Experiences of Social Risk Screening in the Safety-Net Among Patients with Mental Health Needs

Social risk screening is a significant expansion of clinical care that raises a complexity of challenges for healthcare providers and patients alike.

To understand the experience of responding to social risk screens among patients with mental health needs, how they prioritize health-related social needs when seeking care, and the impact of social risk screening on the patient-health system relationship.

Qualitative study; one-on-one key informant interviews.

Primary care patients at an academic urban safety-net hospital in Boston, MA.

Primary data were collected via qualitative interviews with patients who presented at primary care with a mental health concern (e.g., depression, anxiety) in the past 1-3 months and completed a social risk screening from December 2020 to August 2021. Interviews were held via Zoom in English, audio-recorded and transcribed. Interviews focused on patients' experience of being screened for social risks and needs, their conceptualizations of social risk domains (e.g., housing, food, transportation, etc.), and the importance of these needs relative to medical care access. A deductive analysis using the Information-Motivation-Behavioral Skills model was applied to identify themes.

A total of 148 individuals were approached with 30 participating in semi-structured interviews (20.3% recruitment rate): 19 (63%) participants self-identified as female and 14 (47%) as Black/African American. Data revealed that asking patients about their social needs further emphasizes their already vulnerable position when seeking medical care, particularly when addressing mental health concerns. Patients stated that they were reluctant to disclose future health-related social needs when prior reported needs were not supported or addressed.

When patients reported prior instances of sharing health-related social needs where those needs went unaddressed, instances of "double loss" occurred, leading to potential distrust in the medical system. It is important that health systems implement effective referral processes and have adequate resources to address patient disclosed needs, especially for at-risk patient populations.