Researchers Call for Integration of Social Risk Factors in Mental Health Care

An understanding of the importance of social risk factors in mental health outcomes has professionals calling for better models and integrated treatments.


A recent editorial in JAMA Psychiatry advocates for a better understanding and integration of social risk factors in clinical settings. The researchers highlight social risk factors, such as poverty, housing instability, and food security, as major drivers for mental health outcomes and call for new funding models and for changing education to better support individuals seeking care.

“Research in the field has underscored that these risk factors play a key role in the development, severity, and chronicity of mental illness and substance use disorders, in part because they make engagement with evidence-based interventions for mental illness more difficult and living with mental illness more challenging,” write the authors, led by Laura Shields-Zeeman from the University of California, San Francisco. “A more pressing question than whether social risk factors affect health is what health care professionals can do about them.”

Social risk factors have been linked to higher hospital readmissions, psychosis, ‘schizophrenia,’ mania.  Shields-Zeeman and colleagues argue that social risk factors also shape health and health behaviors globally.

“The association of social risk factors with health can be direct (e.g., lead ingestion in substandard housing leads to poorer cognitive functioning) and indirect (e.g., neighborhood exposure to violence in adolescence can increase chronic stress, which contributes to the development of mental illness).”

The article outlines two common approaches to addressing social risk factors in mental health care, social risk-informed care and social risk targeted care. They note that the two approaches aren’t necessarily mutually exclusive, but helpful to consider separately.

Social risk-informed care includes, “tailoring clinical plans to reduce the effect of social or economic adversity without necessarily targeting the social condition itself.” An example of this would be to consider how the side effects of a medication may interact with one’s living situation.

Social risk targeted care involves, “more directly helping patients reduce social or economic adversity.” Such as connecting them to community and government supported programs that can provide stable housing, food security, etc.

Although social risk factors are a well-known influence on health outcomes, the authors suggest that less work has been done to investigate how best to integrate this knowledge into practice: “There is not yet a clear consensus on specific strategies to address either how social risks should be addressed (i.e., how should health care professionals change care based on patients’ social risk factors?) or when (i.e., when should mental health or social risks be prioritized in care delivery?).”

In order to integrate social risk factors into the delivery of care, Shields-Zeeman and colleagues advocate for funding models that allow providers to access the resources and time necessary to design and implement integrated care.

“Enabling the spread of effective social care interventions will require funding models that support integrated care delivery,” they write. “This is especially relevant to social needs–targeted care, in which the workforce must review social risks and facilitate social care resource connections. Yet the delivery of such social services has not traditionally been covered by most payers.”

In addition to new funding models, the authors argue that it is necessary to improve education models that reinforce social care: “Curricula for trainees and practitioners should include how to conduct social risk assessments as well as which social risk–targeted interventions are feasible, effective, and sustainable. This training will also require that mental health professionals understand the multilevel influences of community and political structural determinants in shaping clinical presentation and disease course.”

Shields-Zeeman and colleagues call on the field of psychiatry to “champion social risk-informed and targeted care as potential strategies to improve outcomes.”

“Given an increased global focus on health-associated social risks and protective factors, the time is ripe for the field of psychiatry to retake its place at the forefront of medical and social care integration.”



Shields-Zeeman, L., Lewis, C., & Gottlieb, L. Social and Mental Health Care Integration: The Leading Edge. JAMA Psychiatry. (Link)


  1. “…’tailoring clinical plans to reduce the effect of social or economic adversity *without necessarily targeting the social condition itself*.’ An example of this would be to consider how the side effects of a medication may interact with one’s living situation.”

    Sigh. It sounds like the idea is not to help change people’s life circumstances, but just to find ways to get around those circumstances to continue the same old drug-centered model of “care.”

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    • I can see the pamphlet now: “Learning to Live in Poverty: It Can Be Done With the Right Attitude!”

      Neoliberalism at its finest: let’s not worry about ending poverty, let’s help people deal with how they feel when they have no escape from it.

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  2. More than a sigh with this small gleaming.
    Back in the day, professional folks were supposed to work as a team and in the margins oh my the so called patient was suppose to be part of the team. Nothing nothing new here just confirmation of the amensia the last thirty to forty years.
    In teaching hospitals the med students and or residents come from or act as if they come from privileged backgrounds.
    Many have no concept of the feel and look and smell and sound of poverty.
    In my area the RC nuns tried to go into the urban areas to live and many, many could not handle the experience. Catholic Worker and other social justice/ spiritual folks could but again time limited and NOT intergenerational.
    And female health and narratives? Trans and gender? Now not there st all in biopsychistry though my place of work did have a gender transition program and psych was supportive. Things were starting to bubble up and biomarkets and better living through chemistry became an almost only option. Thank you DuPont, Monsanto, and all the Big Pharma national and international for profit big pockets only for me and my family decades of hard hard work. All those emails!
    If one looks at history , actually dance therapy and body movement work developed by guess what females totally squashed. Check out Trudy Schoop and her dance cohorts.
    These folks are just playing the game to look good and trying to gage the current and future times for ONLY their benefit.
    What I want, need and sometimes literally crave is a formal recognition of damage done, formal far reaching apology, and some kind of restorative justice for all of us harmed.
    Again IDK like the church and other institutions outside tribunal may be the only way to achieve any type of concrete change or reformation.
    Humans will always need support but this at least for me not support just horror though the kids in the s
    detention camps have it worse.And nothing is happening in terms of getting The Hague or UN involved.
    It seems we are frozen in any ability not only to speak truth to power but to have all these acts of abuse and torture stopped. There is some talk here and there but too much infighting, too much legitimate and no legitimate fear, and too many zombies in our midsts.

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  3. Since when does food and housing were listed as ‘social risk factor?’ Give me a break. These are primary needs. You can bet your bottom dollar that people who display unusual behavior such as PTSD from past psychiatric abuse or harm, they will get discriminated against. If their medical records follow them, they cannot get on ‘regular’ low income housing lists like those operated by HUD. They must wait for ‘special’ housing for the ‘mentally ill’. Workers at food banks and overnight shelters are not trained to handle behavior that is typically labeled as ‘psychotic’ such as hearing voices or loudly talking to oneself. Lack of training and empathy in dealing with people who experience the world differently results in fear, escalation and aggression. This article is asking for hospital staff to be educated on how to make referrals that will reduce people’s ‘social risk factors’ but the medical model is the bully in the room that makes it so easy for workers in the poverty services community to disengage with their psychiatrically labeled clients, bouncing them back to the mental health system/jail system by calling 911 to quickly deal with unusual behavior that can so easily be prevented from escalating.

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    • I agree, PacificDawn, that’s really what needs to happen. As should have happened with all the psychiatrists after the Bolshevik and Nazi psychiatric holocausts. Especially given that America, and all of Western civilization, is living through another, modern day, psychiatric holocaust today. The truth about which is being suppressed on the internet, and of course is not discussed at all in the mainstream media.

      “exposure to violence in adolescence can increase chronic stress, which contributes to the development of mental illness.” Sounds logical. However, how do we know that the reason “the prevalence of childhood trauma exposure within borderline personality disorder patients has been evidenced to be as high as 92% (Yen et al., 2002). Within individuals diagnosed with psychotic or affective disorders, it reaches 82% (Larsson et al., 2012).” Is not due to the fact that our “mental health” workers can NOT bill ANY insurance company for EVER helping ANY child abuse survivor EVER, resulting in systemic and massive in scale misdiagnoses of child abuse survivors?

      I know, by keeping my child away from insane “mental health” workers – who thought the way to help a child abuse survivor was to neurotoxin poison him – that my child went from remedial reading, right after being abused, to graduating from university with highest honors, Phi Beta Kappa, including winning a psychology award. So I know, child abuse does not always contribute “to the development of mental illness.” What’s your proof that ACEs always “contributes to the development of mental illness?”

      Especially since you forgot to mention that all these so called “mental illnesses” were declared “invalid,” “unreliable,” and “BS,” by the editors of the DSM, and the head of the National Institute of Mental Health, in 2013.

      A question, is a website that publishes psychiatric propaganda that concludes “the time is ripe for the field of psychiatry to retake its place at the forefront of medical and social care integration,” likely a website taken over by psychiatry?

      Personally, I believe “the time is ripe for the field of psychiatry to” be abolished – too many holocausts, too much abuse of power, too delusions of grandeur filled, too many murders of innocents, too little truth and reconciliation, psychiatry.

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  4. So Pacific Dawn does your statement mean or include me?
    I am a former practioner but have lived psych survivorship?
    Again like in Nazi Germany, Apartheid South Africa, Vichy France, the American Jim Crow South and past and present, and those who worked with First Nation peoples bad bad and more bad but there were some who tried to help who if nothing else recognized the wtf aspect of these and other systems.
    And if you did try things fall apart despite one’s best intents.
    So have your anger but see it as a fabric of sky on a cloudy night with a passing light or two.
    Fabric can be used or ripped apart shredded or painted on- up to you.
    I really like your thinking and knowledge base. What would Andrea Dworkin do or say? She admitted she loved the writing of the old white men sexist and whatever else they were.
    Coming from her timeframe we had no other choice but to learn and if awake try to expolate from that KNOWING old white guys are in our mindset forever.
    Think on this please.
    Mad mom- right on target in many ways- see above words.
    You need to be on a Board with your knowledge and passion.

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  5. Well we certainly don’t want to in any way propagate the mental health system, and this is the problem with the original article.

    The leaders and Militia of Vichy France were penalized, like around 10,000 executions. Rarely does anything like this happen. But if it did not happen, things would be the same today as back then.

    Andrea Dworkin was someone whom I mostly did not agree with, though I do support feminism, just not her kind. I agree with Simone de Beauvoir, whom I find to be more radical.

    There is no fabric in this which we can use for anything, except for recycled fiber for making paper.

    The middle-class family makes babies so that they can be broken and so that the parents don’t have to feel their own pain. They end up in mental health, and our government licenses the practitioners. Those in private practice do not seem to understand mandatory reporting. But then if they did adhere to it, they would have no business.

    People who are not happy campers are told that they have something less than mental health, and now on this forum we are hearing advocacy for MDMA and for Ethanol.

    Its going to take a revolution. But this starts with just a few people who will offer no cooperation to the mental health and recovery systems, and who also will feel their feelings though deliberate effort and by staying drug free.

    I am calling for the delicensing of psychiatrists and psychotherapists, and for getting our government out of the recovery and salvation industries.

    Mandatory reporting should be strengthened so that any time a child is sent to any behavioral or psychological therapy, there must be court supervision. Likely this will result in Well Being Checks, as well as court appearances.

    We should revise our inheritance laws, so that like in most all other industrialized countries, you cannot designate a child the scapegoat and then disinherit them. The parents are responsible in all situations. If there is animosity between parent and child, that is evidence of some deeper conflict and so the parents must be held accountable earlier.

    Our government must not be authorizing studies telling people that they need psychedelics for “healing”.

    Those who have been giving mood altering drugs to minor children should be prosecuted for Crimes Against Humanity in the International Court. US Law and Just Following Orders will offer them no protection. Penalties have usually started at 20 years, though they can be much higher.

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