While the mind-body connection is frequently talked about in therapy circles, the ‘body’ part of the connection is sometimes left out. Most behavioral health professionals know that they should encourage a client to visit a primary care doctor if they suspect there is a physical health condition, but the problem is that many behavioral health professionals do not have a lot of training in health care.
A behavioral health professional may argue that it is not their responsibility to understand different medical problems, and that they have little interest in working on issues that they see as medical in nature.
They may choose to stick with the traditional issues found in mental health. After all, this is why we have physicians and nurses to address those things, right? Well yes, but the answer should be no and there are many reasons why.
For example, it has long been thought that half of all smokers die from tobacco-related diseases, but newer research shows that it may be more than 60%.
And since only 22% of smokers have never had a diagnosable mental health disorder, this issue fits well within our patient population.
On average, people with serious mental illness will live an astonishing 25 years less than the general population and tobacco use is one of the major reasons why. While we rightfully worry about issues such as depression, anxiety, psychosis and addiction to alcohol and drugs, many of our clients are actually dying from something else.
According to the National Institute on Drug Abuse, the majority of alcoholics will die from tobacco-related illnesses and not alcohol-related ones.
In addition to the fact that it is our clients who are doing the majority of the tobacco use, the other main reason why behavioral health professionals need to get on-board in addressing health behaviors is because we are the experts in behavior change, not the majority of the medical profession.
When a primary care provider tells their patient that they are pre-diabetic and weight loss may help them, the provider usually does not personally coach the patient on how they should lose that weight. They may tell the patient to go to a gym, take a walk or take the stairs, but behavioral health providers know that changing behavior usually requires a specific plan that also includes reinforcement.
It may require identifying triggers and stepped goals. We have the ability to help our clients make changes that may truly save their lives.
I do not want my clients to work their way through the dark days of depression and anxiety, only to die 25 years before their time from a preventable disease.
We usually ask medical questions on our intake forms; certainly it would not hurt to take a few minutes to determine if there is some aspect of the client’s health with which we can assist. The client may be very happy and surprised that you asked because they may be unaware that you can help.
The main chronic diseases that cause the most death and disability in our country have all been linked to co morbid mental health conditions and together these issues lead to higher mortality rates.
Cardiovascular disease, diabetes, stroke, COPD and cancer have all have been correlated to mental health disorders such as depression or anxiety.
People with epilepsy have a serious increased risk of suicide compared to the general population. Ask yourself, when looking through your intake form, would the patient’s disclosure that they have epilepsy alert you to be aware of the suicide risk? It is safe to say that many behavioral health professionals would not be aware.
When I say “behavioral health,” I not only mean mental health or substance abuse, but also general medical conditions that are influenced by a client’s health behaviors or can impact the patient’s mental health. So, in my opinion, diabetes is a behavioral health issue because in some cases, a person’s health behaviors leads to the development of the disease.
We should use our expertise in helping clients change behaviors to address these chronic health conditions.
I would recommend skipping yet another training on motivational interviewing and finding some basic training on common medical conditions, especially those that are linked to health behaviors. The SAMSHA-HRSA Center for Integrated Health Solutions is a great place to start your search.
Be advised that your conversations with your clients will look differently after you begin incorporating these discussions in your practice. You will not just skim over the medical questionnaire anymore. Your clients may appreciate that you care about their entire self, which could lead to deeper conversations.
Nobody is asking you to practice medicine, only to use your already developed behavioral change skills for a broader purpose.
The good news is that all of that motivational interviewing training can be put to very good use when working with patients on the medical and mental health issues that greatly influence each other.
Robin J. Landwehr, DBH, LPCC, NCC is a Licensed Professional Clinical Counselor in North Dakota. She works full-time at a Federally Qualified Health Center as a Behavioral Health Integration Coordinator.
Goodell, S., Druss, B.G. & Walker, E.R. (2011). Mental disorders and medical comorbidity. The Synthesis Project: Policy Brief, 21. Retrieved from http://www.integration.samhsa.gov/workforce/mental_disorders_and_medical_comorbidity.pdf
Miller, G.A. & Williams, J.M. (2014). Smoking and mental illness: What every prescriber needs to know [PowerPoint Slides]. Retrieved from http://www.nysmokefree.com/ConfCalls/CCNYSDownloads/11292012/11292012Presntn.pdf
National Institute on Drug Abuse (2012). Tobacco use and comorbidity. Retrieved from https://www.drugabuse.gov/publications/research-reports/tobacco/tobacco-use-comorbidity
Sax Institute. (2015, February 24). The numbers are in: As many as two in three smokers will die from their habit, Australian study concludes. ScienceDaily. Retrieved July 17, 2016 from www.sciencedaily.com/releases/2015/02/150224083704.htm
Shafter, P.O. & Sirven, J.I. (2013). Suicide Risk. Epilepsy Foundation. Retrieved from http://www.epilepsy.com/learn/impact/mortality/suicide-risk
Weir, K. (2013, June). Smoking and mental illness. American Counseling Association, 44(6). Retrieved from http://www.apa.org/monitor/2013/06/smoking.aspx