Mental healthcare is evolving

A growing number of psychiatrists, psychologists, social workers, nurses and other mental health professionals around the world believe that existing conventional treatment approaches such as prescription medications and psychotherapy do not adequately address the mental health needs of people everywhere. There are many reasons for this. First of all, even though prescription medications are often effective and safe, they are not available in many parts of the world and where they are available they are often too expensive for many people to afford. The potential value of prescription medications for people who suffer with mental illness is also limited by the fact that many medications are no more effective than sugar pills and sometimes cause serious adverse effects. The limitations of prescription medications have resulted in renewed interest in complementary and alternative therapies, and efforts by mental health professionals, researchers and our patients to find more effective, safer and more affordable ways to treat many common mental health problems and prevent them from returning.

There is a long historical tradition of uses of so-called complementary and alternative (CAM) therapies in the U.S. and other Western countries in the background of the dominant framework of biomedicine. The rapid growth of CAM is being driven by consumer demands for a wide range of treatment choices, growing dissatisfaction with conventional medical care and increasing openness to new ideas in the leading institutions of Western medicine. Trends that are interfering with the ability of Western medicine to provide adequate health care include restrictions on the kind and quality of treatments available under managed care, private insurance contracts and Medicare; concerns over the efficacy and safety of conventional pharmacological treatments; and the increasing cost of medical care in general.

In the above context it is a significant fact that individuals who use CAM to treat any medical or mental health problem are generally more educated compared to those who use only conventional treatments. Approximately two thirds of all adults in the U.S. use various CAM approaches to treat a medical or mental health problem. Many individuals who see Western-trained physicians also see Chinese medical practitioners, herbalists, homeopathic physicians or energy healers for the same problem but many are also self-treating with herbals, supplements or homeopathic remedies without the advice of a naturopathic physician, conventionally trained M.D. or a mental health professional.

At the same time that patients are demanding more choices in health care, mainstream medicine is becoming more open to change. Courses on complementary and alternative medicine are now offered at most U.S. and European medical schools, and increasing numbers of physicians are becoming certified to practice Chinese medicine, herbal medicine, homeopathy and other established world healing traditions. Approximately one half of U.S. physicians refer patients to acupuncturists, naturopaths, homeopaths, chiropractors and other non-conventionally trained practitioners because they believe these approaches are safe and effective. Together these trends are stimulating evolution of medical care in the U.S. toward an eclectic network of perspectives, skills and services addressing the patient’s body, mind and spirit.

The Increasing uses of CAM in mental health care
Approximately one third of the adult population in the U.S. and Europe use at least one CAM therapy annually. In this context more and more people are using CAM and integrative therapies to treat or self-treat mental health problems. It has been estimated that as many as 10% of U.S. adults take prescription medications for depression, anxiety, schizophrenia and other mental health problems. At the same time approximately 10% of U.S. adults who visited an alternative medical practitioner in the previous year had a psychiatric diagnosis, and half of those had sought care specifically for a mental health problem. It is significant that the majority of individuals who see alternative medical practitioners for a mental health problem are self-referred and do not disclose their use of non-conventional therapies to their family physician, psychiatrist or therapist. Over 50% of individuals diagnosed with an anxiety disorder and 60% of individuals diagnosed with a mood disorder use a CAM therapy while few disclose this information to their family physician or psychiatrist. The majority of individuals who use CAM therapies see a conventionally trained M.D. for the same health problem. Among individuals hospitalized for a severe mental health problem almost two thirds had used a CAM approach within the past year and fully 80% had not disclosed this information to their psychiatrist. Severe depressed mood is the strongest predictor of CAM use in psychiatrically hospitalized individuals. The increasing rate of self-treatment in the context of non-disclosure of CAM use raises significant safety issues because many individuals who use vitamins, herbs or other natural substances also take prescription medications resulting in potentially serious toxic interactions.

Integrative mental healthcare uses approaches from Western biomedicine and CAM
The conventional biomedical model of mental health care widely practiced in the U.S. and many other countries emphasizes the use of potent prescription medications to treat ‘disorders.’ Medications will probably continue to play an important role in mental health care—especially in Western countries and especially for managing symptoms of severe mental health problems such as bipolar disorder, dementia and psychosis—however non-medication treatments will play an increasingly important role in mental healthcare as more research evidence accumulates showing that they are both safe and effective. In contrast to the conventional biomedical model, integrative mental healthcare is concerned with maintaining optimal wellness and managing symptoms of each unique person in the context of their values, preferences and circumstances. Advantages of integrative mental health care over the conventional biomedical model, include:

• improved response to treatment
• reducing the dosage of a prescription medication
• reducing adverse effects of prescription medications
• saving money on treatment costs
• having greater control over your symptoms
• greater emphasis on maintaining wellness
• developing a more personalized plan for treatment and prevention

It is important to point out that integrative mental healthcare does not reject the use of prescription medications, psychotherapy or other mainstream approaches or discount their benefits for mental health problems. Medications and psychotherapy are often beneficial and safe and bring enormous relief to human suffering. As integrative practitioners we often prescribe medications and recommend psychotherapy to our patients but we go beyond this limited model of care. In addition to these conventional biomedical therapies integrative practitioners also recommend a wide range of non-medication treatment approaches such as herbals, vitamins and other natural supplements, whole body approaches such as exercise and massage, changes in the diet, mind-body practices and energy therapies such as acupuncture and healing touch, and many other so-called ‘alternative’ therapies where scientific evidence supports their use. Because integrative mental health care focuses on each person’s unique needs and circumstances, treatment is often highly individualized. This means that there is no single ‘best’ treatment for any particular mental health problem, but each person may have a ‘most appropriate’ treatment plan depending on the particular symptoms they are experiencing in the context of their unique life story, values, preferences and circumstances.

Introducing a series of books on integrative mental healthcare
In an effort to address the limitations of the current model of mental health care, I have written a series of books on integrative mental health care. My chief goal in writing the books was to create a practical and affordable resource on safe and effective non-medication treatments for many common mental health problems. The books in the series provide concise reviews of the evidence for a variety of non-medication approaches used to treat many common mental health problems.
The series covers the following mental health problems:

Alcohol and Drug Abuse
Attention-deficit hyperactivity disorder (ADHD)
Bipolar disorder
Dementia and mild cognitive impairment
Post-traumatic stress disorder (PTSD)

Click here to learn more about my books and order them.

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