May is Mental Health Awareness month, an opportunity to highlight our society’s progress toward a more accepting attitude about mental health and mental illness, as well as the continued need for increased awareness.
The mind, body, and spirit collaborate interdependently within us like notes in a musical chord; when a person is disintegrated, dissonance results in the form of illness from the fragmentation of interdependent parts.
Just as musical dissonance is obvious to those who hear it, illness presents itself disharmoniously to those who are living in tune with the community. It remains quite a challenge to destigmatize mental illness from the shame our culture has placed on those who experience it, and yet we are hopeful for the day when receiving treatment for mental health is as understood and accepted as receiving treatment for physical ailments.
An Integrated Approach
Mental healthcare is part and parcel of patient care at Alliance Medical Ministry.
Since our inception, Alliance has offered care to address the mind, body, spirit interconnections of our patients via pastoral care services through chaplain interns from Duke Divinity School. In 2010, we created our Pastoral Care and Counseling services with a chaplain on staff. Since 2013, we have cultivated a more comprehensive staff and volunteer team of psychotherapists including pastoral counselors, psychologists, social workers, marriage and family therapists, and a psychiatrist. With an uninsured patient population, Alliance has developed a collaborative approach to patient care by integrating mental healthcare directly into a primary care setting.
Psychotherapy was born from the theories and clinical practices of Sigmund Freud. The Greek term “psyche,” from which Freud coined his psycho-analysis, however, represents the complexity of an “embodied soul,” a much more unified understanding than our modern connotations of an exclusively mental emphasis. “Psyche” does not separate a person into parts, as do the words “pneuma” (spirit) and “soma” (body). Thus, treating the “psyche” involves treating an embodied soul, not simply one’s mental state.
At Alliance, we strive to treat our patients as embodied souls created in the image of God with whom we can collaborate to address the interconnections of their physiological, psychological, environmental/social, and spiritual lives.
The Challenge & Our Approach
Within the historical primary care framework, physicians solely treat a patient’s physiological makeup, often without having communication or collaboration with the patient’s mental health practitioner(s). In a traditional primary care setting, a physician may grow concerned about a patient's mental health and make recommendations for area mental healthcare providers. However, the burden ultimately falls on the patient to navigate issues of cost, health insurance coverage, convenience, mental health expertise, as well as generally overcoming the stigma of seeking mental health care.
For uninsured patients, the ‘follow-through’ is even more complex with far fewer affordable mental health options. Patients must take time from work to research available providers, determine co-pay, make an appointment, find transportation to the provider, complete the appointment, and determine financial resources to pay for any prescribed medication.
Alliance removes many of these barriers by providing our patients with access to free, on-site mental health options. Having mental healthcare providers onsite in a primary care setting normalizes mental health care as synonymous with patient care. As our primary care physicians address patients' physiological needs, they can collaborate with our mental health providers and patients in addressing mental health, directly referring (often immediately) patients for on-site counseling, and creating an integrated care plan toward wholeness.
When primary care moves toward addressing patients as integrated beings, it incorporates more of its patients’ unexplored stories and understands better how relationships, conflicts, and communities impact health and healing.
At Alliance Medical Ministry, we strive to create relationships in which our patients are empowered toward self-care and healing. Relational approaches to mental healthcare have moved toward creating a collaborative environment in which providers and patients journey together to empower patients to participate in their return to wholeness rather remaining in a condescending hierarchical relationship of superiority and inferiority. Patients become teachers of their tremendous stories of pain and resilience, and we providers listen with curiosity to understand so we work together with our patients toward their wellbeing.
An Opportunity for Healing
Having time with a counselor at AMM is an opportunity for our patients to journey with someone into the depths of oneself to discover brokenness, stifling patterns, and unhealthy tendencies, as well as virtues of courage, perseverance, character, and resilience that they did not see in themselves. Encountering someone willing to sit and listen attentively without judgment is a gift that not many of us have in our lives, and our patients routinely reveal to us very intimate hurts and sacred moments that they have never shared with anyone. At Alliance we offer relationships of time, presence, and care to empower our patients and encourage their collaboration and self-participation in their healing.
As we explore deeper into our patients’ lives, we discover stories of disintegration that have led our patients’ dis-eases. Many of our patients have experienced overwhelming trauma that have greatly disrupted their health to the point of fragmenting their minds, bodies, and spirits. Painful events that disrupt wholeness render us scattered, afraid, unable to process, and at times unable to articulate the deep, dark, suffering moments and places within, where we can remain stuck. In a safe, caring environment of a nurturing relationship, we can find connection and begin the process of reconnection.
We often treat patients who lack access to basic human needs, and face particular barriers that make them more susceptible to illness and disease. Maslow’s hierarchy of needs highlights how far from self-actualization patients without access to their basic needs, including rest, food, safety, etc.) remain.
Through social workers and community partnerships we can assist our patients with addressing these basic needs, such as prescription medication, food, transportation, improved employment, childcare assistance, and immigration issues.
A community that is disintegrated is dis-eased and ill. When individuals find safe environments of care in which they can reveal themselves and become reintegrated with themselves, they can heal and become reintegrated into the community. The Christian gospel accounts document that Jesus’ healings returned his care recipients to wholeness in mind, body, and spirit, and consequently restored them into community, no longer defined by illness or outcast from society as unclean. Similarly, the practice of Shiva in the Jewish faith ends with a return of the bereaved to community.
Peter Drucker famously shared a story that has become a parable about the kind of vision necessary to be an effective leader:
“A man came across three stonecutters and asked them what they were doing.
The first replied, ‘I am making a living.’
The second kept on hammering while he said, “I am doing the best job of stonecutting in the entire county.”
The third looked up with a visionary gleam in his eye and said, ‘I am building a cathedral.’”
When we approach community collaboratively, we recognize that until all are healthy, we remain a sick community. It takes more time and effort than the culture offers in most primary care settings, but at Alliance we are not simply doing the best job of managing patient symptoms, we are striving toward a healthy community.
Toby Bonar, Psy.D, M.Div., CFBPPC
Director of Pastoral Care & Counseling
1 Cooper-White, Pamela. Many Voices: Pastoral Psychotherapy in Relational and Theological Perspective (2007).
2 Drucker, Peter. The Practice of Management (1954).