Mental Health Treatment is Like a Three-Legged Stool
to the Journal By Anthony DiGiovanni, MD
who seek professional help for emotional distress often focus on medication as
the answer to their struggle with depression or anxiety. They believe that if
they can just find the right pill, their problem will be fixed. However, there
is much more to effective treatment of mental health problems than medication
best framework for mental health treatment entails three aspects of care. It
can be thought of as a three-legged stool. If any leg is too short or not
strong, the stool will be unstable. This model of treatment, called the
biopsychosocial model, is evidence-based and embraces the latest research. The
biopsychosocial (BPS) model considers a person’s unique biological,
psychological, and social factors as equally important. Each aspect represents
a leg of the stool and each is important to one’s overall stability.
are the biological considerations in mental health treatment?
individual biology is very significant. There is evidence, for example, that
people can be genetically predisposed to certain illnesses, among them bipolar
disorder, anorexia, and depression. We also know that state of mind and brain
function are interconnected: the brain scan of a depressed person shows areas
of hypo-function, which indicates a definite physiological component to
depression. This means that working your way through depression involves more
than just pulling yourself up by your bootstraps. Exploring the
biological/physiological component of your emotional distress helps your
psychiatrist or psychologist frame what medications might help you.
does the psychological component in BPS address?
psychological component in BPS explores the way we think, what our assumptions
are, and our ability to cope with stress. This is important because medication
does not help with our assumptions or coping skills. This is why talking
therapy is so crucial. In therapy, you learn more about how you view things,
how you respond to stress, and how you can modify your stress response. The
importance of psychology cannot be overstated in effective mental health
do you mean when you talk about the social component?
as important as your biology and your emotional state (psychology) is the
environment in which you live. All the various aspects of your social network
make up your environment. In this component of the BPS model you examine the
impact of your job or school, your living situation, and your relationships. Do
you like your job or not? Do you enjoy school or are you struggling, and why?
Are you being abused at home? Are you an alcoholic living with drinkers?
your environment is much harder than taking medication; however, even small
changes in your environment can make a difference. If you suffer from depression,
for example, more light in your environment can help you start to feel better.
Removing alcohol from the home is a good start for someone being treated for
alcoholism. Finding a new housing situation for someone who suffers abuse at
home is an important environmental change. Another small but helpful change is
educating your parents or roommate about what is going on with you and how they
can help you. Doing what you can to make your home a calm, safe nesting place
can have an impact on your mental health.
research supports that talk therapy and environmental change can alter a
person’s brain function, which is why the biopsychosocial model for mental
health disorders is in such wide use today. BPS is the model of treatment in
the Behavioral Services Unit at Cayuga Medical Center. From a patient’s initial
mental health evaluation through discharge planning we think in terms of BPS
and the mind-body connection. Like a solid three-legged stool, giving equal
importance to these three aspects of care provides a balanced and effective
approach to treatment.
DiGiovanni is board certified in psychiatry and neurology. He is on the medical
staff of the Behavioral Services Unit at Cayuga Medical Center and specializes
in adolescent psychiatry.