Self-direction and the Social Determinants of Health
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BRIEF REPORT
Self‑direction and the Social Determinants of Health Bevin Croft1 Received: 12 December 2018 / Accepted: 26 February 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Social determinants of health—defined by the World Health Organization as “the social factors and physical conditions of the environment in which people are born, live, learn, play, work, and age”—are increasingly discussed as having relevance in community mental health service systems. This brief report describes how self-direction—an approach in which people with serious mental health conditions choose the services and supports that work best for them to support their recovery—is a tool that may directly and uniquely promote the social determinants of health by expanding the bounds of traditional service delivery to address the needs of the whole person. Keywords Social determinants of health · Self-direction · Self-directed care Social determinants of health are “the social factors and physical conditions of the environment in which people are born, live, learn, play, work, and age” (World Health Organization Commission on Social Determinants of Health 2008). Self-direction—an approach in which people with serious mental health conditions choose the services and supports that work best for them to support their recovery—is a tool that can directly and uniquely promote the social determinants of health by expanding the bounds of traditional service delivery to address the needs of the whole person.
The Salience of Social Determinants of Health A growing body of literature documents the importance of social determinants of health (Bachrach et al. 2014; Olshansky et al. 2012; Wilkinson and Pickett 2006) and mental health (Allen et al. 2014; Sederer 2016), pointing to a complex relationship between the health of communities and of individuals. Roughly 10–20% of health determinants derive from medical care, while social, behavioral, and environmental factors account for the remaining 80% to 90% of health outcomes. Although research on the social * Bevin Croft [email protected] 1
Human Services Research Institute, 2336 Massachusetts Avenue, Cambridge, MA 02140, USA
determinants of mental health is less extensive, studies have established strong relationships between mental health and income inequality, adverse early life experiences, food insecurity, and discrimination based on race and ethnicity (Shim and Compton 2018). The research confirms what is, to many of us, self-evident: mental health is inextricably related to physical wellness, housing stability, educational attainment, connection to community, and socioeconomic status. Evidence suggesting the critical importance of social determinants of health has resulted in their prioritization by key federal agencies through initiatives such as Healthy People 2020 and major foundations like the Robert Wood Johnson Foundation. A focus on social determinants of health is consistent with the conclusions from seminal reports released at the federal level
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