So, you are feeling down and seeking professional help. You’ve got your GP and psychologist but maybe it is time to add a few more players…
Who else to include in your professional team?
Firstly, you don’t need to figure this out alone. Your GP can help understand your concerns and, from there, work out if anyone else needs to be included. Responding to mental health concerns can be understood using various models including the ‘bio-psycho-social’ model. This model suggests that there are three key domains that contribute to distress including biology, psychology and social factors.
Biological factors refer to those which are occurring within the physical body. For example, our genetics, changes to neurotransmitters like dopamine and serotonin and hormonal fluctuations. What food we eat, and our level of exercise also impacts biological factors that contribute to mental health. Psychological factors are those linked to how we think such as thoughts about ourselves, others and the world. Finally, social factors include what is happening in our external worlds including work, family, friends, hobbies and the world around us.
When we are experiencing mental distress, a doctor or mental health professional will help you understand what is contributing to these feelings according to the bio-psycho-social model and plan treatment accordingly. Treatment can also include referrals to other professionals including dietitians for nutritional changes and exercise physiologists (EPs) to increase exercise.
Introducing exercise physiologists and dietitians
There is emerging research demonstrating the effectiveness of dietitians and EPs in relieving mental distress. At the Food & Mood Centre we recently published a world-first randomised control trial. The trial investigated the effectiveness of Accredited Practising Dietitians and Accredited EPs for alleviating depression symptoms in those with mental distress (equivalent to low grade depression) throughout Covid-19 lockdowns. The dietitians and EPs were also trained in health coaching, motivational interviewing and mental health first aid. Participants in the study could continue taking any medications they were on or seeing other health professionals throughout. We found that 8 weeks of dietary and exercise intervention was not inferior (‘as good as’) to 8 weeks of psychological treatment with psychologists. So, while this research is new as it was the first trial to directly compared one approach to the other, in the real world the inclusion of appropriately trained dietitians and EPs within a multi-disciplinary team could be a beneficial way to reduce mental distress.
Multidisciplinary approaches for mental health
Multi-disciplinary teams can also support one another to provide collaborative treatments for mental health. Sadly, mental health treatments in the community can be siloed which can limit communication and collaboration between healthcare professions. For example, it is not uncommon that you might repeat your story to your GP, psychologist, physiotherapist etc and, in some rare cases, receive conflicting treatment advice.
But we can work towards a future of greater collaboration!
Ideally, healthcare systems are designed to facilitate regular meetings between all the members of your team. Your dietitian, EP, psychologist and GP could come together to discuss your concerns and collaborate on how to best help you. For example, when working with a dietitian they may identify that a psychologist could help with navigating unhelpful thoughts that are getting in the way of you making nutrition or lifestyle changes (such as, perfectionistic thoughts/expectations around habits, body image concerns, or disordered eating). Similarly, your GP can assess any medical barriers to physical exercise, and your EP can tailor an exercise program accordingly. Therefore, the whole team is working together to provide safe, effective and impactful treatment.
In the future, we can hope to better integrate lifestyle therapies (including nutrition and exercise) into standard mental health practices. This could include gyms and cooking classes in mental health inpatient units, stronger education of lifestyle approaches for mental health workers and greater inclusion of lifestyle healthcare workers in mental health services.
So, should a dietitian and exercise physiologist be part of your team?
Effective treatment planning is always subject to a strong bio-psycho-social assessment and not all people experiencing psychological distress will need a dietitian and EP. However, our research showed improved nutrition, and physical activity had a positive impact on mental health regardless of pre-treatment diet and exercise habits. We recommend speaking to your GP and/or psychologist and together decide if a dietitian or EP would be beneficial for you. Perhaps you are only two players away from hitting that home run for your mental health.
Our research showed lifestyle therapy was as effective for people with low grade depression as psychological care but we still don’t know if that is true for people with clinical depression. If you want to contribute to our research exploring whether lifestyle therapy is suitable for people with depression of moderate to severe severity and have major depression or bipolar disorder, check out our HARMONE trial.
If you need urgent support after reading this article, please call Lifeline on 13 11 14 or visit your local hospital. For children and young adults, call Kids Helpline on 1800 551 800.
Written by Prof Adrienne O’Neil and Sally Brown. Professor Adrienne O’Neil is a behavioural scientist who specialises in promoting the use and quality of evidence-based lifestyle medicine and rehabilitation in mental health and cardiac settings. Sally Brown is a clinical psychologist at the Food & Mood Centre with a background in social psychology, healthcare worker wellbeing and mood disorders. Sally is currently working as a Research Fellow and group facilitator on the HARMON-E Trial.
