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Mind-Body Dualism: An Outdated Approach to Health Care

Written By : Joe Casciani

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Psychologists have been working in nursing homes for decades, at least since Medicare first authorized reimbursement for mental health services in 1990, and probably before that on a consultation basis. Clinical services have focused on assessment and mental health treatment of psychological disorders in the older adult population, principally with the chronic, long term stay residents.   In recent years, however, there has been a shift in nursing home admissions. The National Hospital Discharge Survey noted a clear trend towards patients being admitted with more acute illnesses, shorter stays after admission from the acute care hospital, and requiring more interdisciplinary care. These patients are not typically admitted for long term placement. On the contrary, they are being treated for acute conditions, such as a hip fracture or a stroke, (though they may have co-existing, chronic conditions), and are often expected to return to independent living after they progress through rehabilitation. And, as a result of their position in these long term care facilities, psychologists are de facto members of the interdisciplinary care team, now working with short and long term patients.

Mental health word cloudWe have long known that mental health professionals are essential in the rehabilitation of medically-ill patients. Rehabilitation hospitals and primary care settings have had psychologists on staff for decades. What is relatively new, however, is the addition of this post-acute, rehab population in nursing homes to the extent that we are witnessing today. These “short stayers” require greater interdisciplinary collaboration, greater involvement of the patient in his own care, and a better understanding that the patient is not isolated from his disease. In order for mental health professionals to work with these patients, we must consider the interactions between the medical and psychological conditions, and emphasize the importance of behavioral health approaches in understanding, assessing, and treating the patient.  How much does the patient’s attitude about his condition impact his recovery? How does his interpretation of the causes of the medical problem color his future outlook? And, how is his motivation to participate in rehab influenced by co-morbid psychological factors, such as depression, hopelessness, guilt, non-compliance, low self-efficacy, denial, or a host of other factors?

Remember, the biomedical model looks at disease in isolation from the patient. The disease is on the center stage. It is independent from the person suffering from it. Each disease has a specific cause and the cause can be correctly determined through enough diagnosis. Viewed in the extreme, the biomedical model does not allow us to look at the actual psychological impact of having an acute or chronic medical illness, and how this impact influences management or recovery from the medical condition.

The alternate model, the biopsychosocial model, says that the body does not function in a vacuum. The mind and body are closely related, such that an imbalance in one leads to symptoms or disease in the other. Further, the biopsychosocial model would hold that, by not looking at the psychological impact of the condition, or the patient’s attitudes and motivations that impact the management of the condition, routine care from a strict biomedical perspective might constitute under-treatment. It is, in effect, treating the patient for a problem without knowing the whole clinical picture.

The mental health professional helps the short term rehab patient in the following ways:

  • helps her understand the emotional impact of the trauma, injury, or disease that led to the need for placement
  • assesses the patient’s values, attitudes, and perceptions regarding plans for the future
  • identifies barriers to participating in and/or benefitting from treatment, and how to overcome these barriers
  • helps families understand their role in bringing about patient change, and to develop realistic goals for the patient.

These behavioral health services, in the nursing home setting, benefit the patients, their families, and the facilities where they are placed. Behavioral health treatment is an important factor in older adult care and mental health in older adults.

Thanks for your interest in the CoHealth Blog series.

Filed under: Mental Health

Written By :

Joseph M. Casciani, PhD, is the founder and President of Concept Healthcare and CoHealth Psychology Services.

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