Q&A: Integrative Mental Health Care

Dr James Lake, Integrative Medicine columnist at Psychiatric Times, recently published a series of 10 e-books on integrative mental health care. His chief goal was to create a practical and affordable resource on safe and effective integrative managementof common mental health problems.

James Lake, MD (JL): In a few words, integrative mental health care emphasizes a person-centered approach to mental health and takes into account the needs, preferences, and circumstances of each patient. It focuses on maintaining optimal health and treating symptoms, not disorders. We use mainstream approaches-such as medications and psychotherapy-and complementary and alternative therapies. Practice is based on the best available evidence from both biomedicine and complementary and alternative medicine (CAM).

JL: The e-books are intended for both mental health providers and their patients. The first book in the series introduces important concepts and methods of integrative mental health care. The remaining 9 e-books briefly review the evidence for a variety of non-medication and integrative approaches that address mental health concerns and describe safe and effective strategies for implementing them in clinical practice.

JL: The books cover evidence-based uses of herbals and other natural supplements, mind-body approaches, and energy therapies for alcohol and drug abuse; anxiety disorders; ADHD; bipolar disorder; dementia and mild cognitive impairment; depressed mood; insomnia; PTSD; and schizophrenia. Each book contains concise summaries of CAM approaches, such as categories of treatment; how it works, natural supplement dosages, examples of safe and effective treatment combinations, adverse effects and warnings, and average duration of treatment needed to achieve beneficial results.

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• Understanding the problem. This section includes concise reviews of the causes and risk factors associated with the particular mental health problem being discussed. Typical symptoms of the mental health problem being covered are described together with medical or mental health problems that may occur together with that problem.

• Taking inventory. This section provides a concise review of symptoms associated with the mental health problem being addressed and includes links to standardized assessment tools to assist clinicians or patients in determining whether symptoms are mild, moderate or severe.

• Identifying treatments that make sense for you: evaluating the evidence. This section reviews the research evidence for specific non-pharmacologic treatments of the mental health problems covered in the series. It is the largest and most important part of every book in the series and provides the information needed to develop a treatment plan or advise a patient. Highlights for each treatment are summarized in easy-to-read bullets and links are included to permit quick scanning of the material included under a particular treatment.

• Developing a custom treatment plan. This section discusses the steps needed to develop a treatment plan taking into account current symptoms and co-morbid psychiatric or medical problems including problems that have not yet been diagnosed or are not being adequately treated. Developing a personalized treatment plan takes into account previously tried treatments, personal values and preferences, treatments that are available where the patient resides, and financial considerations.

"The emerging paradigm of integrative mental health care does not reject the use of prescription medications, psychotherapy, or other mainstream approaches widely used in biomedical psychiatry."

-James Lake, MD

• Making changes along the way: re-evaluating and optimizing the treatment plan. This section will help the clinician or patient answer common questions: How do I know whether the current treatment plan is adequate? What can be done about adverse effects? How long should the clinician or patient wait before trying a new treatment if there is no improvement in target symptoms? When is it appropriate to seek professional care (ie, for individuals who are self-treating)? When is it appropriate to discontinue current treatment and switch to a different treatment?

• Repeating the steps until a more effective treatment plan is identified. If the initial treatment plan has unsatisfactory results this section will guide the clinician or patient through steps that will lead to more effective treatment plan.

• Summary. This section is a concise review of the most important concepts and methods in the e-book.

• Finding quality products and services. This section provides links to Internet resources on natural supplements, safety information, and a variety of non-medication approaches intended to help the clinician or patient develop a safe and effective evidence-based treatment plan.

LM: How does integrative psychiatry compare with general psychiatry and why might psychiatrists consider incorporating it into in their practices?

JL: The conventional biomedical model of mental health care widely practiced in the US and many other countries emphasizes the use of potent prescription medications to treat “disorders.”

While medications will probably continue to play an important role in mental health care-especially for managing symptoms of severe psychiatric disorders such as bipolar disorder and psychosis-non-pharmacologic treatments will play an increasingly important role in mental health care as research evidence accumulates supporting their safety and effectiveness for treating depressed mood, anxiety, bipolar disorder, and other common mental health problems.

Not surprisingly, in contrast to conventional psychiatry as currently practiced, integrative care emphasizes optimal wellness and managing symptoms of each unique person in the context of their values, preferences, and circumstances.

JL: Advantages of integrative mental health care over the conventional biomedical model include improved response to treatment; reduced dosage of a prescription medication; fewer adverse effects of prescription medications; and saving money on treatment costs. Patients also have greater control over symptoms and emphasis on maintaining wellness, as well as a more personalized plan for treatment and prevention.

JL: The emerging paradigm of integrative mental health care does not reject the use of prescription medications, psychotherapy, or other mainstream approaches widely used in biomedical psychiatry. It also does not discount the benefits of such conventional approaches. Medications and psychotherapy are often beneficial and safe and bring enormous relief to human suffering.

Integrative psychiatrists often prescribe medications and recommend psychotherapy but go beyond this limited model of care. In addition to conventional biomedical therapies, integrative psychiatrists also recommend a wide range of non-medication treatment approaches. These therapies can incorporate herbals, vitamins and other natural supplements, whole-body approaches (eg, exercise, massage), dietary changes, mind-body practices and energy therapies (eg, acupuncture, healing touch), and many other so-called “alternative” therapies where scientific evidence supports their use.

Because integrative 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 patient 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.

About Dr Lake:
Dr James Lake has authored numerous peer-reviewed articles and chapters in medical journals and textbooks, and has co-authored or edited 4 textbooks covering the theory and practice of integrative mental health care. He was a founding member and former Chair of the American Psychiatric Association Caucus on Complementary and Alternative Medicine and the International Network of Integrative Mental Health. Both initiatives are committed to educating and training clinicians about safe, evidence-based uses of complementary and alternative approaches in mental health care and bringing the methods and treatments used in integrative mental health care into mainstream clinical practice. His website is here. The e-books can be found here.