An Interdisciplinary Approach to Improve Care Transitions Through Standardized SDOH Assessment

Abstract

Veterans diagnosed with serious mental illness (SMI) are faced with many dynamics and challenges of functionality within our communities. Veterans with SMI struggle to be “normal and fit in” within the societal definition of normalcy. SMI veterans are disadvantaged with coping mechanisms of daily life, yet strive to function, socialize and adapt within their communities, families, and relationships. More often, barriers to their functionality exist due to non-adherence and disengagement with treatment (Breslau et al., 2018). It is imperative that the inpatient psychiatric treatment team provide effective approaches with care transitioning as veterans discharge back to their perspective communities.