What does it mean to integrate care between psychology and food?
Everywhere we look people are talking about what it means to eat “healthy” and be aware of our food. We hear of “foodies,” new diet trends, and the way students are getting sassy about the First Lady’s school lunch program (#ThanksMichelleObama). We are letting others talk about human behavior and food nutrition in ways that mental health professionals (the experts in human behavior) and dietitians (licensed experts in nutrition) should be running the show. Celebrities help by bringing attention to the issue such as actor Jeff Bridges, NY Times contributor and cook book author Mark Bittman, and a coalition of Food Network’s chefs fighting to end childhood hunger. But in the end, mental health professionals should be more involved in the work that dietitians do and in the food movement in general.
Poverty is a big issue in American families. Poverty impacts food intake. Food intake impacts human development.
- The impact of malnutrition on development is a serious issue as it can limit physical and cognitive growth as well as a child’s ability to fight disease1. Mental health providers working with impoverished families cannot underestimate the impact of malnutrition on children and may need to work with a dietitian to seek appropriate care for the client. Need a lesson about just how draining poverty is on our brain and body? Check out this infographic to put it all in perspective.
- Family dinners are not about bringing back June and Ward Cleaver. They’re about something more, such as encouraging good communication, time management skills, togetherness, and cohesion. Eating dinner together as a family has been going out of style for the last century or so for a variety of reasons, including offering fewer home economics classes in schools2. I’ve written about this before in the APA Center for Excellence Newsletter in citing how workplaces can do more to send employees home for dinnertime. Ever wondered what it would be like for psychologists to offer sessions around a dinner table? That’s another story for another time….
- Dietitians deal with poverty every day because it can go hand in hand with obesity. Obesity can signal a family’s inability to access and afford healthier, more nutritious foods. Check out the movie A Place at the Table for a look at this issue. Furthermore, when I spoke to a clinical psychologist who works in a weight management clinic, she described her job as helping to address barriers to healthier eating, including examining a family’s access to food. Poverty is an aspect of diversity. It is a psychologist’s job to understand all aspects of diversity.
Some amazing programs already exist that combine food and psychology, sometimes without the steady contribution of dietitians or psychologists. We can do more to research, understand, and create programs to make it easier for dietitians and mental health providers to work together.
- Using a combination of psychoeducation and experiential learning, a team3 used cooking classes to help clients with diabetes better manage their symptoms. By increasing self-efficacy, clients had a better likelihood of maintaining healthy eating patterns. After all, a diabetes diagnosis can predict frequent health care appointments, often clogging an office’s resources and perhaps suggesting that preventative and psychological care is needed to address motivation and healthy eating4.
- To increase students’ sense of self-competence and encourage pro-social behavior, schools in Tennessee created a job-training program in food preparation5. To top it all off, the food that is prepared is served at community soup kitchens. That’s a win-win for mental health and the community.
- Incarcerated women facing drug related charges in San Francisco can learn how to cook and shop for healthy foods and it may be leading to lower levels of recidivism6.
- The Wall Street Journal recently published a piece about the benefits of cooking and using time in the kitchen towards treating mental health concerns like anxiety and depression by providing an increased capacity towards self soothing and positive thinking7. There’s a reason cooking is considered a coping skill.
What can mental health providers and dietitians do in the future?
For starters, each field can try harder to understand and utilize each other. When I spoke to two registered dietitians (RDs), they referenced their extreme respect for the field of psychology and the skills psychologists bring to the table. One of them noticed that psychologists in her treatment team are often the least versed in medical issues. The two RDs also felt they had received zero training in how to collaborate their care with other disciplines.
This reveals two suggestions for a future relationship between the two disciplines: provide training to all healthcare disciplines in models of collaborative care and train students in the mental health field about implications of medical diagnoses. For example, educators and training directors in graduate programs can create practicum sites at places where dietitians work or in sites that are more medically oriented. In addition, in some mental health graduate programs, students have the ability to forge relationships with training sites with whom the school had not previously communicated. Students in these programs may have more latitude in creating practica experiences with a patient-centered medical homes (PCMH).
The National Committee for Quality Assurance (NCQA) is the accrediting board for healthcare organizations committed to the model of PCMHs. These models are working and they are becoming more popular8. The goal of a PCMH is for providers to talk to each other so the patient has a better outcome, which should include better nutrition. But how often are dietitians working in these PCMHs and how easy is it for them to do so? For example, the American Association of Diabetes Educators has suggested that dietitians educate themselves in the PCMH model as the first line of advocating for their inclusion in the treatment team9.
Secondly, dietitians who already serve as a member of a diabetes care team are familiar with the integrated style of a PCMH and have received credentialing as a Certified Diabetes Educator (CDE). If dietitians were interested in and in possession of such a CDE, it may be easier to become a member of the PCMH, as their skills in treating diabetes would be highly needed. This could be organized in different ways, such as encouraging PCMHs already in practice to look to how physical medicine rehab teams have already begun integrating dietitians into their treatment teams.
Lastly, psychologists and dietitians can also take a greater stand on policy issues. For example, I recently took myself over to a Philadelphia Food Policy Advisory Council meeting. What’s a food policy council, you ask? It’s a combination of chefs, land use planners, lawyers, politicians, poverty advocates, managers of food banks, urban farmers, etc. that come together to create unique solutions to food systems problems. The Philadelphia council meetings are open to the public and at this meeting in particular, Philadelphia’s Mayor Nutter was in attendance. I was thrilled to briefly introduce myself and discuss the need for psychologists to be involved in the food systems movement.
As other attendees introduced themselves, I was surprised that no other dietitian or mental health professional was at the meeting. Afterwards, one attendee approached me, handed me his business card and expressed a desire to learn more about behavior change. I believe that the attendees at these meetings want and need more information from both dietitians and mental health professionals to help solve food systems issues. Go to a meeting. After all, many mental health professionals are trained in the art of systemic thinking and creative problem solving. The food movement is a food system. We have skills to bring to this systems issue.
1. Berk, L. (2012). Infants and children: Prenatal through middle childhood (7th ed.). Boston: Pearson Allyn & Bacon.
2. Cunningham-Sabo, L. & Simons, A. (2012). Home economics: An old-fashioned answer to a modern day dilemma? Nutrition Today, 47(3), 128-132.
3. Archuleta, M., VanLeeuwen, D., Halderson, K., Jackson, K., Bock, M., Eastman, W….Wells, L. (2012). Cooking schools improve nutrient intake patterns of people with type 2 diabetes. Journal of Nutrition Education and Behavior. 44(4), 319-325.
4. Savageau, J., McLoughlin, M., Ursan, A., Bai, Y., Collins, M., & Cashman, S. (2006). Characteristics of frequent attenders at a community health center. The Journal of the American Board of Family Medicine, 19(3), 265-275.
5. Long, C., Page, J., Hail, B., Davis, T., & Mitchell, L. (2003). Community mental health—in an alternative school, in the public schools, and in the kitchen! Reclaiming Children and Youth, 11(4), 231-235.
6. Novak, L. (2006, November 13). Not just peeling potatoes. The New York Times, p 20.
7. Whalen, J. (2014, December 8). A road to mental health through the kitchen: Therapists use cooking to treat depression, anxiety and other psychological problems. The Wall Street Journal. Retrieved from http://www.wsj.com/articles/a-road-to-mental-health-through-the-kitchen-1418059204
8. Novotney, A. (2014). Psychology’s expanding roles in patient homes. Monitor on Psychology, 45(10), 38-40.
9. Brown-Riggs, C. (2012). The Patient-Centered Medical Home — The Dietitian’s Role in This Healthcare Model That Improves Diabetes Outcomes. Today’s Dietitian, 14(8). Retrieved from http://www.todaysdietitian.com/newarchives/080112p26.shtml
Allie Abrahamson, M.S., is a fifth year doctoral student in the Clinical Psychology program at Chestnut Hill College in Philadelphia, Pennsylvania. Mrs. Abrahamson is a graduate of the University of Delaware with her bachelor’s degree in both history and psychology. She began her graduate education eager to develop skills in child and family focused psychology, particularly in systems issues. Allie enjoys finding ways to give back to the community and to the profession. It was an honor for her to co-receive the 2014 American Psychological Association Award for Distinguished Graduate Student in Professional Psychology with her classmate for their work creating a program and partnership between their graduate school and a Philadelphia refugee resettlement agency. Allie is currently serving as the American Psychological Association of Graduate Students (APAGS) member on the Commission on Accreditation (CoA). As a part of CFHA, it has been enlightening and exciting for her to take part in the mentorship program with Dr. Barry Jacobs and to continue to learn more about integrative care approaches and their application to systemic issues.