• Dr. Romi Fung, ND

Integrated Mental Healthcare Post #2: Patient-Centred Care

Updated: Dec 7, 2019


Memory is a common concern in the aging population. This article above talks about the use of a cognitive assessment similar to routine tests including mammography for breast cancers and fecal occult blood testing for colon cancers. Assessments like these give us a better understanding of the patient. As we have defined in our previous post, an Integrated Mental Healthcare team is “a general term for any attempt to fully or partially blend behavioural health services with general and/or specialty medical services" (American Psychiatric Association). In this post, we will explore the importance of having a primary integrated mental healthcare team and how having this in place can provide a level of patient-centred care.

There are two advantages to treating common mental health problems in primary care and other priority health care programs. First, integrated treatment programs in which medical providers are supported to treat common mental health problems offer a chance to treat ‘the whole patient’, an approach that is more patient-centered and often more effective than an approach in which mental health, acute and chronic physical health, reproductive health, and chronic pain problems are each addressed collaboratively, without the detriments of miscommunication (Patel et al, 2013).



Video: Tom Sebastian on his experience of patient-centred care, where he suffered what he thought was a heart attack, turns out to be a manifestation of anxiety and depression.


Second, integrated care programs that can address patients' mental health needs in the context of general or other specialized health care settings are often more attractive to patients and family members who are concerned about the stigma (more in a future post!) that is still associated with mental and substance abuse disorders and the treatment settings that specialize on caring for individuals with severe mental disorders. We understand that there is a label put on someone who’s given a diagnosis, or attending for treatment at a specific health care facility. Having an integrated health care in one setting can potentially alleviate that. (Patel et al., 2013)





Many older adults will experience a decline in short-term working memory, less effective encoding of information and slower retrieval of information over time (Horgan, 2019). This requires more emphasis on recognition of diagnostic symptoms and access to care. As the gatekeepers of the health system, general practitioners play a big role in early detection of mental health conditions (Kates, N. et al, 2010).



Integrated Mental Health Care Sub-Post #1: Aging Theories


Theories of aging provide a foundation which we can take to develop actions, plans and care towards older adults (Horgan, 2019). We use these theories to also determine how we can best interact with older adults with mental health issues (Horgan, 2019). So what would I determine the best theory of aging that is connected to integrated care? I will talk about how the Activity Theory can be connected to integrated care.


By having a collaborative, integrated care, clinicians collaborate in optimizing the health of their patients physically, mentally, emotionally and spiritually. With the Activity Theory which posits that continuation of activities into old age and keeping active physically and socially are encouraged (Horgan, 2019), having a clinical team that oversees all aspects of health can keep the older adult patient more engaged and active. If for instance, an older adult is getting care in maintaining mobility and strength, the older adult is reducing their risk for falls. The lesser the risk of falls, the greater the amplitude in increasing physical activity. And in increasing physical activity, as well as social activity if the older adult is mobile, will they be able to age more successfully.


Another theory to consider is the Continuity Theory. Both Activity and Continuity Theories provide a conceptual framework for examining the impact of activities participation (Winstead, Yost, Cotten, Berkowsky & Anderson, 2014). The Continuity Theory in practice make strategic choices to involve themselves in activity choices linked to their past experiences both personal and social. Thus, optimal aging occurs when the older adult is able to maintain the same patterns of daily living and remain in their homes (Winstead, Yost, Cotten, Berkowsky & Anderson, 2014). Integrated care can help maintain the mental and physical health of the older adult, and can allow the older adult to maintain the same patterns of daily living by optimizing the physical AND mental health.





Integrated Mental Healthcare Sub-Post #2: My Experience as a Naturopathic Doctor


Determining whether an individual is experiencing a mental health disorder is a matter of some subjectivity. Psychiatrists and psychologists apply tests and gather information about day-to-day living from both the individuals themselves and other key stakeholders (e.g., family members, neighbours) to determine the level of interference casued by a mental health issue. However, each diagnostitcian may have a different point at which they would diagnose an individual with a mental health disorder (as opposed to a mental health issue).


As a Naturopathic Doctor, I see things that can be quite different. For example, I have seen patients with generalized anxiety. The last thing you'd want to be doing is telling them to keep calm! Most of these patients are coming in with medications, and though it is a reflex to prescribe something to calm down the patient, that's only a small piece to integrative care. There is now evidence that there is a link between neuroimmunology and anxiety (Salim, Chugh & Asghar, 2012), meaning that there is a physical link to a mental or psychological complaint. In working with the medical doctors, I believe fully in integrated care in seeing the patients as a whole, and addressing the interrelated links of physical, mental and emotional health.






References:

American Psychiatric Association. (2019). Integrated Care. Retrieved from: https://www.psychiatry.org/psychiatrists/practice/professional-interests/integrated-care/learn.


Horgan, S. (2019). Lecture slides.


Kates, N. et al. (2010). The Evolution of Collaborative Mental Health Care in Canada: A Shared Vision for the Future. The Canadian Journal of Psychiatry, Vol 56, No 5. Retrieved from: https://www.cfpc.ca/uploadedFiles/Directories/Committees_List/Collaborative%20mental%20health%20care-2011-49-web-FIN-EN.pdf.


Salim S, Chugh G, Asghar M. (2012). Inflammation in anxiety. Adv Protein Chem Struct Biol. 88:1-25. doi: 10.1016/B978-0-12-398314-5.00001-5.


Winstead, V., Yost, E. A., Cotten, S. R., Berkowsky, R. W., & Anderson, W. A. (2014). The impact of activity interventions on the well-being of older adults in continuing care communities. Journal of applied gerontology : the official journal of the Southern Gerontological Society, 33(7), 888–911. doi:10.1177/0733464814537701

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