Blog entry

Compassion for the Whole Person: Integrated Care vs. Primary Care

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Just saying … it is well past time for us to have compassion for the whole person who is receiving care. The fields of substance use and mental health have clearly learned that treating the whole person is important for recovery and wellness by providing integrated care.

Well, does anyone say this to the field of physical health? There comes a time when physicians and nurses must embrace and understand the impact of their care on a client’s behavioral health. When does physical health care increase mental health symptoms or substance use? Of course, there is a fine line between the anxiety caused by a physical health diagnosis and how it can exacerbate actual mental health, substance use, and physical health diagnosis. For example, if an individual struggling with a substance use disorder receives a cancer diagnosis, this may increase substance use as a way to cope with the fear of this diagnosis. It is imperative that physical care doctors and nurses understand how to decrease and prepare for this cross-section of physical and behavioral health. 

One label for this intersection is “integrated people-centered care”, which was the main topic for WHO’s Global conference this year. This topic addressed how to integrate care and make it more people, not disease, centered. As an example of why this training is important, see this SAMHSA-HRSA Center for Integrated Health Solutions’ website link for an outlining of the cost savings and longevity impact of integrated care:

https://www.integration.samhsa.gov/integrated-care-models/integration-infographic.

The National Institute for Mental Health (NIMH) also highlights the likelihood of an individual with a behavioral health challenge to seek primary care services first: https://www.nimh.nih.gov/health/topics/integrated-care/index.shtml. This is an important entry point – physical care doctors and nurses must change their mindsets (many have) about mental health vs. behavioral health vs. physical health, it is all integrated care since individuals are so much more likely to go to their primary care doctor (or even emergency). Stigma, easier access, and simple lack of knowledge of symptomology impact patient choices and decisions. The more physical health care can be cross-trained and have ready access to behavioral health, the more impact we as a field will have on client whole-person wellness.

One small step readers of this blog can take is to ask your primary care physicians and nurses what steps they are taking to better understand how mental health, substance use, and physical health impact each other. The more everyone is talking about this issue, the more we can break the stigma around it.

Consider the premise that “health” is not always about using medication to treat lifestyle health conditions, such as some forms of obesity, diabetes, and emphysema. If we don’t help people to stop smoking, eat healthier, and get more exercise, their health may not improve dramatically no matter what medication you give them. And often trauma, PTSD and anxiety can affect lifestyle choices that impact health. For instance, how many people “comfort eat”? It’s so common that restaurants even advertise “comfort food!” Sure, that is associated with “home” and a sense of being cared for, but at the heart of comfort, eating is using food as a coping skill. Our motivations and lifestyles impact our well-being, but so does non-holistic care. Physical health doctors need to engage and discuss more holistic views of exercise, eating, sleeping, socialization, and work with their behavioral health clients because … it’s all about that hope.

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