By Rachel Crumpler
Key takeaways:
- SouthLight Healthcare, an outpatient mental health and substance use treatment provider, launched a Social Determinants of Health team in 2025 to help patients get housing, transportation, food and other resources that affect their ability to stay in treatment.
- Unmet basic needs, like housing, transportation and food insecurity can undermine mental health and substance use recovery.
- SouthLight leaders say its new social determinants team and housing assistance program are the kind of support that helps people stay in treatment.
People often walk into SouthLight Healthcare for help on one of their worst days — after an overdose, a psychiatric crisis or an emergency room visit.
But starting substance use or mental health treatment is generally only the first hurdle.
Many patients arriving at the outpatient treatment provider’s clinics don’t know how they’ll get to appointments, where they’ll sleep or where their next meal will come from. Those basic challenges can quickly derail someone’s recovery.
In response, SouthLight has started focusing more on the nonmedical needs that shape health and well-being for their patients. Such needs are often referred to as social determinants of health.
“If they feel insecure about their social needs, if they don’t know what they’re going to eat, they don’t know where they’re going to sleep, they’re worried about their job, their rent, things like that, then they’re not going to be able to focus on recovery,” said Adam Hartzell, CEO of SouthLight Healthcare, which has facilities in Raleigh, Durham and Fayetteville.
About 2,300 unique patients walk through SouthLight’s doors each month, Hartzell told NC Health News. Roughly 80 percent of them have co-occurring substance use and mental health disorders, about 20 percent are homeless and nearly 70 percent are from lower-income households covered by Medicaid. The rest are privately insured or uninsured.
No one is ever turned away, Hartzell said.
SouthLight leaders have long recognized the role social needs play in recovery.
For several years, SouthLight has partnered with Oxford House, a recovery housing organization, to pay rent for patients who lack a reliable place to stay and who are participating in its three-month group counseling program. Before offering that support, Hartzell said about half of participants were not completing the program.
Now, only about 12 percent drop out.
“That’s a very tangible example of how a social need can be met and makes a difference in the outcome,” Hartzell said. “If you stay in the program for three months, you’re much more likely to be able to deal with your addiction and your mental health issues than if you have to drop out after a few weeks.”
Over the past year, SouthLight has placed even greater emphasis on addressing social needs to improve treatment outcomes. They launched a two-person “Social Determinants of Health team” in April 2025, funded with money that’s flowing to states from legal settlements with opioid manufacturers and distributors.
more coverage of social determinants of health
Addressing social determinants of health
No two days are the same for Tristan Wever and Ian Hope, who lead SouthLight’s Social Determinants of Health team.
They work out of SouthLight’s Raleigh Hub Drop-In Center, a space where patients can get coffee and a snack, meet with peer support specialists, charge their phones or use a computer to create resumes and search for jobs.
Hope calls the drop-in center “the beating heart” of the SouthLight building — a place that fosters connection among people in recovery and increasingly serves as a gateway to community resources. The center is funded by $400,000 in Wake County opioid settlement dollars, which includes the two positions for the Social Determinants of Health team. They work to connect patients to resources that can make it easier for them to stay in treatment and help them stabilize their lives.
Wever and Hope spend their days responding to referrals from SouthLight clinicians who identify patient needs, as well as to patients who knock on their doors seeking help.
During the first year of the specialized team — from April 2025 to March 2026 — more than 1,200 people came through the drop-in center, about 25,000 visits.
Their needs vary, but housing and transportation often top the list.
Just four hours into the day in June when NC Health News visited, Wever had already fielded three requests for transportation assistance, two for food resources, two related to housing, one for clothing and one for medical services.
“We’ve had so many times where we’ve been helping someone and they’ll leave and another person comes in and they’re like, “Hey, Joe just told me that you help with this. I also need one. Can you help me with that?’” Wever said.
The steady stream of requests reflects the challenges many patients face outside the clinic.
“Try to tell someone, ‘Listen, work on your depression, work on your anxiety, work on this,’ but they’re anxious because they don’t know when their next meal is coming, where they’re going to sleep,” Wever said.
That’s not going to be successful, he said.
Hope observed those challenges firsthand while working as a peer support specialist at SouthLight for a year before helping launch the Social Determinants of Health team.
“I did see that a lot of people struggled with establishing that first step in recovery,” Hope said. “There were folks that were like, ‘Well, I don’t have transportation to get here. I had to walk from the bus station to get here, or I slept on the street last night.’ That really does affect their mental health and their hope that they can come in and find their footing.”
Building the team’s resource network became one of Wever and Hope’s first priorities. They keep a growing list of community resources and partners they can direct people to as needs arise, including for less common requests such as pet care and furniture.
Wever and Hope don’t just hand out phone numbers, though. They help make direct connections and help people wade through the red tape.
“It’s easy to hand out a bus pass or give them a phone number, but it’s different to say, ‘I’ll sit with you. We’ll walk through the process,’ or ‘This is a community partner, say that Ian sent you, or Tristan sent you,’” Hope said.
The team also organizes quarterly wellness events to bring resources directly to SouthLight’s patients. Services there have included ophthalmologists fitting new prescription glasses, barbers cutting hair and reentry advocates helping people wade through the paperwork to expunge some of their criminal records.
Hope has seen how addressing even a seemingly small need — a bus pass, hot meal or a pair of glasses — can help people gain momentum.
“It gives people a spark, a little bit of hope, like, ‘Okay, I can continue this now. I have somewhere to start from,’” Hope said.
Some people connect with the Social Determinants of Health team only once in a moment of crisis, seeking help with a relatively straightforward need. Other cases are more complicated and may take weeks or months to address a person’s needs, such as for affordable housing.
But with time and support, Wever and Hope see many folks make progress.
For example, one person experiencing homelessness and serious mental health needs worked closely with the team over an extended period.
Hope said they started by addressing immediate needs, including securing a tent from Healing Transitions and providing bus passes to get back and forth to treatment. Then they connected the person to more intensive community-based services.
“Now, they are absolutely flourishing,” Hope said.
Making social needs part of treatment
Since taking the helm of SouthLight in June 2019, Hartzell has prioritized addressing social determinants of health, believing it’s an important approach to improving health and treatment outcomes.
About four years ago, SouthLight implemented a social determinants of health screening for all patients at intake, modeled after questions developed by the N.C. Department of Health and Human Services. Hartzell said that it’s a vital way to gauge needs that might affect recovery and has become an increasingly important tool.
Before the team formed, social needs were addressed mostly ad hoc with providers suggesting resources during clinical appointments — often taking time away from care. That’s happening less now.
“We have folks that are now dedicated to the social need, so the medical folks can be focused on the medical, and the counselors can be focused on the counseling support,” Hartzell said.
The shift is paying off, Hartzell said. He hopes it becomes a model for other organizations.
“The folks that we serve are on a long journey, and they are facing so many barriers to being able to make themselves well,” Hartzell said. “SouthLight being able to reduce those barriers and increase access to care has significantly increased the number of folks that we see accessing services coming to us and also how long they’re able to stay with us.”
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