding the medications. It doesn't matter if you recommend a medication that's the best ever, if your patient can't afford it, if your patient can't take it, if your patient doesn't like it because they think that other people are going to be weird about them taking medications. I think when we can consider the social determinants first then that can also make everything else a little bit easier as well.
