Social determinants of health (SDOH), as defined by the United States Office of Disease Prevention and Health Promotion, are “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” SDOH like access to safe housing, healthy food, and reliable transportation all not only contribute to living a healthy, quality life, but also can directly impact physical and mental health when they aren’t adequately addressed.

Across the state, community mental health agencies enlist community mental health workers (CHW) to extend their reach. Washtenaw County Community Mental Health partners with Michigan Community Care (MiCC) in providing CHWs. MiCC works in both Washtenaw and Livingston counties, focusing on cross-sector care in order to provide holistic care for each patient. Through working with several organizations, referred patients are able to access not only the health care they require but also work alongside a CHW, who can help navigate complex health care systems, and address other factors in their worlds that may be worsening already existing conditions. MiCC currently utilizes three CHWs in Washtenaw and two in Livingston as part of their care staff. 

Ayse Buyuktur, program manager for MiCC, speaks with MI Mental Health about the extensive work CHWs are doing with Washtenaw County and Livingston County residents.

Q: Can you explain what CHWs are and the roles they play to their communities?

A: In general, CHW roles can differ from place to place. They come from the communities they serve. They often have lived experience with some of the struggles or experiences the community members are seeking help with. They have knowledge of the communities and the resources within them. They build personal connections with the individuals they serve, meet people in the community where they are, and make individuals feel safer and more willing to open about their needs.

Q: How do you feel that building personal connections helps CHWs assist individuals with their health needs and goals?

A: It’s important for a person who needs care to get in the door, see a provider, and get a prescription, but it’s not alway sufficient. The way CHWs work is getting to know the person and understand their goals, and really work with them to meet those goals. If, along the way, they identify other sorts of things that may be feeding into that other need, that’s when that trust and relationship comes up, which grants the ability to  have difficult conversations about those things. It’s a much more holistic approach. 



One role of a CHW is performing home visits with a patient to “meet them where they are,” as Buyuktur explains. These visits go beyond simply helping to make appointments and phone calls, however. CHWs also can analyze what state an individual and their home is in and recommend or find services to assist with things like providing food or furniture, or recommending events in the community to lessen feelings of social isolation. Overall, these home visits help to build relationships with patients that are not always possible in formal health care settings. 

Q: How does having a CHW making a home visit help overcome the stigma of going to a CMH for services?

A: Seeing someone at home, seeing their environment, talking to them at home makes a lot of difference. Sometimes, you need somebody to advocate for you in places where you’re not naturally comfortable. The CHW is looking to address all of the issues. If they’re housing unstable, they’re looking for resources to connect that person with. Child care, elder care, food insecurity, they want to address all of those needs. It’s not just the traditional way we think about providing support, it’s looking at that person and trying to understand what the person’s goals are, and working with them to meet those goals. 

Q: What sets that service apart from more traditional health care services one might receive?

A: They have a very different approach in some ways to providers for example. Because they’re from the same community, it’s a very different kind of advocacy. They’re there doing things a normal provider may not think of. If someone doesn’t have a bed, or lacks other essentials to live the way they want, they go out and try to get that for them. They’re trying to make the person's life better in any way possible in the process of improving their health and wellbeing. It’s very holistic, and specific to that individual. 

CHWs, may note when people are maybe struggling with medications.

Q: Because they are so different from traditional providers, what do you think are ways for CHWs and their work to be more visible?

A: There are a lot of things that we can do as organizations, employers, and community members. Showing appreciation for them is very important. I think it's helpful to have them at community-based organizations, as opposed to medical practices, to have them be embedded in the community. 

Q: Are there changes for CHWs and the way that they are recognized by health care systems?

A: Right now, the state is working out how to pay CHWs who service people on Medicaid. This is really exciting. We’ve been looking forward to this, but there is still a lot of work to be done to make sure CHWs are appropriately compensated for the work they do. That requires understanding their value and the work they do, moving towards a world where they have more security in terms of the way they get reimbursed. There’s a lot we can do for CHWs. They do so much for us. It’s hard in some ways to describe it because they are changing lives. That’s not a cliche in this situation. It’s reality.

Q: Is there anything you want to make sure readers understand when it comes to the work CHWs are doing in and for their communities?

A: I want to emphasize there is not just one way that they help individuals with mental health support. CHWs help to navigate health services, but also navigate feelings regarding one’s health, and look at the person in a more holistic way. There are many different ways in which CHW services come in, and we are very grateful for them.

Visit the Michigan Community Health Worker Alliance’s website to learn more about Michigan CHWs, the work being done in their communities, and how to best support a CHW in your community. Washtenaw and Livingston County residents can learn more about MiCC and their offerings at their website.

Rylee Barnsdale is a Michigan native and longtime Washtenaw County resident. She wants to use her journalistic experience from her time at Eastern Michigan University writing for the Eastern Echo to tell the stories of Washtenaw County residents that need to be heard.

Photos by Lara Jameson, Pexels.
Ayse Buyuktur photo courtesy MiCC.

The MI Mental Health series highlights the opportunities that Michigan's children, teens, and adults of all ages have to find the mental health help they need, when and where they need it. It is made possible with funding from the Community Mental Health Association of Michigan, Center for Health and Research Transformation, Genesee Health System, Mental Health Foundation of West Michigan, North Country CMH, Northern Lakes CMH Authority, OnPoint, Sanilac County CMH, St. Clair County CMH, Summit Pointe, and Washtenaw County CMH.