TL;DR: We can’t fix systemic health issues by siloing mental health. Social determinants like housing and income impact physical health and mental well-being. Addressing both simultaneously is the key to sustainable systems and smarter spending.

A Missing Piece in the SDOH Puzzle
Over the past decade, healthcare and public policy leaders have increased their focus on Social Determinants of Health (SDOH), those non-medical factors like housing, education, income, and social support that inevitably shape a person’s health outcomes. These conditions are now widely acknowledged as foundational to physical health. What remains much less integrated into mainstream care models, however, is how these same social conditions deeply affect mental health. Without addressing that reality, we’re really only solving half the problem.

We often treat physical health symptoms triggered by SDOH stressors while overlooking the emotional toll. The truth is, individuals experiencing housing instability, food insecurity, or unemployment rarely speak about their physical challenges without also naming the psychological burden they carry. Anxiety, depression, trauma responses, hopelessness. These aren’t side effects. They’re central to the experience. Ignoring them leads to incomplete care and missed opportunities for life-long health transformation.

The Interplay Between Social Circumstances and Mental Health
The relationship between SDOH and mental health is not linear, it’s cyclical. People facing unstable housing or financial hardship often experience chronic stress, which elevates the risk of depression, anxiety, and other mental health challenges. Those psychological conditions then create further barriers to navigating systems designed to help.

When someone is fighting to survive, their emotional regulation, decision-making capacity, and ability to follow through with treatment or life planning are often deeply impaired. Even when physical needs are met, like securing housing or stabilizing income, the psychological effects don’t magically disappear. Prolonged exposure to adversity ultimately leads to patterns of hypervigilance, withdrawal, burnout, and maladaptive coping. These require retooling: learning or relearning how to regulate emotions, rebuild trust with others and oneself, and engage with support in a sustainable way.

This isn’t just a mental health issue. It’s a systems issue. Ignoring the psychological consequences of social conditions means pouring resources into downstream care without addressing the root. The same thing we’ve been saying about SDOH in relation to health care for over a decade.

The Economic Case for Integration

If the moral case for integrating mental health into SDOH strategies isn’t convincing enough, the financial case is impossible to ignore.

A 2024 report from Deloitte and the Meharry School of Global Health estimates that mental health inequities will cost the U.S. over $477 billion in avoidable expenses this year alone, with that number projected to reach $14 trillion annually by 2040 if left unaddressed. These costs include medical claims associated with preventable physical health conditions (like diabetes and hypertension), increased emergency department visits, productivity losses, and higher mortality rates.

Underscoring that study, research published in JAMA Network Open this year found that for every $100 invested in enhanced behavioral health services, employers and healthcare systems saw a $190 reduction in overall medical claims. The return on investment is not hypothetical, it’s measurable, and it’s already happening in systems that commit to integrated models.

What Integration Looks Like
To maximize the impact of SDOH programs, mental health care must be embedded, not tacked on as an afterthought. Here’s what that can look like:

• Screen for depression, anxiety, and trauma during social needs assessments.
• Co-locate counseling or therapy services with programs offering housing assistance, workforce training, or transportation support.
• Train outreach and case management staff to recognize signs of emotional distress and connect individuals to support early.
• Include mental health professionals in the planning and execution of SDOH strategies at every level.

It’s not about making systems more complicated, it’s about making them more efficient, more profitable, and more human. A coordinated, cross-disciplinary approach ensures that when we support someone’s external conditions, we’re also supporting their internal capacity to heal, grow, and move forward.

Real Health Equity Demands Mental Health Integration
We can’t continue to treat mental health as separate from physical and social well-being. These domains are inextricably linked, and failing to acknowledge their interplay leads to fragmented care, preventable crises, and unsustainable costs.

By incorporating mental health support into every level of SDOH planning, we move closer to systems that actually work for individuals, communities, and the economy.

This isn’t just the compassionate thing to do. It’s the strategic thing to do. Addressing mental health as part of whole-person, socially informed care is the path forward for resilient communities and smarter public health.