Moving Beyond Medication: Holistic Interventions for the Treatment of Patients with Psychiatric Disorders

By: Helen Griffith

Current models of psychiatric care in the United States have failed patients who suffer from mental illness.

Today, approximately one in five U.S. adults live with psychiatric illness, and this number only continues to rise (“Mental Illness,” 2022).

There are a number of complex factors which have contributed to the astronomical increase in mental illness that can be seen in the general public. For instance, social media and the COVID-19 pandemic have both been associated with the skyrocketing rates of anxiety and depression in the United States (Karim et al., 2020; Xiong et al., 2020). The standard medical model of psychiatric care is used most often by physicians to categorize symptoms of mental illness according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). While this system remains useful for the purposes of distinguishing between different psychiatric illnesses, there are many flaws with its rigid structure, as mental illness manifests in a more fluid nature than previously thought (Young, 2016). Furthermore, current standards of treatment for psychiatric disorders, including medication and psychotherapy, remain limited in terms of efficacy and scope. Therefore, future treatment of mental illness should move beyond these methods to incorporate alternative, evidence-based wellness interventions that focus on integrating exercise, mindfulness, sleep, social connection, and nutrition to better patient mental health. 

Figure 1. The efficacy of antidepressants in treating patients with moderate to severe depression (“How well can antidepressants,” 2020).

The idea that treatment for mental illness should solely revolve around the administration of medication is inherently flawed and often does more harm than good to patients. In fact, in patients with moderate to severe depression, it has been found that only one in five will respond positively to any given antidepressant (Figure 1). For this reason, more emphasis should be placed on other treatment options, such as psychotherapy in combination with research-based wellness interventions. It is absolutely crucial that mental health professionals consider the immense variability between patients who struggle from psychiatric disorders in order to formulate a more personalized, holistic approach to treatment.

As rates of mental illness have increased, so too have the number of people who have been prescribed psychiatric drugs. While these medications can be incredibly useful for some patients, they may have overall neutral or even negative effects on others.

In other words, given the level of efficacy that they provide, psychiatric drugs are being overprescribed, sometimes to the detriment of patient health and wellbeing.

Even if the drugs have a net neutral or positive effect, it is often not enough to bring patients within a standard range of mental well-being (Paris, 2011). According to the Mental Health Quotient (MHQ), a mental health assessment tool, normal mental health scores range from 0 to 200, whereas negative scores indicate at-risk or clinical patients. Furthermore, there are many instances when psychiatrists are unable to predict how patients may respond to a certain medication; as a result, patients are essentially subjected to various forms of experimentation until a seemingly effective psychiatric drug or combination of drugs has been found (Sparks, 2016).

Along with psychiatric medications, psychotherapy serves as a standard form of treatment for mental illness. Psychotherapy, also known as talk therapy, functions as a way to help people who are suffering from mental illness or other emotional difficulties (What is Psychotherapy?, 2019). In fact, psychotherapy in general has been shown to be significantly more effective than psychiatric medications in treating mental illness (Cuijpers et al., 2013). Additionally, in patients with treatment-resistant depression, psychotherapy may contribute to symptom improvement when medication does not (van Bronswijk et al., 2019). Nonetheless, the effects of psychotherapy depend on a number of factors, including psychiatric diagnoses and types of psychotherapy (Cuijpers et al., 2013).

As powerful as combinations of psychiatric drugs and psychotherapy can be for the treatment of mental illness, standard models of psychiatric care have not generated significant enough improvements in patient mental health. It is important to consider all possible avenues of treatment for a patient’s mental illness, besides psychotherapy and medication, which could help to improve mental wellness. That is not to say that current psychiatric practices should be abandoned; however, there is more that healthcare providers, specifically psychiatrists, can do to promote mental health and treat psychiatric illness that does not involve expensive or exploratory treatments.

Dr. Saundra Jain and Dr. Rakesh Jain developed the WILD5 program for this very reason. Their intention was to provide an evidence-based model of incorporating wellness interventions into standard psychiatric care. This program involves encouraging participants to center on five facets of health and well-being: exercise, mindfulness, sleep, social connectedness, and nutrition. While this specific program has been supported by research studies, it does not necessarily need to be followed precisely in order to see benefits in patients with psychiatric illness. Placing more focus on these areas of wellbeing would ultimately lead to a transformation of patient care and outcomes in psychiatric medicine (Rolin et al., 2019).

Figure 2. The physiological, immune, and psychological effects of physical activity on stress, anxiety and depression (Mikkelson et al., 2017).

Exercise regimens have been shown to be highly beneficial for peoples’ mental health, regardless of whether or not they suffer from psychiatric illness. Benefits include improved cognition, reduction in depression and anxiety symptoms, decreased risk of developing neurodegenerative diseases and of experiencing drug addiction (Ruegsegger and Booth, 2018). These improvements are hypothesized to result from increased circulation of blood in the brain during exercise as well as modulation of the hypothalamic-pituitary-adrenal (HPA) axis, which controls the stress response. Furthermore, some of the benefits of exercise may potentially be attributed to the social interaction that it can provide as well as feelings of self-efficacy (Sharma and Petty, 2006). 

Mindfulness promotes mental health and is associated with the development of a positive sense of self as well as a greater sense of autonomy and life satisfaction. It is also negatively correlated with psychiatric disorders such as depression, social anxiety, and neurosis, as well as rumination (Ngô, 2013). These benefits are proposed to be a result of enhanced self-awareness and attentional control (Tang et al., 2015; McGee, 2008), but the exact neural mechanisms activated by practicing mindfulness have not yet been discerned (Wielgosz et al., 2019). 

Sleep plays a significant role in mental health status, with many common symptoms of mental illness including sleeping too little or not enough. Studies have shown that ensuring a quality night’s sleep can reduce psychotic episodes as well as insomnia and depression (Riemann et al., 2020). 

Additionally, social connectedness is important for maintaining mental health. In fact, loneliness has been shown to be both a cause and consequence of many psychiatric illnesses (Hare, 2017). Establishing strong social ties can provide individuals with support during hard times and help create a sense of security for them (Taylor, 2020). 

Lastly, nutrition can have a large, positive impact on mental health. For example, consuming a largely Mediterranean diet has been associated with decreased risk of developing depression. This may be attributed to a reduction in inflammation, increased immune system activation, and favorable interactions between the brain and gut microbiome. On the other hand, diets which consist of mostly foods with a high glycemic index are associated with an increased risk of depression (Firth et al., 2020). 

Figure 3. The relationship between diet, physical health and mental health (Firth et al., 2020).

When considering wellness interventions for treatment of psychiatric illness, it is also important to acknowledge the sociological factors that can impact mental health, including but not limited to race, income level, religion and culture. For example, the killing of unarmed, black Americans by the police has been correlated with a decline in mental health among black citizens, especially in the location where the instance of violence occurred (Williams and Etkins, 2020). Additionally, poverty can be both a predictor for and symptom of mental illness (Murali and Oyebode, 2004). There are also times when a patient struggling with psychiatric illness could benefit from meeting with a religious figure, such as a chaplain, or even by introducing some component of spirituality into their daily lives (Cook et al., 2012). Finally, different cultures possess varying definitions of and perspectives on mental health and the ways in which psychiatric illness should be treated; this could impact whether, for instance, a patient is open to going to therapy versus taking psychiatric medication (Eshun and Gurung, 2009). All of these sociological factors should be taken into account when considering the ways in which patients’ mental health could be improved and what forms of treatment would benefit them based on their individual history (Wong and Cloninger, 2010; Zaman et al., 2019). It is also important to note that a patient’s medical history, for example, previous eating disorders, should be taken into consideration when prescribing a course of treatment.

Ultimately, psychiatrists and other mental health care providers must ensure that they consider patient treatment from a holistic perspective to provide a unique combination of psychiatric medication, psychotherapy and wellness interventions for each individual who is experiencing mental illness.

In most cases, introducing wellness interventions into psychiatric treatment plans can only benefit the patient; options such as introducing exercise regimens or encouraging patients to get better quality sleep are both cost-effective and accessible.

Therefore, these wellness interventions serve as convenient, evidence-based forms of psychiatric treatment that may be even more effective than psychiatric drugs or psychotherapy alone. With levels of mental illness increasing globally, it is essential that current models of psychiatric care be reevaluated to consider the health and well-being of individuals, thus improving the overall mental health of psychiatric patients. These wellness interventions must be introduced to the general population as preventative measures in order to ensure that our world remains as mentally healthy as possible. 

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Images

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