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​NDNR Spotlight on the PsychANP

NATUROPATHIC DOCTOR NEWS & REVIEW
Posted December 1, 2017 
Kabran Chapek, ND

NATUROPATHIC NEWS
It has been 1 year since founding members from across the United States and Canada incorporated the Psychiatric Association of Naturopathic Physicians (PsychANP) as an affiliate of the American Association of Naturopathic Physicians (AANP). What is our raison d’etre in a generalist profession?

WHY THE PSYCHANP WAS FORMED
A naturopathic team – sparked by Carlo Calabrese, ND, MPH, one of our board members – published a research paper in 2011 suggesting that psychological disorders may be more frequent in naturopathic practice than in conventional care.1Why would this be? Maybe it’s because we are known as “doctors who listen,” or because patients may know that naturopathic physicians have treatment options other than the perhaps-overused psychopharmaceuticals. The National Institute of Mental Health (NIMH) estimated that in 2015 as many as 18% of US adults experienced a mental illness (4% of them a serious mental illness), yet only about half received treatment.2 In addition to frank mental health complaints, Dr Paul Anderson, at a recent AANP convention, said of his patients, “In complicated and chronic disease patients, what you are dealing with 70% of the time is their mental health.”
Do we naturopathic doctors feel adequately equipped to help patients in significant psychological distress? I didn’t when I graduated from Bastyr. My son was born the same day I received my board exam results. That was a day I will never forget, but it also ignited a sense of urgency to provide for our family. I found one of the rare jobs for naturopathic doctors that was actually salaried at a local dual diagnosis treatment center north of Seattle, and began work there. I quickly realized that this was “on the job” training in mental health, and the learning curve was steep, as many patients had recently been in the hospital for suicide attempts or had just come out of detox for alcohol dependence. As part of a team, I was able to gain extensive on-the-job training working with experienced therapists and psychiatrists over the course of 6 years.
To address the apparent need, the PsychANP founders envisioned an evolving practice of care with interprofessional exchange in psychiatry, behavioral medicine, and psychology to refine a mental health practice informed by naturopathic principles. While our ultimate vision is to provide effective, efficient, compassionate mental healthcare for all, our efforts are focused on helping naturopathic doctors specifically gain the tools and skills they need to contribute to that task while integrating emergent information.

ACCORDINGLY, THE PSYCHANP MISSION IS:

1. To lead in developing naturopathic psychiatry education and practice, including residencies and continuing education consistent with the evolving standards of naturopathic psychiatry
2. To integrate clinical practice and research that comprise the emerging field of naturopathic psychiatry
3. To define the principles of care and advocate for appropriate scope of practice as it relates to naturopathic psychiatry
4. To provide a definitive resource of information regarding naturopathic psychiatry for the collaborative health care community

BUILDING EDUCATIONAL OPPORTUNITIES
In the development of education in naturopathic psychiatry, we encourage schools, clinics, and hospitals to create more mental health-focused residencies for naturopathic doctors. The same facility where I had my initiation in mental healthcare as a new ND, now has a formalized residency program through Bastyr – a prime opportunity for those wishing to specialize in mental health. Several treatment centers and small clinics have sprung up to offer mental health residencies, and we hope to double the number of residencies currently available for naturopathic doctors.
The PsychANP provides educational opportunities to naturopathic doctors in active practice in order to gain skills in handling mental health concerns. For example, PsychANP sponsored a webinar on patient crisis management by Dr Karen Lamb, who is both a naturopathic doctor and a marriage and family therapist. An upcoming webinar will discuss the management and tapering of psychiatric medications (see psychanp.org for information).
We queried members on what types of engagement would be most helpful (in addition to conferences and webinars), and they responded that they would like more intimate small-group discussions. Study groups among members then met online to address treatment strategies and clinical experiences. Drs Tara Peyman and Stephan Ducat also started a one-on-one mentorship program (with a small fee to members) for those would like additional support in mental health work.
PsychANP’s first annual conference this year was undertaken in conjunction with the AANP convention. As our chair of the Professional Development Committee, Dr Peyman was key in helping the conference come together with the board and volunteers. Dr Peter Bongiorno, a PsychANP Board member and a national leader in the field of mental health and natural medicine, was the keynote speaker. Dr Eric Vose moderated a panel which displayed diversity and commonalities in naturopathic mental health practice. Next year’s PsychANP conference will be in conjunction with the California Naturopathic Doctors Association (CNDA). For our next conference in April 2018, on “Integrative Psychiatry and Neuro-Immunology,” we have teamed with CNDA.
These initiatives have been undertaken with the assistance of a remarkable, multi-talented group within the naturopathic profession. Dr Jennifer Bahr, president of CNDA, has been a key player in getting our organization off the ground, aiding in the creation of our mission and vision, and fundamental structure, and leading professional development efforts. Moira Fitzpatrick, PhD, ND (one of the standout speakers at our last conference), with long practice as a psychologist and naturopathic doctor, has been developing a residency at her group practice. Dr Erik Vose (our Board Secretary with a background in Somatic Experiencing), has proven to be a technological whiz while leading the development of our website (http://www.psychanp.org/) and logo. He also did an excellent job as the moderator of the panel discussion at our recent conference. Gary Piscopo, ND, LAc, is our Facebook expert (https://www.facebook.com/psychanp/). Dr Carlo Calabrese works with a committee to help define clinical competencies on which training and board certification can be based.
GOALSWe hope to reach our goals of doubling residencies and establishing practitioner certification within the next 3 years. On a longer timescale, we are gathering the strands and waves of information that formed the history and current practice of natural medicine in psychiatric care, and are beginning to articulate a state-of-the-art on which we can build. Stephan Ducat, ND, PhD, has drafted a vision for a textbook of naturopathic psychiatry that maps many of the potential contributions of naturopathic practice to psychiatric care. Katherine Raymer, MD, ND, is attending to relevant curriculum development. We welcome and will need your contributions to this emerging map of naturopathic psychiatry.
From the naturopathic community, there has been a warm reception of PsychANP and its goals. Some naturopathic doctors consider “psychiatric” and “psychiatry” to be too pathologically or pharmaceutically oriented. There have been questions at times about naturopathic doctors specializing at all. Resistance may also come from allopathic psychiatrists who regard “psychiatry” as a proprietary domain. The term encompasses addressing both the biological and psychological causes and treatment of psychological distress. Naturopathic psychiatry, ideally practiced, has a holistic-systems perspective of body, mind, and spirit. We do psychiatry differently. Though there may be some contention around boundaries, that doesn’t make the cause of improving practice and building a competent workforce in naturopathic mental healthcare incorrect or ill-advised. Other naturopathic specialty groups, such as Pediatric ANP and Oncology ANP, faced similar questions at their inception, yet now have certification and residencies. This has helped to improve practice and help patients find naturopathic doctors with additional interest and training in their specialties. Working at the Amen Clinics, I have experienced strong support from my psychiatrist colleagues for what we are doing, as well as support from mental health providers across the country in addressing the workforce shortage and restricted options in mental health care.
Like any new organization, we have an abundance of freedom at this point, with the least amount of bureaucracy; however, we also have limited work hours from our mostly-volunteer workforce. If you have an interest in joining our PsychANP and/or to volunteer on any of our projects, please contact me or go to our website: www.psychanp.org.
Much gratitude and thanks to Dr. Carlo Calabrese for his assistance with this article.

References:

1. Chamberlin SR, Oberg E, Hanes DA, Calabrese C. Naturopathic practice at North American academic institutions: description of 300,483 visits and comparison to conventional primary care. Integr Med Insights. 2014;9:7-15.
2. National Institute of Mental Health. What is prevalence? NIMH Web site. https://www.nimh.nih.gov/health/statistics/prevalence/index.shtml. Accessed August 15, 2017.

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