Introduction: A Biopsychosocial Model of Care

The past decade has been an exciting one for the field of psychosomatic medicine. It has been recognized as a specialty and now has a certification examination. In addition, fellowships became available under the aegis of the Accreditation Council for Graduate Medical Education, and the selection of fellows became streamlined through the Electronic Residency Application Service.

It may not be entirely coincidental that the timing of these changes has been accompanied by a long overdue awareness, within the health care community and among those concerned about the costs of health care, that untreated mental health care needs are a major factor in poor overall health outcomes and higher costs. Study after study and survey after survey over decades have shown that mental health issues-including disorders such as depression and substance abuse-and behavioral issues that lead to nonadherence shorten lives and raise costs.

An article published in the October 2, 2014, issue of The New England Journal of Medicine reports the results of a 3-generation study of a family troubled by mental and physical illness.¹ The authors note that it “will come as no surprise to primary care physicians that ‘social deteminants of health’ actually determine health.” It is exciting to see the new approaches that are springing up in an effort to broaden access to mental health care, incorporate mental health care into the larger health care system, and truly bring to life the biopsychosocial model of care that has been the goal of psychosomatic medicine for so many years.

In this Special Report, we present 6 articles that discuss some of the approaches that are being taken to special populations within the psychosomatic medicine community. The somatic symptom and related disorders, known as the somatoform disorders in the earlier DSMs, are challenging to medical practitioners as well as psychiatrists and can be difficult to treat. New medical technologies bring new challenges in their wake. We can offer cutting-edge treatments, such as solid organ transplant, to a wider range of patients, or we can keep a frail debilitated patient with multi-organ failure alive-but should we and who should decide?

The gains from new treatments and early detection are leading to longer survival and higher cure rates among cancer patients. This can also present new challenges for patients and those caring for them. Although it may seem unlikely that meaningful psychotherapy could take place in the chaotic hospital setting, where contact may be brief and privacy nonexistent, the crises patients face may actually allow them to be more open to psychotherapeutic intervention.

Finally, we need to consider new approaches and new ways to deliver care if we are to change the outcomes for patients and families such as those described in The New England Journal of Medicine article. Here at Montefiore, a variety of approaches are being taken to integrate mental health care into medical care, and some of these are described. Time will tell which of these approaches will bring us closer to our goal of comprehensive and meaningful care for every patient.

Disclosures:

Dr O’Dowd is Professor of Clinical Psychiatry and Behavioral Sciences and Director of Psychosomatic Medicine at the Montefiore Medical Center in New York. She reports no conflicts of interest concerning the subject matter of this Special Report.

References:

1. Sayer C, Lee TH. Time after time-health policy implications of a three-generation case study. N Engl J Med. 2014;371:1273-1276.