NEJM Catalyst forum addresses mental, behavioral and social health determinantsby Bill Snyder Jan. 29, 2018, 8:36 AM
Healthcare is more than diagnosing and treating disease. To truly improve health outcomes for individuals and communities, the mental, behavioral and social determinants of health must be fully integrated with physical factors at all levels of the healthcare system.
That was the take-home message from last Thursday’s audience participation and live-streamed web event produced by NEJM Catalyst and hosted by Vanderbilt University Medical Center (VUMC).
NEJM Catalyst is a digital resource for healthcare leaders and clinical leaders provided by the Massachusetts Medical Society, publisher of the New England Journal of Medicine.
“No matter which area of the healthcare industry you come from, we’re all grappling with how to serve not only the physical needs of our patients, but their mental, social, spiritual and behavioral needs,” said Jeff Balser, MD, PhD, VUMC’s President and CEO and Dean of Vanderbilt University School of Medicine (VUSM), who welcomed audience members to the event.
In her opening talk, Amy Compton-Phillips, MD, executive vice president and chief clinical officer for Providence St. Joseph Health, spelled out the urgency of the problem: suicide is now the second leading cause of death among adolescents. Drug overdoses killed nearly 64,000 Americans in 2016, up 21 percent from 2015.
Poverty, unemployment, lack of affordable housing, poor nutrition and adverse childhood events, notably abuse and neglect, all contribute to what Compton-Phillips called our “national trauma.”
Yet the healthcare system tends to focus on physical illness. “We need to change the conversation,” said Tyler Norris, MDiv, chief executive of Well Being Trust, a foundation that promotes innovative solutions for mental, social and community health.
“Why don’t we do what we know we need to do?” asked Rebecca Onie, JD, CEO of Health Leads, which helps healthcare organizations connect patients with the community-based, social-needs resources they need to be healthy.
Across the country, that work is already underway.
Russell Rothman, MD, MPP, Vice President for Population Health Research at VUMC and director of the Vanderbilt Center for Health Services Research, described his involvement in efforts to engage ambulatory practices and clinicians across the country in quality improvement and comparative effectiveness research.
To be effective, Rothman said, physicians and other healthcare providers must speak to their patients “in plain language.” They must understand and address social and environmental circumstances that may make it difficult for their patients to follow doctors’ orders and make the lifestyle changes they need to be healthy.
To achieve change, healthcare providers also must be “embedded in the community,” and work closely with community-based services, added Consuelo Wilkins, MD, MSCI, executive director of the Meharry-Vanderbilt Alliance, a strategic partnership between VUMC and Meharry Medical College, and an expert on community engagement.
“I’m not asking you to save the world,” Wilkins said in response to a question from the audience. “I’m asking you to think about what the person in front of you needs.”
Failure to treat the whole patient has serious economic consequences, said R. Corey Waller, MD, senior medical director for education and policy at the National Center for Complex Health and Social Needs.
Five percent of patients consume 50 percent of this country’s healthcare dollars, he asserted. These are the patients with addiction, mental health problems or who are suffering from the long-term effects of early childhood trauma and who end up repeatedly in the emergency room, in jail or on the street, he said.
What’s needed, said Jürgen Unützer, MD, MPH, founder of the AIMS Center (Advancing Integrated Mental Health Solutions) at the University of Washington and an alumnus of Vanderbilt University School of Medicine, is a renewed emphasis on addiction medicine and interdisciplinary, collaborative care in medical and health professional schools.
“This is not a simple change in healthcare,” Unützer said. “We’re asking for pretty complex change.”
And yet, concluded Compton-Phillips, “it really is up to us to change the system. We owe it to our patients, families, communities and nation.”