Considering Social Determinants of Health: A Case for the Just Treatment of Vulnerable Adolescent Mental Health Inpatients

Abstract

The goal of this paper is to consider the case of a vulnerable adolescent inpatient who received the standard of care, and then to propose a harm reduction approach that reflects the patient's lived-reality and better fulfills the ethics of care. For certain vulner- able adolescent mental health inpatients, the idealized treatment they receive in hospital does not align with their lived-reality upon discharge. These adolescents experience unfavorable social determinants of health (SDH). They may live in families who experience poverty, trauma, unmanaged mental illness, and lack the capacity to navigate the healthcare system. The difference between the supports these adolescents receive as inpatients and those familiar to them before admission can negatively impact their ability to get and stay well upon return to their communities. As inpatients, interdisciplinary teams can provide medication management, therapy, emotional support, proper nutrition, education, recreation, and a daily routine that promotes sleep hy- giene, positive coping, and safety. These are the evidence-based ingredients that offer the best chance for recovery and management of mental illness in adolescents. If these cannot be sustained in the community, there exists an additional obligation for healthcare providers to act in the role of advocate, to ensure that the best interests of the patient are promoted through a harm reduction ap- proach. This approach entails providing treatment options and follow-up plans that reflect and respect the patients’ lived-realities even when in conflict with standard practices or hospital operating procedures. It is an approach rooted in beneficence, respect for autonomy and justice. The values of respect and compassion for the patient are promoted when healthcare providers broaden their concept of harm reduction to include bridging the gulf between idealized treatment and lived-reality outside of the hospital. Conclusion − A harm reduction approach that considers and responds to the effects of social determinants of health can better fulfill the ethics of care for vulnerable adolescent mental health inpatients.