Alternative Approaches to Mental Health Care
The use of alternative approaches to mental health care can be substantially helpful to people living with severe mental illness as they cope with fatigue, insomnia, anxiety, and stressors that are often compounded by the serious symptoms and consequences of mental illness. A recent Center for Mental Health Services (CMHS) Fact Sheet, Alternative Approaches to Mental Health Care, describes complementary approaches to mental health care including self-help, diet and nutrition, expressive therapies, acupuncture, yoga, and relaxation and stress reduction techniques; and highlights how these approaches and practices can play an important role in recovery and healing.
Although some people with serious mental health problems recover using alternative methods alone, often people combine alternative approaches with more traditional treatments such as psychotherapy, and perhaps medication. In the medical field, the use of alternative health care practices such as acupuncture, stress reduction, and mind/body interventions have been documented to be effective in the treatment of physical and psychological problems such as hypertension, chronic pain, cardiac arrhythmia, anxiety, and the symptoms of both cancer and AIDS.
In 1992, the National Institutes of Health established the Office of Alternative Medicine (OAM) to “facilitate the evaluation of alternative medical treatment modalities to determine their effectiveness” and to disseminate information about alternative approaches (NIH, OAM Newsletter, 1998). Large-scale random surveys indicate that 30 to 50% of the general population use some form of alternative care (Eisenberg et al., 1993; Landmark Report, 1998; & Astin, 1998). A recent article published by Kessler and his colleagues (2001) supports these figures, reporting that in a representative sample of 2,055 respondents, 66.7% of those seen by a conventional provider for severe depression and 65.9% of those seen by a conventional provider for anxiety attacks also used complementary and alternative therapies.
This issue of Recovery and Rehabilitation describes a current research study that addresses aspects of alternative approaches among people who live with serious mental illness, provides personal consumer testimonies of using alternative practices, and highlights resource information for readers to learn more about holistic healing practices and the use of alternative practices and their effect on recovery.
A National Survey of Alternative Health Care Practices and Their Perceived Effect on Functional Recovery
With funding from the National Institute of Disability and Rehabilitation Research (NIDRR) and the Center for Mental Health Services (CMHS), the Center for Psychiatric Rehabilitation at Boston University has initiated an exploratory study into the role of alternative health care practices in the process of recovery and vocational functioning of people with psychiatric disabilities. This project entitled, A National Survey of Alternative Health Care Practices and Their Perceived Effect on Functional Recovery, is an attestation to the growing number of people using nontraditional practices to facilitate their recovery from psychiatric disabilities. Anecdotal data suggest that such practices often supplement, or serve as an alternative to, traditional mental health and rehabilitation services. Despite the growing interest in alternative treatments, very little is known about their use among persons with psychiatric disabilities. Specifically, questions that arise from literature for which there is no empirical evidence include:
- What are the patterns for use of alternative treatments among persons with serious mental illness?
- Are certain alternative treatments perceived as being particularly effective for mental health consumers and for various diagnostic groups or symptom clusters?
- What are the mechanisms through which alternative treatments can facilitate recovery from psychiatric disabilities?
- Do persons with mental illness who use alternative care integrate that care into traditional care? If so, how?
- Does the use of alternative care among individuals with psychiatric disability present any negative ramifications for rehabilitation and recovery?
- What are the implications of the use of alternative care for traditional mental health care?
To begin to address these questions and issues, this exploratory study is obtaining information about the experiences of people who report benefiting from the use of one or more spiritual and/or holistic healing practices while recovering from a disabling psychiatric condition. Phase one of the study consists of administering a mail survey with a national sample of respondents. In the second phase, in-depth telephone interviews will be conducted with a small sub-sample of the survey respondents who represent diverse experiences in using alternative practices. In addition, interviews will be conducted with the mental health care and rehabilitation providers of selected respondents in order to examine the ways in which both consumers and providers integrate traditional care with alternative practices. It is expected that the study will generate substantial new knowledge and provide the scientific basis for continued work to better understand the effectiveness of alternative methods for the treatment of severe and persistent mental illness.
Reflections from Practitioners of Alternative Approaches
“Over the past 20 years, I have experienced dozens of major life interruptions due to the disabling effects of depression. Recognizing my depression as ‘treatment resistant,’ I finally turned away from relying exclusively on traditional Western medical treatment to explore the benefits of several Taoist alternative approaches, including tai chi, acupuncture, tui na (a treatment in which the healer literally transmits his/her energy into my body to break up and remove emotional blockages embedded in my tissues), shiatsu (acupressure massage), and occasional medicinal herbs. The goal of Taoist arts is to keep energy, chi, balanced and constantly flowing. Since my depression manifested itself, in great part, as a lack of energy, I soon recognized a clear connection between my improved mental health and the study and practice of tai chi. When I began my studies in Taoist energy arts, I heard from several _veteran practitioners that it will gradually alter my body, mind, and spirit if I stay with it long enough. It has, and continues to do so. I am on a journey where, for the first in decades, I now look forward to the future.”
“Meditation has saved my life numerous times. In moments of active suicidal ideation, I have been able to slow my thoughts, calm my mind, and think more clearly about my experience and the nature of my intent, which has helped me to reach out and resist self-destructive impulses while I waited for help and hope. Less ‘dramatically,’ meditation helps me through days filled with anxiety by regulating my breathing, which in turn allows my physical ‘arousal’ to decrease and reduces my anxiety level even more. It is a self-perpetuating cycle.” -Anonymous
“I am a yoga practitioner and the type of yoga that I am doing, Viniyoga, has had a profound impact on my stability, energy levels, and clarity of mind. I can use certain practices to raise energy, and certain other practices to calm agitation. I live with post traumatic stress and depression and have been disabled since 1992. However, I am actually at a point of working sufficiently to end SSDI payments. I need less psychiatric medication and my asthma, which was once chronic, only requires rescue medication 2 to 3 times a year.
My belief is that this is all due to the specific breathing techniques of viniyoga asana (postures) practice to stimulate the vagus nerve. ‘Yoga is the ability to direct the mind without distraction’ using a set of techniques or tools designed to increase one’s ability to meditate and achieve one-pointed focus of the mind. The technologies of yoga are presented in such a way that the religious beliefs are left up to the individual, thus any one choosing to use the techniques can utilize them to further their unique religious path.”-Anonymous
“I am a strong believer in, and user of ‘alternative therapies’ and I have been using them all my life. My mother first introduced me to the study of nutrition and the use of food supplements over 50 years ago. As an adult I have expanded my interest to include massage, acupuncture, homeopathies, and meditative practices.
My first massage was like a gift from God and I continue with a regular schedule of massages-scheduling in an extra session if I am feeling anxious or out of sorts. Acupuncture provides me with relief from chronic physical problems. I use homeopathies on a daily basis to ‘tweak’ my mood and to relieve symptoms that makes me feel less than OK. I see a nutritionist regularly and depend on her analysis of my blood work and how I am feeling to guide me in deciding what I should ‘put in my mouth.’ I have explored all kinds of meditative practices through reading, workshops, and lectures. Those that have been most helpful, I have incorporated into my daily routine including yoga, breath work, deep relaxation, visualization, and working from time to time with my inner guides. I often find answers to pressing problems and issues in my life through this routine. In short, I check out anything that is simple and safe and if it helps I will use it. I also tell others about it. I have found that being open to these options has created great positive change in my life.”
-Mary Ellen Copeland
- Alternative Medicine.com is one of the Internet’s largest databases of alternative medical information including topics related to mental health. A search result for mental health includes types of mental disorders, diet and nutritional factors, nutritional therapy, stress and lowered immune function, diet and nutrition, biofeedback and relaxation techniques, and self-care. This site advertises a magazine, books, and educational programs where readers can acquire more information related to alternative practices.
- The National Center for Complementary and Integrative Health at the National Institutes of Health was established in 1998 to stimulate, develop, and support research on complementary health approaches for the benefit of the public. The NCCIH is an advocate for quality science, rigorous and relevant research, and open and objective inquiry into which complementary health practices work, which do not, and why. The NCCIH Clearinghouse is the public’s point of contact and access to information about complementary practices and NCCIH programs, conferences, and research activities. Services include a toll-free information line (1/888/644-6226), publications, a database, and referrals to other information resources and databases. The NCCIH website also offers many fact sheets and resource information. https://nccih.nih.gov/
- The Wellness Recovery Action Plan (WRAP) developed by Mary Ellen Copeland, MA, MS, is a “structured system for monitoring uncomfortable and distressing symptoms and, through planned responses, reducing, modifying or eliminating those symptoms.” The goal is to teach consumers recovery and self-management skills and strategies. The WRAP includes developing a plan for Daily Maintenance, identifying Triggers and Early Warning Signs, dealing with symptoms When Things are Breaking Down, and Crisis Planning. Intensive five-day seminars to become facilitators of the WRAP are led by Mary Ellen Copeland and her staff several times each year in Brattleboro, Vermont. Consumers, family members, and health care providers are welcome to participate in the training. Mary Ellen’s extensive website provides information related to all of her publications, seminars, newsletter, and research on successful outcomes of Wellness Recovery Action Planning.http://www.mentalhealthrecovery.com/
- Recovering Your Mental Health: A Self-Help Guide, identifies activities and strategies that people can use to help manage their own illnesses and services. This booklet is intended to support and enhance the nationwide focus on self-help for and recovery from mental health problems. It is based on the extensively reported day-to-day experiences of people with psychiatric symptoms, and how they get well and stay well. The booklet offers practical steps that people need to keep in mind as they work on their own recovery. This publication can be retrieved electronically at http://www.mentalhealth.org. Additional copies may be obtained by calling the CMHS Knowledge Network at 1/800/789-2647.
Astin, J. A. (1998). Why patients use alternative medicine. Alternative Medicine, 279 (19), 1548-1553.
Eisenberg, D. M., Kessler, R. C., Foster, C., Norlock, F. E., Calkins, D. R. & Delbanco, T. L. (1993) Unconventional medicine in the United States. The New England Journal of Medicine, 328 (4), 246-252.
Kessler, R. C., Soukup, J., Davis, R. B., Foster, D. F., Wilkey, S. A., Van Rompay, M. I. & Eisenberg, D. M. (2001). The use of complementary and alternative therapies to treat anxiety and depression in the United States. American Journal of Psychiatry, 158 (2), 289-294.
The Landmark Report on public perceptions of alternative care. (1998). Landmark Healthcare, Inc., Sacramento, CA.