Educating Psychiatry Trainees on Social Determinants of Health

Some psychiatric care teams have had little option but to better seek out and put consideration toward the social determinants of health that impact their patients’ communities—whether due to factors present in in the confines of the doctor’s office, or well beyond their walls.

The benefit of putting such considerations into place with mental health care is substantial enough that some directors would like to see social determinants of mental health be among the curriculum of psychiatry residents.

In an interview with HCPLive during the American Psychiatric Association (APA) 2022 Annual Meeting in New Orleans last week, Ana R. Ozdoba, MD, director of the department of psychiatry and behavioral sciences residency training at Albert Einstein College of Medicine and Montefiore, discussed why applying the social determinants of health into psychiatric evaluation and care is not a common practice—but why it’s an important opportunity for residency training programs.

Ozdoba stressed the available evidence showing the impact of social factors on individuals’ mental health, acknowledging that some may not identify it as a necessity amid rising rates of new patients.

“The main hurdles for teaching about social determinants of health is that sometimes our situations are not on the same page about having these important discussions—assessing education, living situations, difficulties with transportation is limited in some institutions,” Ozdoba said. “We’re all pressed for time, we’re all seeing a large quantity of patients, and sometimes gathering the social determinants of health is not made a priority."

Ozdoba and fellow psychiatry residency directors mets at APA 2022 to review and share their own institutions’ strategies to educate trainees on the social determinants of health—of which there are endless resources. She noted regional mapping insights, interactive games, collaborations with local historical societies and other community representatives could be enough to better inform residents on the neighborhoods they’re treating.

Specifically speaking to her team at Montefiore, Ozdoba highlighted the system’s partnership with the Office of Population Health, through which she and colleagues may visit community centers and become better educated on the resources most coveted and requested by residents that could fall under their care.

“If they don’t trust the mental health system, then we come to them,” she said. “Coming to the religious communities, the resources they have available helps us connect with the community in a different way, and it also teaches our residents and faculty to be advocates for the patients.”

Even for teams like her own that have prioritized the social determinants of mental health in their work, there’s many more factors within it to reach: issues with racism, discrimination and community safety are among the key burdens Ozdoba would like to see better addressed in her work as a Montefiore-based psychiatrist and educator.

“There’s a lot of different structures that impact care that we’re still trying to understand, and that’s why we have to teach our residents to think about that as part of the treatment,” she said.