Growing national research on the social determinants of health reported that access to quality health care contributes only 20% to an individual’s overall health and well-being, while social risk factors, behaviors, and physical environment contribute 80%. Critical social risk factors that influence an individual’s overall health include: 

• Food insecurity, housing insecurity

• Lack of transportation

• Access to educational, economic, and job opportunities,

• Legal or justice system involvement

• Social isolation

The individuals Roya serve often have low to no income, stigmatization, isolation, and lack of connections to community resources. Persons with serious mental illness (SMI) experience a cascade of environmental and socioeconomic factors that place the group at significantly elevated risk. In fact, the NASMHPD report suggests that the diagnosis and experience of serious mental illness itself is a key driver of excess disease and death. Druss (2002), Chassin (1998) and others noted that the clustering of economic risk, lower quality housing, lack of access to quality food, and a variety of person, provider and health care system factors result in lower access to care and inferior quality and poorer healthcare outcomes for the population of persons with SMI, particularly those who are homeless.

Roya Health recognizes that social/environmental factors play a critical role in recovery and welcomes the emphasis on social determinants of health (SDOH). The conditions in the environments in which people live, learn, work, play, worship, and age affect a wide range of health, functioning, and quality-of-life outcomes and risks. In addition to the more material attributes of the place where people live, the patterns of social engagement, sense of security, and well-being are also affected by where people live. Roya Health uses a version adapted from the Center for Medicare and Medicaid Services SDOH Tool to identify and improve the social and physical environments that promote good health for everyone we serve. Roya Health completes the SDOH assessment on every individual we serve. We know that a substantial number of individuals have housing stability issues, including homelessness, trauma issues, loneliness, employment, and food insecurity. Knowing this information allows us to target the services and supports to address these primary needs. To address these needs, Roya Health employs professionals who serve as Housing Specialists, Employment Specialists, and Psychosocial Rehabilitation Day program managers.   

Social determinants also impact overall physical health. In a Robert Wood Johnson survey of over 1000 Primary Care Physicians, four out of five (85%) said that unmet social needs directly lead to worse health for all Americans. The same percentage of physicians indicated that patients’ social needs are essential to address as their medical conditions. This is especially true for physicians (95%) serving patients in low-income, urban communities who reported that necessary social supports are often lacking for the individuals they treat.

Colten and Druss, 2006 identified that individuals with mental health issues have a significantly higher risk of co-occurring chronic physical health disorders (Colten and Druss, 2006). In Arizona, the study reported that individuals with a serious mental illness have a life span between 25-30 years shorter than average. The American Journal of Public Health (2010) reported that the best opportunities to promote lifestyle changes are through the inclusion of health and wellness programs in physical healthcare. Roya Health enhances community clinics to provide integrated care by hiring Primary Care Providers, Medical Assistants, and Health and Wellness Coaches to address this issue.