Commentary

Differing views of ‘behavioral health’


 

In the wake of Dr. Nasrallah’s recent editorial “Stop calling it ‘behavioral health:’ Psychiatry is much more” (From the Editor, Current Psychiatry. June 2020, p. 9-7,38), we offer an alternative viewpoint as members of a multi­hospital (academic and community), multifaceted, multidisciplinary behavioral health institute.

Naming a field, institute, department, or group of collaborators is crucially important, and must be undertaken with care. We all are familiar with Departments of Psychiatry, Departments of Psychiatry and Psychology, and Institutes for everything from Behavioral Health to Living. Even within the discipline of psychiatry, there have been adjustments over time in subspecialties (as seen with consultation-liaison psychiatry becoming psychosomatic medicine and then back again).

In our hospital system, we have recently adopted the term “Behavioral Health Institute” to denote the work and worth of significant numbers of caregivers (psychiatrists, psychologists, chemical dependency counselors, social workers, child life workers, advanced practice nurses, and others) who strive to improve the health and well-being of patients with both substance abuse and mental illness. We endeavor to remain mindful that a diversity of providers are involved in caring for and about our patients, and that “psychiatry” cannot—and should not—be the extent of how we conceptualize our services.

We submit that the modern view of behavioral health is ahead of other fields of medicine in recognizing that concepts, such as teamwork and diversity, are key to achieving positive patient outcomes. By identifying our providers as part of a Behavioral Health Institute, we acknowledge that not all mental distress is psychiatric illness but may still benefit from intervention and, importantly, that psychiatrists are not the center of the mental health (behavioral health) world. Treatments ranging from medication management to psychiatric procedures to psychotherapeutic modalities show the depth and breadth of our field, and the multiplicity of providers and modalities should be considered laudable. Recognizing the complexities inherent in behavioral health and its varied treatment options does not diminish but, in fact, elevates the field of psychiatry—and psychiatrists themselves.

Further, we note that behavioral health is not the only term that casts a larger net than the physician in a respective field. Does the term “primary care” insult internal medicine, family medicine, and pediatric physicians? Physicians and health care teams join in partnership with patients and families, either to cure or learn how to manage disease. We believe that constructing a health care system centered on physicians and their identities, rather than on patients and treatment outcomes, has been foolish. To that end, the tenor of Dr. Nasrallah’s editorial runs counter to the overall efforts of our field to improve collaboration, and, at its extreme, such articles promote the antiquated notion of physician elitism.

The editorial’s historical context is of course important, and the caution not to water down what “we” do (as psychiatrists) is appropriate. However, instead of comporting ourselves in a psychiatry-centric way, the use of the term behavioral health allows all of us to acknowledge (with appreciation and humility) the many contributors who work in our field. The use of a broad-minded, inclusive term neither minimizes nor trivializes psychiatry as a medical specialty. Rather, accepting this term and this mindset can place psychiatrists in the unique role of being innovators for the rest of medicine, because we embrace multidisciplinary teams and the value that interdisciplinary care can bring to patients and colleagues alike.

Jeanne Lackamp, MD, DFAPA, FACLP
Director, Pain Management Institute
University Hospitals Health System
Case Western Reserve University School of Medicine
Cleveland, Ohio

Patrick Runnels, MD, MBA
Chief Medical Officer, Population Health – Behavioral Health
University Hospitals Health System
Case Western Reserve University School of Medicine
Cleveland, Ohio

Lori Locke, RN, MSN
Director, Psychiatry Service Line and Nursing Practice
University Hospitals Health System
Case Western Reserve University School of Medicine
Cleveland, Ohio

Erum Ahmad, MD
Director, Child and Adolescent Psychiatry Unit
University Hospitals Health System
Case Western Reserve University School of Medicine
Cleveland, Ohio

Robert Ronis, MD, MPH
Douglas Danford Bond Professor and Chairman
Psychiatrist-in-Chief
University Hospitals Health System
Case Western Reserve University School of Medicine
Cleveland, Ohio

Continue to: Dr. Nasrallah responds

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