A part of New York State’s strength lies in its diversity, which provides us with the wisdom of many different cultures from which we can all learn. But diversity is often accompanied by inexcusable inequity, as residents of some communities are exposed greater risk of health problems.
The COVID-19 pandemic has made this starkly clear. The pandemic has hit our African American, Latino, Native American, and Asian-American communities especially hard. All saw higher infection, hospitalization, and death rates than white communities. Why is this? There are several factors, related to inequities in living conditions and access to health care – including mental health.
Researchers have been studying these factors and have called them the “social determinants” of health and mental health. These determinants include work and school conditions, employment opportunities, housing quality, physical environment, family and social supports. All of these environmental factors play a role in shaping an individual’s mental health.
New York State understands the urgency to address these inequities. A new report from OMH, The Social Determinants of Mental Health: A White Paper Detailing Promising Practices and Opportunities at the New York State Office of Mental Health, describes these inequities in detail and offers opportunities for solutions. The paper was written by Merrill Rotter, MD, Senior Forensic Advisor to the Commissioner of OMH, and Michael T. Compton, MD, MPH, Research Psychiatrist at the New York State Psychiatric Institute.
The researchers explain that these determinants are not only are risk factors for behavioral disorders, but also consequences of them. For example, the stress that a family feels when they’re at risk for losing their home, called “housing instability,” can affect their clinical condition, including behaviors that could jeopardize any future opportunities for good, affordable housing. We’ve seen that, at OMH, many of the people who’ve come under our care are in such situations and are from groups that have significantly greater exposure to adverse social determinants – such as people experiencing discrimination, trauma, poverty, insufficient access to health care, criminal/legal contact, and insecure housing.
An Agenda for Action
This work studying social determinants has, in recent years caught the attention of government, health care providers, insurers, and community headers – driven by fiscal, clinical, and public health priorities, as well as considerations of health equity and social justice.
OMH has been contributing to these efforts in several ways, as exemplified by participation in the development of the current cycle of the New York State Prevention Agenda, which includes multiple themes pertaining to the social determinants. Many of OMH’s efforts have come about as part of the its routine activities and areas of commitment. For example, state-operated facilities attend to a number of social needs, due to the extent of social disadvantage among clients served, rather than from a distinct initiative founded upon addressing social determinants and eliminating inequities.
Given the critical and increasingly recognized importance of the social determinants of health, OMH in August 2018 established a Social Determinants of Mental Health (SDMH) Workgroup to help define a social determinants agenda and coordinate with other agencies. Specific bureaus and related initiatives have been instituted at the New York State Department of Health (DOH) and the New York City Department of Health and Mental Hygiene (DOHMH).
The White Paper – a product of the SDMH Workgroup – outlines the spheres of influence of OMH as a means of framing thinking and an even more intentional approach to addressing the social determinants. It describes current social determinant-related activities, new initiatives, and potential opportunities within each of those spheres, as OMH continues to increase its contribution to this critical approach to clinical care and social justice:
- Policymaking – Setting policy both within the agency and in conjunction with other state agencies and the state legislature.
- Data collection and analysis – Collecting data from a variety of reporting sources, with dedicated staff to provide sophisticated analysis and visualization of results.
- Research – Our two research centers, the New York State Psychiatric Institute and the Nathan S. Kline Institute for Psychiatric Research, have and will continue to focus on SDMH with the goal of improving health outcomes for all New Yorkers.
- Training – Educating the state workforce through variety of venues and platforms, including professional conferences, on-line state-wide grand rounds, the OMH-supported Center for Practice Innovations, trainings developed in collaboration with community-based agencies, and the mandated modules on the State’s learning management system.
- Informal influence – Using OMH’s “bully pulpit” to endorse, encourage and commend activities that support addressing the social determinants at both the societal/structural and individual client levels.
- Regulation and licensing – Overseeing and surveying of thousands of inpatient, outpatient, and residential programs across the state.
- State operations – Operating a vast array of inpatient, outpatient, and residential services.
Reducing Disparities in Behavioral Health Caused by Discrimination
Social determinants don’t exist in a vacuum and they can’t be remedied without addressing discrimination itself.
We all have implicit biases that affect the way we think and act. These, in turn, can affect an organization’s policies and practices. OMH’s efforts are grounded in the belief that self-reflection is key to creating and sustaining long-term change. OMH is working toward this change by supporting leaders in the mental health system, both internally and externally, to examine personal, historical and institutional biases and how they affect the delivery of mental health services in our communities.
We’re also working to examine agency policies and practices that contribute to structural racism.
OMH’s Office of Diversity and Inclusion provides written resources, educational opportunities, and individualized consulting on implementing strategies to reduce disparities in access, quality, and treatment outcomes in marginalized populations for OMH state-operated, licensed and funded programs. The office coordinates data-driven policy change at the agency to ensure system improvement for New York’s most-vulnerable citizens and marginalized population groups, such as people of color, members of the LBGTQ community, older adults, rural New Yorkers, veterans, and immigrants.
Since 2007, OMH has overseen two Centers of Excellence for Culturally Competent Mental Health. These Centers identify and disseminate best practices for behaviors, policies, and structures to support the delivery of culturally competent care. The Nathan Kline Institute for Psychiatric Research and New York State Psychiatric Institute house the centers and conduct research that focuses on disparities in service delivery for marginalized and minority populations.
Since 1989 OMH has made use of the valuable input of the Statewide Multicultural Advisory Committee, a 25-member advisory committee whose membership includes consumers of mental health services, experts in the field, policy makers, and researchers. Members advise the Commissioner and OMH on policy, programs, procedures, and activities addressing disparities in access, quality, and outcomes for members of historically underserved, disadvantaged, and marginalized populations.
The Black Youth Suicide Prevention Workgroup is an extension of the work of OMH’s Suicide Prevention Office and the Suicide Prevention Center of New York and grounded in Governor Andrew Cuomo’s 2019 Suicide Prevention Task Force report. This workgroup is a coming-together of government, academia, faith leaders, family members, and people with lived experience. Their shared the goal is identifying and supporting the implementation of public-health approaches to lowering rates of suicide for Black youth in New York State.
The Coordinated Disparities Research Workgroup, which convenes research and data collection efforts internal and external to OMH, is charged with ensuring the agency is creating actionable intelligence to drive improved access, quality, and treatment outcomes for special populations. A secondary goal is applying research findings to influence policy and program changes in New York’s mental health system.
Overcoming Communication Barriers – OMH works diligently to ensure individuals and families with language access needs obtain quality mental health services and supports. OMH employs a centralized approach to supporting these efforts; a Statewide Language Access Coordinator works closely with facility- based Language Access Coordinators.
Comprehensive Workforce Diversity and Inclusion Strategy. The Office of Diversity and Inclusion works systematically across OMH facilities and offices to support the unique challenges faced by OMH employees from historically marginalized groups. This support includes the facilitation of staff and leadership dialogues on race, discrimination, and ways OMH can continue to provide a great work environment for all employees. It also includes the provision of training and technical assistance developed specifically to support supervisors and leadership in addressing race and discrimination in the workplace.
Researchers Have Grouped Sixteen Categories of Social Determinants of Mental Health Into Four Broad Areas
1) Highly Detrimental U.S. Societal Problems
- Adverse childhood experiences
- Discrimination or social exclusion
- Exposure to violence
- Criminal justice involvement
2) Immediate and Global Physical Environment
- Adverse built environment
- Neighborhood disorder
- Global climate change impact
3) Socioeconomic Status and Opportunities for Accruing Wealth
- Low educational attainment
- Unemployment or job insecurity
- Poverty and income inequality
- Neighborhood poverty
4) Basic Needs of Housing, Food, Transportation, and Health Care
- Housing instability
- Food insecurity
- Poor access to transportation
- Poor access to health care
The mission of OMH is to promote the mental health of all New Yorkers. Identifying and analyzing the social determinants of mental health gives us the potential to better understand their impact and reduce the risk of the disorders that are associated with social inequities.
If you’d like to know more, our White Paper is available at the OMH Institute for Program and Policy Innovation website: https://omh.ny.gov/omhweb/omh-institute/sdmh-white-paper.pdf. For more information on OMH’s efforts to combat racism and eliminate disparities in access, quality, and treatment outcomes contact Matthew Canuteson, OMH’s Diversity and Inclusion Officer, at Matthew.Canuteson@ omh.ny.gov.