Evidence and Feasibility of Implementing an Integrated Wellness Program in Northeast Georgia

Aug 10, 2017

hswChronic disease takes a heavy toll on residents in the United States. Heart disease is the leading cause of death. Risk factors for heart disease include diabetes, obesity, poor diet, and physical inactivity. Additionally, mental health concerns also affect a large proportion of Americans and are many times experienced concurrently with chronic diseases. Individuals with mental illness are more likely to experience chronic health issues such as obesity. Severe mental illness has been associated with consumption of high-fat, low-fiber diets; increased sucrose, saturated fat, and sodium intake; limited fruit and vegetable consumption; and a diabetes prevalence that is two-thirds higher than among individuals not diagnosed with mental illnes. Adults diagnosed with a severe mental illness are also three times more likely to die of coronary heart disease. Rates of mental illness are highest among Americans who are living below the poverty level, are unemployed, or are uninsured or covered by Medicaid, further limiting access to care. These data demonstrate a mind–body connection and suggest the need for affordable wellness programs that address both mental and physical health.

The northeast region of Georgia experiences many of these health concerns. A recent community health needs assessment indicated an increasing prevalence of diabetes and obesity, as well as emergency room visits for hypertension. The assessment prioritized the following health needs for northeast Georgia: mental health issues, substance abuse, cardiovascular health, diabetes, obesity, and cerebrovascular care, as well as accessibility to services. The needs assessment noted that 20 percent of adults in the region were uninsured and 40 percent did not have consistent access to health care. Furthermore, all 12 counties in the region are designated as health and mental health professional shortage areas. These findings illuminate the particular need in this region for affordable and accessible wellness services that address physical and mental health.

A small nonprofit mental health agency has served the northeast Georgia region for more than 25 years, providing psychotherapy services for individuals, couples, families, and children. The agency expanded services to include sporadic yoga classes on-site and through partnerships with local yoga studios and has adopted a holistic approach to psychotherapy that considers other aspects of wellness. The agency wanted to implement a more comprehensive and explicit wellness program that integrated mental health and wellness services with the aim of helping to address the mental and physical health needs of this region. Given the need for a wellness approach that integrates mental and physical health, and this agency’s interest, Amber Flanigan, LMSW, MPH, CHES, and Trina Salm Ward, PhD, APSW, conducted a study to (a) review the evidence for integrated mind–body wellness services, and (b) explore the feasibility of implementing such a program in a small mental health agency serving northeast Georgia. Their findings were published in a recent issue of the journal Health & Social Work.

Due to the lack of availability of existing surveys in the literature, a 10-minute anonymous survey was created in collaboration with agency leadership to explore the feasibility of implementing such a program in a small mental health agency. The survey included multiple-choice and Likert-scale questions assessing demographic data and agency affiliation. The agency was interested in how much potential wellness service clients would be willing to pay for wellness services; therefore a question measuring willingness to pay was included. Both the researchers and the agency wanted to know what evidence-based wellness services potential clients were interested in; therefore a question assessing survey participants’ interest in the wellness services explored in the literature was included. The authors created the survey questions based on these interests and obtained feedback from staff therapists, interns, and the executive director.

The study’s authors identified four components to be incorporated into an integrated wellness program:

  • Yoga
  • Tai Chi
  • Mindfulness Meditation
  • Nutrition Education

They maintain that there is ample evidence for integrating the practices of yoga, tai chi, mindfulness meditation, and nutrition education into a wellness program to address both mental and physical health issues. However, evidence for providing an integrated wellness program does not necessarily translate into high rates of participation among agency clients. Thus, a survey was conducted of agency clients and other affiliates to identify level of interest in such services, as well as willingness to pay.

Clients ranged in age from 18 to over 75 years, with slightly more identifying as male (54.5 percent) and with a little over half being married (51.5 percent). The majority (82 percent) of clients expressed interest in some type of wellness services, with yoga being the most highly endorsed (66.7 percent), followed by meditation (54.5 percent) and mindfulness (54.5 percent). Clients also wrote in additional services of “energy healing,” “acupuncture,” and “Pilates.” The majority (84.8 percent) of clients agreed or strongly agreed that wellness services were important to their mental health and well-being. Most were willing to pay between $10 to $30 (32 percent) or $30 to $50 (23 percent) for services. Clients also commented that “willing and able are not synonymous” regarding ability to pay for wellness services, and “I believe it is important; although it can be pricey. If it was affordable people might participate.”

Other affiliates of the agency ranged in age from 18 to 75 years and older, with the majority (62.5 percent) being female. The majority (87.5 percent) of other agency affiliates expressed interest in some type of wellness services, with nutrition education as the most highly endorsed (60 percent), followed by meditation (50 percent) and yoga (45 percent). The majority (85 percent) of other affiliates agreed or strongly agreed that wellness services were important to their mental health and well-being. Other affiliates reported being willing to pay $10 to $30 (37.5 percent) or $30 to $50 (27.5 percent) for services. Comments from other affiliates included, “I think wellness is important but I would probably not pay anyone else to help me with it. I think it is something I can do for myself”; “I’m happy to see another potential place offering tai chi. It’s a little harder to find than yoga”; “This does not fit my faith”; “I do think these services are useful and valuable for many, although I am not interested in/capable of paying for them now”; and “This is definitely an area that needs to be strengthened in the human services profession. Glad to see a survey on this topic.”

Since there is strong evidence for agencies to consider including wellness services such as yoga, tai chi, mindfulness meditation, and nutrition education into mental health services, either through referring clients to these services or offering some of these services, the authors maintain that mental health agencies should consider incorporating wellness services to further meet the needs of the clients and to appeal to a broader range of clients.

An integrated wellness program has the potential to address the growing mental and physical health needs in northeast Georgia and beyond by offering services (yoga, tai chi, mindfulness meditation, and nutrition education) empirically proven to improve and reduce mental and physical health conditions. Offering integrated wellness services could be an opportunity to further meet the mental and physical health needs of clients and could be a way to recruit new clients to the agency. Wellness services represent an innovative complement to traditional psychotherapy, with many potential benefits to clients. Perhaps clinical social workers, other mental health professionals, and researchers could expand their reach as it relates to the health of clients by including or recommending activities such as the wellness activities explored in this article in our clinical practice. Not only do these activities promote physical health, they also promote mental health.

Social workers and mental health professionals can expand their repertoire by becoming more familiar with complementary and alternative therapies, either through continuing education opportunities or through incorporating complementary and alternative medicine education into graduate-level curricula. Exposing budding mental health professionals to the philosophical underpinnings of complementary and alternative medicine in mental health could expand the way they approach mental health early in their professional careers. Incorporating complementary and alternative medicine education into graduate-level curricula could create buy-in across the profession and encourage more research into complementary and alternative medicine in mental health. Furthermore, mental health professionals could pursue in-depth training in complementary therapies, for example, yoga or mindfulness, which would allow them to become dual practitioners offering a broader array of complementary therapies to their clients.

An example of the survey used is below.

Wellness Program Needs Assessment Survey

The purpose of this survey is to capture your interest in wellness services at [name of agency]. You do not have to participate in the survey. If you choose to participate in the survey you can stop anytime. Your participation will involve answering the following questions and should only take five minutes to complete. Responses are anonymous and will be kept confidential. Results of the survey may be published; however, survey data are anonymous.

Gender:__________ Age:__________ Relationship Status:__________

  1. What is your affiliation with [agency]? (select one)

Client Clinician/Staff Friend Supporter Board Member Other

  1. Are you interested in wellness services provided by a certified professional? Circle all that apply:

Yoga Meditation Nutrition Education Mindfulness

Tai Chi Other:__________ None

  1. Do you believe that wellness services such as yoga, meditation, and nutrition education are important to your mental health and well-being?

Strongly Disagree Disagree Neutral Agree Strongly Agree

  1. How much are you willing to pay for a one-hour wellness consultation service?

$0–10 $10–30 $30–50 $50–70 $70–90 $90–110

  1. Please feel free to share additional comments below.