Board of directors

Steeringgroup

Outpatient clinic

Researchgroup

Information

Training

"poli IP" & "Sterpoli"

"The Middle Way"

1. Website
2. Consultation
3. Yearly Conference Integrative Psychiatry

1. Workshops on IP
and Mindfulness
2. Residency psychiatry traning
nurses and psychologists

Patient care is offered within the outpatient clinic of Integrative Psychiatry. Integrative mental health care is offered to people who, besides standard health care, are interested in or prefer complementary and alternative medicine, or who want to include meaning and spirituality into there treatment. Clients are referred by general practitioners, ambulant health care givers (employed by Lentis) who only offer standard health care, or by other mental health care providers. Thanks to word of mouth a growing amount of clients find their way to our outpatient clinic.

After enrolment the patient is offered a standard questionnaire¹ concerning personal data, lifestyle, point of reference and vision on life, complaints and strengths, positive and negative characteristics, treatment history, distinctive marks of the periods without complaints, and preference of treatment. The answers to these questions are the guideline for the intake interview; the moment where the request for help is translated into a treatmentplan in accordance with the Treatment Consent for Medical Science Law (WGBO).
Treatment follows the principle of ‘stepped care’. The first step is optimizing a patient’s self-healing possibilities, of course only if a patient’s condition allows this type of treatment. This is established by focussing on the solutions, by appealing to the health stimulating factors that are already present, and by offering patients basic group lifestyle training². The latter involving: healthy food, exercise, and stress reduction (relaxation and meditation).
The second step entails conventional, complementary and/or alternative protocol bound (procedural documented) treatment, focussed on complaint reduction. When dealing with a conventional diagnosis, treatment according to official guidelines is always offered. Always keeping EBM principles in mind. The patients preferences combined with the therapist’ expertise and experience can result in favouring an alternative treatment to standard treatment. It goes without saying that the effectiveness of the alternative treatment needs to be scientifically proven. For instance, when a depressed patient resists antidepressants or cognitive behavioural treatment, also a good St. John’s Wort preparation or a combination of fish oil and running is an option. When a patient prefers a complementary or alternative treatment of which effectiveness is not proven for the patient’s complaints, there are four strict conditions which have to be met before approval (which is in it’s initial testing phase at this moment).

• First, the preferred treatment is only given when the patient combines it with a treatment which effecicay is scientifically proven. When the proposed treatment has been proven ‘in-effective’, it’s not one of the options.
• Second, patients who choose combined treatment can be (temporarily, under strict criteria) referred to external therapists for the alternative part of their treatment. These therapists are part of the outpatient clinic`s cooperation network.
• Third, to be a part of this network, the CAM therapists have to meet a high demand for quality and professionalism. For instance, the alternative therapist has to be a member of a guild and perform his work in accordance with the guild’s professional charter, keep records and utilize a clear complaint procedure.
• Fourth, the alternative therapist has to take part in a scientific research by Lentis which studies the effectiveness of the used treatment. The therapist has to agree to publication of the outcome, no matter what the result is³.

When encountering complex issues, or when treatment results are insufficient, the next step will have to be further diagnostics or a referral. For that, the third step is a ‘super’ specialist mental health care center. The patient will, if necessary, be referred to a specialist center or a specialized department of the mental health care center.

¹ This questionnaire is available at the CIP
² Parts of these modules are still under development
³ The complete working method is available as “CAM protocol” at the CIP

Because integrative psychiatry is a relatively new area, the authors feel that participating in integrated psychiatric treatment always needs to be supported by scientific research. This is organized by a research group called ‘De Middenweg’ (which can be translated as: ‘The Middle Way’), within this group therapists, researchers (Lentis and other universities), students, and participating external caregivers in the CAM field, all work together

For the scientific effect-evaluation of the offered treatments, different methods are being used. This concerns randomised and controlled studies (RCT’s), but also single case studies (n=1’s). RCT’s are related to determining ‘efficacy’ (a relation between the intervention and the outcome in ideal, controlled circumstances) and n=1’s to ‘effectiveness’ (a relation between the intervention and the outcome in clinical, naturalistic circumstances). A n=1 study works best when it’s conducted after a successful RCT, when the efficacy of a method or intervention has already been established (Ottenbacher & Hinderer, 2001). An ‘in general’ working treatment will turn out to be effective in special circumstances, which are clearly described by the results in the n=1’s. On the other hand, n=1’s can generate really good hypotheses for new RCT’s. When a new intervention is carefully being conducted on a small group of people (for example in an uncontrolled pilotstudy) and seems to be working, this can lead to further research conducted in a bigger group and under controlled circumstances.
With this in mind, the Center for Integrative Psychiatry has developed the following guidelines:

• CIP works with ‘Routine Outcome Assessment’ (ROA). All treatments are evaluated with six short questionnaires which are aimed at complaints, powers, quality of life, cost of health care,customer satisfaction and patient-choice of a measurement;
• All insufficiently studied treatments are subject of scientific effect-evaluation;
• With relatively new, unknown, or marginally described treatments or combined treatments, CIP normally start with n=1 studies, uncontrolled, or baseline controlled pilotstudies in small groups;
• The hypotheses which are generated by these studies, can be tested after that with a controlled study;
• The control condition might consist of a waiting list, a placebo-treatment, or a treatment which is considered standard and is in the official guidelines for treating a certain disorder;
• With convincing ‘evidence based’ interventions, new controlled studies are in principle unnecessary. But for the personal or contextual perspective it is very interesting to continuously screen whether or not the intervention has the desired result indeed. As soon as there is an indication that the renowned treatment is ineffective for certain personal variables or circumstances, n=1 studies can be started to find out which factors make the difference. If there are hypotheses which can be formulated, a comparing study will be conducted to test this.

The treatments within the outpatient clinic Integrative Psychiatry are being supported by the supply of printed material from different sources. These are Mental Health Care (GGZ in Dutch), the Dutch Psychiatry Association and patient associations. Besides that, patients are referred to trusted, professional printed and digital sources of information of CAM. In the near future we will open a (digital) information centre where referrers, patients and others who are interested can easily access information from relevant and trusted sources.

To inform those in favour, as well as those who are against, about developments in the area of Integrative Psychiatry and to establish a platform where controversies can be discussed and futher elaborated on, Lentis organises an annual conference about the theme. Meanwhile three conferences have been held. In 2006 “The best of two worlds”, 2007 “In search for new perspectives” and 2008 “New perspectives on body and mind”. The huge success of the conferences (about 1000 participants, renowned speakers from all over the world, lots of media attention) illustrates how hot the theme “Integrative Psychiatry” is. The fourth conference, which will be held on March 10th, 2010 (“Selfhealing Capacity”), is in full preparation.

In relation to education, the therapists and researchers of the Centre are working together in educating co-assistants, residents, (specialised) nurses, psychology students and psychologists. Lectures, workshops and courses about integrative psychiatry, working directed at health and solution, and mindfulness are all being held or given on a regular basis.