When patients seek standard care for depression or other mental health conditionsonly between 55% and 75% feel that their treatment was at least somewhat helpful (Harris 2020). When patients are prescribed an antidepressant, only 50% end up taking the medication as recommended (Sansone 2012). When combined with the fact that depression is one of the leading causes of disability worldwide, it becomes obvious that something needs to change (GBD 2018).

The current system of mental health care often fails to appropriately address the concerns of patients.

There is a desperate need for a more comprehensive system that provides for better outcomes and better meets patients’ expectations.

And yet current resources for mental health care in the United States are dwindling. 70% of practicing psychiatrists are over 50 years old with numerous providers only seeing patients part time. This, combined with decreasing numbers of graduates seeking residencies in psychiatry, is leading to a severe shortage of providers specialized in addressing mental health care (Butryn 2017).

A functional medicine approach to psychiatry has the potential to help step into this growing need. 

Data has long been accruing that mental health conditions often have roots in biochemical and physiological conditions or imbalances that can be measured and addressed. For example, excess inflammation is a common driver of treatment resistant depression (Yang 2019). And for some mental health conditions, treating nutrient deficiencies can lead to markedly better outcomes (Syed 2013).

Understanding the complex interplay between mind and body is the core of a functional medicine approach to mental health care. Identifying nutrient deficiencies, hormonal imbalances, disturbances in the gut flora, inflammatory conditions, genetic abnormalities, and toxicities often provides insight into the underlying causes of poor mental health.

And these causes are treatable.

Over my long career in psychiatry practicing functional medicine, I can attest to the markedly better treatment outcomes that can be achieved through a broader, functional approach, where standard medicine is combined with functional assessment and treatment.

Unfortunately, comprehensive training in a broader approach to mental health care is mostly lacking throughout the country and the world. While there are reputable programs focused on training health care providers in functional and integrative medicine more generally, the need for training in functional mental health care is often cursory or overlooked altogether.

Due to all of these factors combined, the burden of mental health treatment is often falling on the shoulders of primary care providers with minimal training in how to address mental health concerns. And these providers almost exclusively rely on medications to address mental health conditions that provide marginal benefits at best.

The need for a more comprehensive, collaborative model of mental health care that supports and utilizes research-based approaches beyond medications has even been recognized in the research literature (Lake 2017). Some large insurers have also taken tentative steps towards including a more integrative approach, describing a philosophy of whole-person care and openly discussing research-based alternative and integrative medicine treatments (Bellows 2014, Kaiser 2021).

For this transformation to succeed, the training and resources must be available to support such a transition. While Psychiatry Redefined was incorporated, in part, to take on aspects of this challenge, other leading institutions can also help by focusing on training health care providers in functional and integrative approaches for mental health conditions.

Expanding the toolbox to help address patients’ concerns more broadly, when done with the proper training, will improve treatment outcomes.

This can also translate into better job satisfaction and less burnout for health care providers that focus on mental health care. The epidemic of depression, anxiety, and other mental health conditions demands a better, more comprehensive approach.

If things continue as they are, the epidemic will likely only continue to get worse. We need to expand training and resources into functional medicine and functional psychiatry as a part of the solution. We desperately need to raise awareness of the challenges and expand training opportunities in functional psychiatry. Together, hopefully, we can help to jumpstart the transformation of mental health care throughout this country.

References

Harris MG, Kazdin AE, Chiu WT, et al. Findings From World Mental Health Surveys of the Perceived Helpfulness of Treatment for Patients With Major Depressive Disorder. JAMA Psychiatry. 2020;77(8):830-841. doi:10.1001/jamapsychiatry.2020.1107

Sansone RA, Sansone LA. Antidepressant adherence: are patients taking their medications? Innov Clin Neurosci. 2012;9(5-6):41-46.

GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017 [published correction appears in Lancet. 2019 Jun 22;393(10190):e44]. Lancet. 2018;392(10159):1789-1858. doi:10.1016/S0140-6736(18)32279-7

Butryn T, Bryant L, Marchionni C, Sholevar F. The shortage of psychiatrists and other mental health providers: Causes, current state, and potential solutions. Int J Acad Med. 2017;3(1):5-9.

Yang C, Wardenaar KJ, Bosker FJ, Li J, Schoevers RA. Inflammatory markers and treatment outcome in treatment resistant depression: A systematic review. J Affect Disord. 2019;257:640-649. doi:10.1016/j.jad.2019.07.045

Syed EU, Wasay M, Awan S. Vitamin B12 supplementation in treating major depressive disorder: a randomized controlled trial. Open Neurol J. 2013;7:44-48. Published 2013 Nov 15. doi:10.2174/1874205X01307010044

Lake J, Turner MS. Urgent Need for Improved Mental Health Care and a More Collaborative Model of Care. Perm J. 2017;21:17-024. doi:10.7812/TPP/17-024

Bellows J, Young S, Chase A. Person-focused care at Kaiser Permanente. Perm J. 2014;18(1):90-91. doi:10.7812/TPP/13-165

Kaiser Permanente. Natural Medicines. Accessed October 15, 2021.  https://healthy.kaiserpermanente.org/oregon-washington/health-wellness/natural-medicines