Gold-Standard Behavioral Health Care: The Importance of Collaboration between Therapists and Psychiatrists - Humantold

Gold-Standard Behavioral Health Care: The Importance of Collaboration between Therapists and Psychiatrists

Landon Coleman, DNP, PMHNP-BC February 15, 2024

Healing through engaging in behavioral health treatment and medication is most effective with holistic, thoughtful collaboration of providers.

Seeking behavioral healthcare can be a confusing and daunting process, but the effort is worth it when you are able to find the right behavioral healthcare team for your specific needs. This may seem obvious, and yet there is something unique about seeking behavioral healthcare that differs greatly from seeking routine medical care. Healing through engaging in behavioral health treatment requires the sharing of many topics that may be very personal and private, which is why it can be especially important to find a clinical team that matches and supports your unique needs, especially if you are seeking to incorporate medication into your care plan, alongside therapy. The collaboration between psychiatrists and psychotherapists is a fundamental aspect of comprehensive client care and is considered to be the gold-standard evidence-based approach to providing the utmost quality of behavioral health care services. Both professional groups bring unique skills and perspectives to the table, contributing to a holistic approach that addresses the multifaceted nature of mental health issues. Collaborative efforts allow for a more thorough examination of a patient's condition and different healthcare professionals bring diverse expertise, leading to better-informed diagnoses and more effective treatment plans. In this blog post, we’ll explore the importance of collaboration between mental health counselors and psychiatrists and why we have blended the two with Humantold and Carnegie Hill Psychiatry staff. 

So, who does what exactly? 

Psychiatry providers, whether medical doctors or nurse practitioners specializing in psychiatry, play a pivotal role in the realm of mental health care. Their responsibilities go beyond traditional behavioral health assessments by extending into the domain of medical physiology and pathophysiology. 

Employing their deep understanding of medical physiology and pathophysiology, psychiatric providers are able to employ a multifaceted approach to assess and diagnose mental health conditions. One important difference that sets psychiatric providers apart from their psychotherapy counterparts is the comprehensive psychiatric evaluation. This evaluation must also include a medical assessment (and ongoing monitoring during follow-up encounters) of the 11 body systems (Cardiovascular, Digestive, Endocrine, Integumentary, Lymphatic, Muscular, Nervous, Reproductive, Respiratory, Skeletal, and Urinary; see image below) while psychotherapy providers do not (unless they have the appropriate certification). Psychiatric providers conduct other services, such as clinical interviews and psychological assessments, but these are not services unique to only psychiatric providers. 

Both psychiatric and behavioral health psychotherapy providers rely on the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) for identifying an accurate diagnosis. However, psychiatric providers have an added responsibility within the DSM-5. The majority of DSM-5 diagnoses necessitate a "medical rule-out" (process of demonstrating that a condition is NOT due to an underlying medical condition or substance use disorder) to correctly validate the behavioral health diagnosis as accurate. The additional medical background role of psychiatric providers serves a crucial purpose – preventing the misdiagnosis of medical condition as behavioral health disorder. With this sometimes being a nuanced aspect of their role, it is crucial. Recognizing that certain medical conditions can manifest with symptoms resembling behavioral health conditions further assists in preventing a misdiagnosis. Psychiatric providers are able to recommend and order several different medical services (labs, Radiology, etc.) that further assist in the assessment and diagnosis process. The only outcome for a misdiagnosis is ineffective treatment. 

Take, for instance, the evaluation of thyroid disorders. Hypothyroidism frequently manifests with depressive symptoms, while hyperthyroidism can present as agitation, impulsivity, or even mania. Psychiatric providers recognize the importance of addressing underlying medical conditions before substantiating and validating a behavioral health diagnosis. Administering psychotropics without addressing the underlying Thyroid disorder may not be clinically indicated and also may cause serious harm to the Client. Psychiatric providers navigate these complexities, ensuring a holistic understanding of the client's health.

Personal Success Story (and why I love my profession)

A perfect example of a medical condition masquerading as an endocrine disorder would be a situation that I experienced as a provider while on active duty in the military. I received a new client on the inpatient psychiatric ward who had been on deployment with his combat unit in Afghanistan. A few months into his deployment his behavior changed abruptly. This particular soldier previously had a very good reputation as a young soldier, and many of his leaders were expecting great things from him and his career. The report from the Client's command revealed that the Client had a sudden onset of unusual behavior; he became impulsive, disrespectful, confrontational, damaged a 5-ton military vehicle due to negligence, and several other militaries "no no's." By the time he reached the ward, his command had already started the administrative paperwork for a dishonorable discharge, an unfitting end for what was once a stellar soldier. 

During a standard initial history taking assessment upon his arrival, I found something very disconcerting. Although the Client had seen several medical and behavioral health providers prior to arriving to my location, a critical lab result had been missed by all. The Client experienced what is called a "Thyroid Storm," a severe and potentially life-threatening hyperthyroidism diagnosis, and his thyroid was essentially running itself to the point of exhaustion. We were able to quickly get him established with an Endocrine specialist to address his thyroid. He was not Bipolar, as the multiple medical reports stated. This was an underlying medical condition that resulted in symptoms frequently associated with bipolar manic or hypomanic symptoms. He was placed at risk because he was started on multiple psychotropics for a bipolar disorder that he did not have. That was bad enough, but his career was also over. 

Regarding his career, there was nothing I could do to stop it due to military administrative policies. Through lobbying with several peers, we were able to provide the evidence required for his discharge to change from a pending dishonorable to a general discharge, which was very important. This meant he was not going to lose his military and veterans benefits, as occurs with dishonorable discharge. 

This is just one example from one provider. Within and throughout Carnegie Hill Psychiatry and Humantold, you will find a vast number of amazing providers with the skills and patience to comprehensively examine patients effectively.

Why Collaborate?  

Ongoing communication between psychiatrists and therapists is essential in the coordination of the highest quality of comprehensive behavioral healthcare. This process involves regular updates on a client's progress, changes in symptoms, and any emerging concerns help ensure coordinated and effective care. Collaboration between psychiatrists and psychotherapists aims to empower clients by providing them with a range of therapeutic options, and clients are actively involved in decisions regarding their treatment. The collaboration is also particularly beneficial in preventing relapses in treatment. 

Psychotherapy providers, such as psychologists, social workers, or counselors, conduct thorough assessments focused on understanding the psychological and emotional aspects of a person's well-being. While therapists do not prescribe medication, they collaborate with psychiatrists by providing valuable information on the client's progress, side effects, and any concerns related to medication. If adjustments to medication or therapy are needed, the collaboration between all team members allows for a timely and informed decision-making process. Therapists can also assist clients in understanding the role of medication or promptly alert their psychiatric counterpart (collaboration). Psychotherapists specialize in various therapeutic modalities (such as CBT, DBT, EMDR, and others) and engage in psychotherapy or counseling sessions to address emotional and behavioral challenges, provide coping strategies, and promote personal growth. While some psychiatrists also provide psychotherapy, it is not their primary role. 

Putting it all together 

Despite these differences, both psychiatrists and therapists contribute to educating clients about their mental health conditions, treatment options, and self-care strategies. The unique blend of behavioral health expertise and medical knowledge equips psychiatric providers to offer a nuanced and comprehensive approach to mental health care. Their role extends beyond behavioral health diagnoses, encompassing a thorough consideration of medical factors to provide accurate and effective treatment. By incorporating these refinements, it emphasizes the critical role of psychiatric providers in ensuring accurate diagnoses and navigating the intricate interplay between behavioral and medical aspects of mental health. 

In summary, the collaboration between psychiatrists and therapists is a synergistic partnership that enhances the overall quality of mental health care. By combining their expertise, these professionals create a more comprehensive and tailored approach to address the diverse needs of individuals seeking mental health support. Carnegie Hill Psychiatry has brought a large team of highly trained psychiatric providers. With this addition to Humantold, potential Clients will have access to an expansive variety of treatment options and interventions based upon the highest levels of research studies and each provider's professional experience. If you are interested in starting the process for healing, there is an amazing behavioral health team standing by to assist you at Humantold.

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