Addressing the Diverse Needs of Patients: Implementing an Integrative Approach to Mental Health

To get a better understanding, in 2019, the National Institute for Mental Health published an analysis showing that young adults ages 18-25 have the highest percentage of mental illness, followed by middle-aged groups 26-49 followed by groups 50 and up (Figure 1). The prevalence of mental illness throughout younger generations forecasts an unsettling trend, one that shows every generation increasing in mental illness. Inevitably, if this trend persists, mental health intervention will grow. As we predict the need for care to grow, we must ask ourselves if our mental healthcare system is prepared. This paper will analyze research conclusions indicating a detrimental lack of preparation in the psychiatric curriculum. If we want to enact positive change, we must re-establish trust and transparency. A part of that transparency includes acknowledging the complexities of patients and their issues. A part of that trust includes providers giving patients more treatment options for further individualized care and a better system. Such a system would incorporate a range of modalities to better address the unmet, often ignored, needs of patients, such as psychosocial, physical, spiritual, and basic needs. For these needs to be met, we must develop strategies for implementing an approach that blends conventional perspectives with integrative practices. The American Psychiatric Association (2021) defines integrative medicine as “... the practice of combining conventional medical treatments with non-conventional ("alternative" or "complementary") ones.” (Integrative Medicine, Para. 1)

Thesis

By showing the need for change, this paper urges the reader to understand the benefits of implementing integrative approaches to further improve care before, alongside, and or after the pharmaceutical intervention. This paper aims to start a dialogue between patients and providers regarding their treatment options for various mental health issues and why it may be beneficial to consider alternative approaches in conjunction with conventional methods. We will be going over why integrative approaches to mental health care are needed and who benefits, figuring out the best way for patients and providers to communicate this approach, challenges that both patients and providers may encounter, and how this approach could revolutionize healthcare models. 

Background 

To see why integrative medicine is so important, we need to understand the current state of our mental healthcare system better. As of 2021, approximately 66% of U.S. adults take prescription drugs (Health Policy Institute, 2021). The leading drug classes amongst these prescriptions are antihypertensives, pain relievers, and mental health medications (Statista, 2021). A meta-analysis of available data from 1999-2013 (Anderson, 2021) showed that antidepressants were the highest prescribed psychiatric medication, followed by sedatives (for anxiety), psychostimulants (presumably for ADHD), and antipsychotics (Figure 3); psychostimulants had the highest percentage increase in prescriptions, followed by antidepressants, sedatives, and antipsychotics (Figure 4). The increase in prescription rates likely indicate mental illness is increasing but is this increase in prescriptions justified? Or have our ideals become too incongruent with societal expectations, so we put great pressure on patients to seek help and providers to offer optimal solutions. As technology advances, medication prices should be decreasing. According to prescription drug statistics published by Dr. Jacobson (2021), the price of lifesaving prescriptions has increased by 5% in 2021 alone (Prescription drug price trends, Para. 1). This may be enough information to conclude that profit-driven intentions have corrupted our healthcare system but to put another nail on the casket, according to statistics of public data (Farley, 2021), pharmaceutical companies have spent more, double in some cases, in marketing and political funding than in research and development (Figure 1). These statistics may show us what intentions are truly held. 

Why Integrative Approaches to Mental Health Care Are Needed and Who Benefits?

The field of psychiatry has always been multidisciplinary. Interestingly enough, some disorders may be rooted in evolutionary adaptations leading us to reconsider some classifications according to an article. The concept of alternative strategies and its relevance to psychiatry and clinical psychology (Troisi, 2004) is an article that views the term 'alternative strategies' through an evolutionary lens and explores its implications in society, clinical psychology, and psychiatry. The article defines 'alternative strategies' as a concept explaining the origin of behavioral syndromes, currently classified as mental disorders and emotional dysfunctions, and their importance within the population and particular need for recognition in psychiatry. Troisi raises the point that "normal" is very subjective and explains how statistical normality is often confused with biological normality (p. 60). Some fields of medicine have a propensity to be guided by statistics in times of uncertainty which has helped before but could confuse averages with the ideal. Another critical point was how medicine aims to alleviate suffering; therefore, individual differences need to be better understood to achieve personal and social well-being. This highlights the need for individualized care that encapsulates broader aspects of the patient experience, with influence from evolutionary standpoints, identifying the importance of divergent neurocircuitry in society. Furthermore, this article supports the need for treatment that fits the neurodiversity of patients. 

Figuring out the best way for patients and providers to communicate this approach. 

In an interview, integrative psychiatrist Dr. Aparna Iyer shares her reasonable approach to mental health (Saklecha, personal communication, August 30, 2017). When tailoring a care plan, Dr. Aparna Iyer considers a patient's complexity; she believes medication cannot be a cure-all and rarely ever is. One key aspect of her practice is putting psychotherapy before psychiatry, which is not a common practice. She also promotes a combination of traditional and integrative psychiatry to get the best of both worlds essentially. We must get a provider's perspective, so I must include this in my review. This unique perspective gives us a glimpse into both worlds as Dr. Aparna Iyer practices both modalities. We get an honest opinion on integrative medicine and its implementation in real life. At the end of the interview, the doctor projects the growth of alternative and integrative approaches to psychiatry. This interview links back to my thesis by reaffirming the presence of patient populations in need of diversified treatments. Integrative medicine seeks to help mental health care teams individualize care plans and provide alternatives for treatment. 

Challenges Patients and Providers May Encounter 

Creating a better system is not easy. Disparities in education or training on both ends of the patient-provider relationship are already prevalent. But providers play an integral role in assuring safety and optimal outcomes. Trust and honesty are important factors to furthering and 6 personalizing treatment. As patients present providers with questionable alternative treatments, it is their duty to find clarity through personal research. In a research publication assessing the integrative medicine curriculum needs of psychiatrists (Ranjbar et al., 2019), results found that there is a considerable disparity amongst medical students receiving an integrative curriculum. A vital point made by the study was that preparing residents with a proper integrative curriculum, as opposed to our current limited interventions, could help address burnout and better equip the next generation of psychiatrists (Conclusions). These findings are conducive to paving the way for improving treatments within the field of psychiatry. 

How this approach could revolutionize healthcare models. 

According to a recent systematic review (Mitchell et al., 2021), regarding prescriptions and pharmaceutical industry incentives, a causal relationship was found between the pharmaceutical industries giving incentives and providers filling prescriptions (Conclusions). To finally connect this data with my claim, I ask the reader to question the provider’s motives for prescribing medications. Some medications are powerful and, if prescribed incorrectly, could have the potential to be deadly, so unless medications are acutely needed, patients should educate themselves on integrative approaches to enact recovery through whatever it takes instead of relying on whatever works. Though it may put financial stress on providers and call for added healthcare preparation, patients need to be put back at the center of care. 

Conclusion

In summation, there are various benefits to implementing integrative approaches to mental health care, not only by creating more treatment options but by supplementing existing interventions.