Infrastructure, Incentive, and Intention
Synergy in interventions targeting social determinants of mental health
June 25, 2021

Social determinants are comprised of a number of influences and environmental impacts that, when unaddressed, contribute to negative mental and physical health outcomes.

WHO flow chart for multilevel framework of social determinants

In the third and final part of this three part series on social determinants and mental health, we analyze the cross-sectional interventions that can be used to help mitigate these social stressors and ultimately create better mental health outcomes.

Wider Society: The impact of community on mental health outcomes

The World Health Organization highlights the relationship between mental health and social determinants, advising against universal approaches to strengthening mental health and recommending instead interventions "calibrated proportionately to the level of disadvantage." To be most effective, these interventions should work across communities to bring together not only members of the medical and digital health neighborhood, but the larger community as well.

Basic Needs Mental Health and Development Program in Ghana, Photo from BasicNeeds US.

In early civilization, synergies within the community had to be present in order to survive. This included working together for child rearing, cooking, hunting, etc. While our needs have evolved over time, the human need for community and connection remains the same. Meeting this need can become difficult as one’s environment can become hostile within itself or from outside sources, including humanitarian crises and economic despair, which results in an increase in mental health issues. 

“Synergies between interventions: information about how mental health and its social distribution are influenced by interventions to improve aspects of the local educational services, health-care services, built environment, natural environment, transport, income generating opportunities, and community development.”
- World Health Organization

The Basic Needs Mental Health and Development Program in Ghana was created to facilitate access to psychological resources and services with a basis in community enrichment and helping the participants become active and respected members in their communities. The program included support for things like medical care, temporal needs such as food and shelter, and financial credits for individuals with mental health conditions as they participated in this new program.

As a result, individuals who participated in these support groups saw an increase in community engagement and engagement in care resources and treatment programs that were critical to improving their health.

Similarly, supporting our communities and individuals who have mental and behavioral health conditions requires a willingness to:

1. Address the social determinants that are currently impacting their mental health

2. Provide a community-based approach that enlists the support of both family and friends, as well as health care member support teams, to help individuals keep to their care plans

3. Offer incentives that empower individuals to provide for their temporal needs and motivate them to keep going (especially on the bad/hard days!)

Addressing stigmas and mental health in the LGBTQIA Community

Social determinants expand beyond the traditionally thought-of temporal needs—such as food insecurity or homelessness—and can include discrimination faced based on sexual orientation or gender identity.

In celebration of Pride month and our LGBTQIA members, we want to highlight some of the principles our members have shared about supporting other LGBTQIA communities in the healthcare space.

The role of and need for empathy in LGBTQIA mental health

LGBTQIA communities have significantly higher rates of mental health conditions, with 60 percent experiencing mild depression or anxiety and 13 percent having severe diagnosed mental health conditions. Compared to non-LGBTQIA individuals, 12 percent and 4 percent respectively, it's clear that supporting members in LGBTQIA communities requires compassion and an accounting for existing stigmas that make getting appropriate care even more difficult.

67 percent of respondents in a survey conducted by the Human Rights Campaign said they had heard a family member make anti-LGBTQIA statements. This rejection from family can be a key trigger to the presence of mental disorders (as discussed in part two), and should be screened for as part of routine medical care.

Wellth recognizes the stigma the LGBTQ community faces when seeking medical care, and works to meet members where they are, as who they are, and offer support through incentives that can act as a safety net for key needs, an app designed to encourage, motivate, and build, and member support teams that are there to check in when an individual has not been adhering to care plans and encourage them to improve.

Improving adherence in patients with HIV

AIDS Memorial Quilt at the National Mall in Washington DC

While medical advances have made living a long and full life possible while living with HIV, the high mortality rate of HIV and AIDS before such advances cause the stigma behind HIV/AIDS to continue long after a treatment was found. Stigmas like this, while not always tied to an economic background or sexual orientation can be detrimental to an individual's ability to get, and stay on, treatment.

As a result, the average overall adherence of HIV medication is 50 percent. Because high adherence is critical to lowering the viral count of HIV positive individuals, low adherence is problematic and dangerous for the individual. Understanding this, why is adherence so difficult?

Many individuals with HIV are stigmatized by being HIV positive and often struggle receiving thoughtful and appropriate healthcare. Some face homelessness and may not be able to afford to consistently refill their prescriptions. 

In 2019, Wellth teamed up with a healthcare provider in New York that serves underserved communities in the Bronx in particular to increase adherence among HIV positive patients. Providing a sponsored smartphone to complete check-ins, as well as a live support team to check in to any individuals who may be struggling with their adherence, Wellth offered financial incentives members could use for essentials they could not otherwise afford.

By offering empathetic assistance and an easy-to-use app with incentives that addressed social determinants, Wellth was able to increase overall adherence to an average of 73% daily adherence.

Systems: Eliminating care disparities in health and wealth

Services in place to help low-income communities are often under-funded or stopped due to budget concerns. Unfortunately, this means many resources are removed without first hearing the voices of the individuals who desperately need those resources. As a result, members end up in a cycle of discrimination, poverty, and mental health conditions. As each phase of the cycle feeds into the others, adequate intervention becomes difficult but necessary, and one of the most impactful components can be reforming healthcare disparities.

Infographic on racial disparities in healthcare from The Undefeated

In order to close the gaps in health and wealth disparities, marginalized communities must be given the resources to invest in their own communities. As mentioned in part 2, incentive-based programs such as Wellth can help people, previously disenfranchised by health plans, re-engage in their health and invest in purchases that are beneficial for their health and ultimately the economy of their neighborhood. The improvements to their physical and mental health through prolonged adherence helps the member sustain stable employment and housing, which builds habits that set the member up for success even after the completion of the program. 

“Before you know it, now the program is over and I still get up every morning and I put my pills in the same spot and now it’s a habit because I did it for 6 months. You put them in the same spot so that way I can take a picture of them every morning to make my money, and now it’s just a way of life and I’ve been good for almost a year now and I love it...Not only the money, it’s another tool in my toolkit.”
-Feedback from a Wellth Member 

Wellth believes in and fights for health equity by operating with empathy and always remembering that we are here to help people, not just their condition. 

Macro-Level Context

Wellth employee helping a Wellth Member with their app

"Rome wasn’t built in a day,” and neither is societal and healthcare reform.

Making the changes necessary in improving mental health outcomes requires a synergy of efforts from all different sectors. From community support, legislation, social justice, education, and healthcare, no one component can act on it’s own to fix the large-scale issues, but programs that target and change behavior have a high success rate in initiating change in the trajectory of these cycles. 

There is no one size fits all solution for these issues, and the same applies when we engage with the members at Wellth and how they strive to “meet members where they’re at.” But there is one principle that does work across the board: true change starts with everyday actions and a long term commitment to health and community.