What makes a mental health provider an integrative practitioner?

By Julie Luzarraga

For mental health providers to offer value to an integrative team, they need to understand what makes a mental health provider integrative.  Medical providers who use an integrative medicine approach have additional training in nutrition and supplements, complementary practices, mind-body medicine, and other integrative approaches to providing care. Similarly, a mental health provider practicing as an integrative practitioner has additional training in primary health education, integrative and complementary therapies, mindfulness and stress reduction skills, and the emotional intelligence to work collaboratively with the integrative medical team.

Integrative practitioners view health as “a state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity,” according to the World Health Organization. We pay particular attention to the relationship between chronic medical health conditions and mental health conditions.  In addition, integrative practitioners make conscious decisions to break down barriers between different disciplines.  When those walls are removed, a mental health provider needs to be equipped with the tools to support an integrative practice.  An integrative mental health provider uses their traditional training in conjunction with integrative skills.

Anxiety and depression are common presentations to a mental health therapist.  Anxiety, which affects 31.1 percent of American adults at some point in their lifetime according to the National Institute of Mental Health,, has been associated with chronic illnesses such as heart disease, chronic respiratory disorders, and gastrointestinal conditions.).

The National Institute of Mental Health (NIMH) estimates 21.4 percent of U.S. adults will experience some type of mood disorder in their lifetime. Patients with chronic health conditions have a higher risk of depression, and those with depression are at increased risk for developing certain medical conditions, says the NIMH.   Understanding how medical conditions present and relate to mental health symptoms helps the provider ascertain the complex relationship between physical and mental health.

Integrative mental health providers have enough education to refer for further assessment while not taking the place the of a primary care provider. The mental health provider’s expertise in mental health conditions can then further inform the medical team’s overall understanding of a patient’s presenting symptoms, enhancing treatment.  Psychodynamic therapy will only go so far when a patient’s depression is impacted by low vitamin D levels or an undiagnosed thyroid disorder.

Through an integrative lens, the mental health provider assesses a patient’s psychological functioning as well as any potential medical conditions, diet, and lifestyle.  When a mental health provider is grounded in integrative and complementary therapies, it enriches the treatment plan, including modalities outside of their primary training.  Knowing the research in integrative medicine and complementary therapies, such as mind-body medicine, nutrition, yoga, bodywork, and acupuncture are part of the integrative mental health provider’s repertoire.  This additional education creates more options for the patient, who may gravitate more towards one approach than another.

Integrative mental health providers are prepared to work with the integrative team in supporting patients as they make health behavior change. Diet and lifestyle choices contribute to overall health and wellbeing.  Yet, when patients don’t feel well or experience chronic stress, making healthy changes can be very difficult.  Integrative mental health therapists are equipped with mindfulness-based therapies and stress reduction training.  Armed with an understanding of the physical disease states, integrative mental health therapists use mindfulness-based therapies, stress reduction training, motivational interviewing, cognitive behavioral therapy, and other approaches specifically to support the patient in making positive health behavior changes.

While mental health providers are expected to be proficient in therapeutic communication with their patients, the exchanges from the couch do not always translate to the collaboration required of an integrative team member. In his article, What Makes a Leader, Daniel Goleman, PhD, an internationally known psychologist, lists five components of emotional intelligence:

• Self-awareness

• Self-regulation

• Motivation

• Empathy

• Social skill.

These skills are vital to functioning on an integrative team in which a mental health therapist must navigate between the therapy office and the exam room.  When providers can do this with emotional intelligence by practicing these five components, a parallel process of communication and empowerment is created for the patient.

When collaborating with or referring to a mental health provider it is helpful to ask about their experience with integrative healthcare and offer to provide resources pertinent to the patient care.  For example, if you are prescribing a certain diet, guide the mental health therapist to the credible sources of information.  The more the therapist knows about your preferences, the more he or she can help support the patient in asking questions and identifying and working through barriers.

Invite the treating mental health therapist in to the shared patient’s appointment.  This is a great way to not only demonstrate the collaborative holding space for the patient, but it also provides education and training for the mental health provider.  Set aside time for meaningful consultation.  A mental health therapist can provide insight into your patient’s capacity for change and any psychological issues influencing their physical health, which may change your approach in working with them.  Creating alliances with mental health providers and bringing them into your space enhances the patient care and experience.

Sources

Goleman, D. (1998, November/December). What Makes a Leader. Harvard Business Review, pp. 93-102.

Harvard Health Publishing. (2017, June 6). Anxiety and Physical Illness. Retrieved from Harvard Health Publishing: https://www.health.harvard.edu/staying-healthy/anxiety_and_physical_illness

National Institue of Mental Health. (2017, Novmeber). Any Anxiety Disorder. Retrieved from National Institute of Mental Health: https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder.shtml

National Institute of Mental Health. (2017, Novmeber). Any Mood Disorder. Retrieved from National Institute of Mental Health: https://www.nimh.nih.gov/health/statistics/any-mood-disorder.shtml

National Institute of Mental Health. (n.d.). Chronic Illness and Mental Health. Retrieved from National Institute of Mental Health: https://www.nimh.nih.gov/health/publications/chronic-illness-mental-health/index.shtml

World Health Organization. (n.d.). World Health Organization. Retrieved February 28, 2017, from Constitution of WHO: principles: http://www.who.int/about/mission/en/