Biopsychosocial Model Offers Better Approach to Medical Integration

Behavioral healthcare executives need a clinical orientation in our diverse, yet stigmatized field. Our healthcare services are uniquely multi-dimensional, and yet stigma impedes access and brings needless shame. A biopsychosocial approach is a broad, impartial orientation that welcomes all subspecialties. It can be a reliable anchor for executives, supporting business growth and the defeat of stigma.

A clinical orientation exists at a higher level of abstraction than diagnostics or treatment. The biopsychosocial approach recognizes major categories of healthcare, but it is an orienting perspective rather than a body of knowledge. The creator of this approach, Dr. George Engel, conceived it as a useful model for all medical providers:

The model does not add anything to what is not already involved in patient care. Rather, it provides a conceptual framework and a way of thinking that enables the physician to… become more informed and skillful in the psychosocial areas.

How is this perspective well-suited for executives? Psychiatrists may see mainly biology, or therapists mostly psychology, but executives need an all-encompassing perspective. They are conductors of a full orchestra. Executives need higher order concepts, not for understanding individual patients, but to perceive populations, systems and trends.

The biopsychosocial orientation was conceived by a psychiatrist, and yet few psychiatrists actively embrace it. PCPs are more likely to see its value today. They face the urgency of health behaviors and comorbid behavioral issues in their practices. PCPs are learning that there is a behavioral element of some importance in the genesis or treatment of every condition diagnosed in primary care.

This focus by PCPs leads many to welcome behavioral clinicians into their practices. Yet this will be maximized only when behavioral executives explore opportunities from both clinical and business perspectives. Given the ubiquitous need for thinking about behavior change, our executives should negotiate a more coequal partnering in primary care. PCPs will need help to see our full value.

Stigma has been one of the major, pernicious roadblocks to our field, adding an unwarranted layer of pain for clients and their families. Years of anti-stigma education have had limited impact, and a more comprehensive structural route is needed. The private, isolated settings of behavioral healthcare nurture stigmatizing beliefs in ways that primary care might dissolve. It is routine, general care for all.

This institutional shift for our field, from specialty status to core primary care dimension, would also bring the biopsychosocial orientation center stage to orient all care. For example, it prompts the PCP to ask new questions (e.g., why did the patient cut himself?) and explore personal conflicts for deteriorating patients (e.g., unstable diabetes with anxiety and drinking). They will need help in this.

The biopsychosocial orientation offers other advantages for stigma. We currently rely on a medical view of extreme psychiatric disorders and present them as being “like other diseases.” This traditional focus of anti-stigma campaigns leaves behind common misery, dangerous drinking and the multitude of less urgent needs requiring psychotherapy, addiction counseling and other psychosocial services.

The biomedical model is even more limited. It offers valuable care for many with severe psychiatric symptoms (e.g., psychosis, mania), and yet it is only one of the restorative services many patients value. The biopsychosocial orientation not only recognizes the importance of various psychological therapies, but it also embraces how peer counseling helps many lead resilient, highly functional lives.

Our executives know that integration is a pressing need closer to home. Mental health, substance use and health behaviors are separate domains that need clinical integration upon the removal of historical silos. Here again the biopsychosocial approach has value. Our patients experience the consolidation of these problem areas, and so every clinician should be prepared to address these interconnections.

This orientation may seem less impactful than the biomedical model. Those with depression and addiction may prefer the non-judgment of confronting a disease. We surely must banish ideas like character defect and moral failing. Biomedical ideas are attractive in their hope for cure. Yet the biopsychosocial orientation is experienced powerfully every day as a reality, not a distant hope.

Executives function as leaders and unifiers at different times, and the biopsychosocial orientation supports each role. We will be integrated into multiple healthcare settings over time as medical owners seek synergies between our services and theirs. We cannot easily do this under the biomedical banner. It slights the array of psychosocial tools we offer, and it minimizes some important ways people heal.

Ed Jones, PhD, is senior vice president for the Institute for Health and Productivity Management.