Documenting the Social Determinants of Mental Health in clinical care: practices, potentials, progressions

Abstract

With growing recognition of the importance of social, economic, and physical environments, there has been increased psychological and psychiatric interest in the Social Determinants of Mental Health. There is ongoing debate regarding the best ways to address factors such as unemployment and loneliness in clinical practice. Something which could have a positive impact on this endeavour is if health care service providers documented social contextual factors of all service users to inform treatment, aetiological models, and policy making. Yet, it is currently unknown whether documentation of Social Determinants of Mental Health occurs in routine practice and if it might affect clinical practice. This PhD therefore examined the documentation of Social Determinants of Mental Health in clinical practice as a way of contributing to more holistic care. Chapter 1 outlines the construct of Social Determinants of Mental Health and explores the potential impact that recording this information might have on clinical practice; identifies gaps in the literature, and presents the research aims of this PhD. Chapter 2 discusses the methodologies employed across the studies and explicates the epistemological foundations of the whole research program. Chapters 3-8 embody the five doctoral studies and two correspondences of this PhD. All studies are interlinked and discussed in chapter 9. Initially, study 1, a scoping review identified how the Social Determinants of Mental Health are conceptualised in the literature, especially in relation to the Social Determinants of (physical) Health. Secondly, practices of documenting social contextual information were examined. Study 2 analysed historical English mental health care records, revealing a progressive erosion of social contextual information. Study 3 investigated current routinely collected data in one NHS Trust, demonstrating that opportunities are underused to document social determinants within medical nomenclature. Thirdly, study 4 tested the potential effects of providing service users’ social contextual information on clinical practice; 140 mental health care service providers were recruited primarily through 32 NHS Trusts for this experimental vignette study. Providing clinicians with additional social contextual information about service users did not significantly impact on referral recommendations, prognoses, or generalised attitudes towards mental health care users, but did lead to more person-centred doctor-patient communication. Finally, progressions in the documentation of social contextual information were explored. Study 5 reports the development and content validation of a questionnaire to assess the Social Determinants of Mental Health in clinical practice. Recommendations for potential changes to medical record keeping are outlined in two published correspondences to The Lancet Psychiatry, chapter 8.

Date of Award	31 Dec 2023
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Yvonne Awenat (Supervisor) & Sara Tai (Supervisor)