Is it time for more multi-disciplinary approaches to health?
*For many years in Aotearoa we have supported a health system where, in a general sense, doctors, nurses and surgeons attend to bodies, psychologists, therapists and counsellors attend to emotions, psychiatrists attend to neurological pathways, educators and mentors attend to minds, culturally aware professionals and social workers attend to culture and spiritual advisers attend to spirits.
This network of separate professions served us well during an era when we thought it best for each practitioner to first approach the mind, the body, the emotions or the spirit. We now know that a single focus approach is not conducive to healing the whole person. The health system sits uneasily in the current environment where every health professional knows there is no separation, everything is connected and every person is, in every moment, affected by all elements within and without their being. Each person is also woven into culture and community. Those of us who began our careers in professional or voluntary settings thirty or more years ago were encouraged to believe individual clients were made up of separate parts working with or against each other. Like most colleagues I referred people to specialists for attention to what seemed to be physical, social or cultural issues.
The practice of ‘referring people on’ is necessary and effective but it perpetuates the isolation of each profession. I don’t see individual clients now, but if I re-established my practice, I would markedly increase the number of times I asked clients for permission to consult with a multi-disciplinary team or with health professionals they were already seeing. Every health-related practitioner knows that pain located in one area of the body is connected to every aspect of our being. Every therapist knows emotions aligned to single events are linked to all the experiences we have in life. Mind, body, emotion and spirit cannot be separated but it has often been the practice to assess people’s needs from our own view of the human condition and focus on one element, be it emotion, the body or the spirit. Some clients/patients often search for a single focused treatment or an ‘alternative health remedy’ in order to ameliorate one symptom, one area of pain. In many ways, we have encouraged these fruitless searches by building a divisive health system.
People are not often advised that no one element is causal on its own and no one healing intervention is successful as an isolated entity. Is it time to acknowledge that people are best served when practitioners suggest to clients that a multi-disciplinary approach is likely to enhance the pathway to good health? It is important to retain specialist skills and a singular creative focus is crucial when the body is severely damaged, resources must be addressed, or people are at severe risk emotionally. However, each element needs to be attended to within the context of the 'whole of life' picture. Every medical, therapeutic, cultural or spiritual intervention will only promote healing if the question is asked, 'Who is this patient, this person, who is impacted every moment by the ebb and flow of relationships, aspirations, trauma, stories in the mind, self-care, culture and the natural environment?
Perhaps it is time to establish more public and private practice settings where different practitioners work closely together and consult using a multi-disciplinary team approach. One of the objections to being more collegial across professional boundaries has to do with the preservation of confidentiality. Confidentiality has been a cornerstone in each health profession. It has also been a limiting factor. Those who might be effective healers (partners, family, trusted advisers and carers) are often kept in the dark. When clients find themselves in a hospital emergency room and life is under threat they talk openly to medical personnel, first responders, friends and family. They also expect their medical or psychological 'condition' will be discussed across the spectrum of all those who are there to promote healing. While numbers of specialists read medical files, confidentiality is still preserved. Family members inform the professionals (and vice versa) and all participants are involved in the healing process. In some locations there are multi-disciplinary health centres. Professionals consult colleagues to check opinions, discuss treatment possibilities and review their relationships with clients or patients. Practitioners meet in groups to gain new insights from each other.
The future of holistic health care lies with the establishment of more team settings using peer reviews and multi-disciplinary supervision. In some locations, practitioners encourage family support, cultural and community resources, creative contributions from volunteers and wisdom based on indigenous approaches to enhancing health. The big questions are challenging. How inclusive should the training be for each health professional? Should therapy and psychology students have a more extensive knowledge of human biology and medical treatments? Should general practitioners be required to reach a certain standard when assisting people who are emotionally distraught? Should each profession be taught basic skills for entering homes, noticing living environments and consulting with communities? Is it time to establish multi-disciplinary professional bodies that conference together, research together, comment on each other’s academic papers, attend practicums together when training and approach politicians together on behalf of consumers? Should trainees in each profession be alerted to the disadvantages for clients when practitioners practise in isolation? Is it time to challenge the accepted tradition of each practitioner being supervised solely by a practitioner within their own profession? Is it time for trainees to be examined by a multi-disciplinary, culturally aware panel?
Perhaps it is time to encourage research, knowledge and skill to be linked across disciplines. There is potential for tutors in training institutions to teach across professional boundaries and publish papers authored from a multi-disciplinary platform. In the practice ārena, establishing more holistic health centres would require a significant realignment of funds and a willingness to break fences that keep each profession isolated. Are we ready to promote unity and inclusiveness in the health ārena?
It is very difficult to address the way each health profession insists on preserving tight boundaries around a knowledge base, access to funding for clients and their profile within the health sector. However, knowledge, skills, training programmes and political initiatives could be usefully shared if it was acknowledged that a connected prevention and treatment environment would benefit clients immensely.
Perhaps the way forward is to keep reminding ourselves, clients, and colleagues in related professions that there will be multiple reasons why we feel unwell on this day, at this time, in this family or community and at this stage in our life.
A. Roy Bowden *Summary of a chapter in ‘Psych-O-Therapy Aotearoa – 76 New Zealand Psychotherapists tell their stories’