Penicillin. Cardiac stenting. Insulin. CT imaging. The medical community has achieved many breakthroughs over the past 100 years. But how much farther can we advance without incorporating behavioral health care into the management of physical conditions?
Behavioral health problems such as depression and anxiety are increasingly shown to precede physical health problems – and hold the key to a patient’s recovery.
Brian Rothberg, MD, is associate professor of psychiatry at the University of Colorado. As a certified group psychotherapist through the American Group Psychotherapy Association and a group leader for 10 years, Dr. Rothberg is ready to widen his net.
“Initially the majority of my patients had behavioral health disorders such as depression, bipolar disorder and anxiety,” he said. “Now we’re expanding to individuals with substance use disorders.”
However, Dr. Rothberg is not willing to stop there. He is at the forefront of a movement to integrate behavioral health care with physical health care.
“The dichotomy between physical and behavioral health is somewhat false,” he said. “Physical health issues are known to affect behavioral health, and vice versa. Separating the behavioral and physical worlds is to the detriment of some populations; patients with schizophrenia, for example, die on average 25 years earlier than the general population.”
Dr. Rothberg is involved in a joint project between the Departments of Neurology and Psychiatry, where he is working with patients who have non-epileptic seizures. Here, his main treatment is a group intervention lasting for 12 sessions.
“Group therapy is about empowering people to help not only themselves, but also each other,” he said. “People are usually somewhat anxious to join groups; deep down they’re not sure if they will be accepted.”
However, Dr. Rothberg’s experience of working with the non-epileptic seizure program has been profound.
“Many if not all of our members were so isolated and lonely as a result of their disorder that their reaction in connecting with each other was quite remarkable.”
“Logically, a person may understand there are others out there who face the same challenges, but emotionally there’s a disconnect. It takes meeting in person for the change to take place, and it’s a real honor for me to connect them.”
Robert Feinstein, MD, professor of psychiatry and vice chair for clinical affairs and education, explains that Dr. Rothberg’s contribution to this pilot has been invaluable.
“Dr. Rothberg’s development of our entire group program has been exceptional,” he said. “His patient-centered group program has dramatically increased access to behavioral health care, providing both short- and long-term care for patients with trauma, co-occurring substance use and mental health disorders, personality disorders and severe and persistent mental illness.”
“As a talented educator, Dr. Rothberg brings a wealth of psychotherapy skills to patients, staff and trainees, making sure that every member of our diverse group offers varied forms of treatment,” Dr. Feinstein explained. “This includes medication along with supportive psychotherapy, psychodynamic therapy, mindfulness, dialectical behavioral group therapy and trauma-informed groups.”
Dr. Rothberg states he has always been fascinated by group dynamics, and says that while the non-epileptic seizure program represents an exciting expansion of his role, it has also proved challenging.
“It is extremely rewarding to see people getting the care they need, whatever clinic they are in,” he said. “But at the same time you realize there are always administrative challenges involved in a project like this – scheduling, billing, logistics. One of the major challenges has been financial, regarding the way these types of services have been and continue to be reimbursed. As health care changes from fee-for-service to a population-management model, I hope we can overcome some of these barriers.”
Aside from the primary benefit of providing the right care to the right population, Dr. Rothberg hopes the integration of physical and behavioral care will lead to other advantages.
“Expanding our services and education means increased understanding about different populations. We as clinicians sometimes harbor stereotypes of people with behavioral illnesses, but by building connections between clinicians and departments we may be able to overcome some of these stigmas.”
And since robust psychological health is known to be a protective factor against diseases such as cardiovascular disease, cancer and diabetes, such connections might be the key to addressing many non-communicable diseases.
“It is only with better integration that we can help clinicians and patients understand how someone’s psychological health is intimately connected to their physical health,” said Dr. Rothberg. “Each aspect works in concert with one another, and cannot be separated.”
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