Defragmenting Mental Health Treatment with Integrative Psychiatry
Britta Zimmer, N.D. - Medical Director at Pacific Quest
Brenda Zane is a Sky’s the Limit Fund board member, Founder of Hopestream Community, and podcast host of Hopestream
About the episode:
It’s confusing and sometimes frustrating when you’re dealing with a list of medications for psychiatric conditions and help from various medical and professional resources. What’s working and what’s not? Our guest, Dr. Britta Zimmer, a licensed Naturopathic Physician, started the Integrative Model at Pacific Quest of blending conventional psychiatry with nature-based interventions and whole person wellness. In this episode, Dr. Zimmer talks about the benefits of Integrative Psychiatry to optimize an individual’s mental health and treatment plan including the importance of incorporating nutritional supplements, mind-body practices along with a complete diet containing anti-inflammatory foods.
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Hi, we’re back for another session of the Sky’s Limit the Fund Speaker Series. And we have a great conversation today. I’m Brenda Zane. I am the fortunate board member who gets to host these great conversations with people in the field of wilderness therapy of outdoor behavioral health. And just to give you a quick little update on what Sky’s the Limit Fund is, if you’re not familiar, we’re a nonprofit organization that funds wilderness therapy for families who are in need of some help for a young person, whether that’s an adolescent or young adult, and have chosen wilderness therapy as their form of treatment. Yet it is a little bit out of access, because it is a quite expensive form of treatment. So Sky’s the Limit Fund helps to provide funding for the treatment, as well as the wraparound services, when young people leave treatment and come home and continue to need to heal their families integrate back into their environment. So that’s what we do. And we provide this Speaker Series is just a way to get you information straight from the source straight from the people who are providing treatment or run programs are involved. And it’s a way for you to educate yourself, become more empowered in making your decisions about wilderness, and just understanding it in general. So today, I am thrilled to have excuse me, I’m thrilled to have Britta Zimmer with us she is with Pacific Quest, which is a program on the Big Island of Hawaii, which sounds like a really great place to go for treatment. She has up their medical team, she has a naturopathic doctor, and I cannot wait to have the conversation. Because I think this is such an important topic for families to understand. We’re going to be talking about defragmentingthe treatment process and everything that goes along with treatment through integrative psychiatry. So welcome, Dr. Zimmer.
Hi, Brenda, thanks for having me. Yeah, thank you. So the Sky’s the Limit Fund. We’ve been I’ve been working with you for probably a decade now and seeing what your scholarship has done for a lot of our patients. So thank you. Yes, it is great. It’s such an honor to be a board member and to really see firsthand how this can really transform lives in a short amount of time. And I know that’s something that you’re really passionate about too, is getting some, you know, really quick and impactful changes in young people’s lives. So why don’t you just start out and tell us about who you are and a little bit about Pacific Quest, then we’ll dive into our topic. Sure. Well, I’m the Medical Director at Pacific Quest, I had been there since 2008. So for a while I was just consulting with them as I had a private practice on the Big Island. My training was at a homeless youth clinic in Portland, Oregon. And that’s where I did my residency and internship. And once I came to the Big Island, I had very much of a general practice. And so I was looking to get back with that age group. And then I discovered Pacific Quest, right, literally in my backyard. So it was I think it was meant to be. And we can talk a little bit further about how my role here specifically has transformed and how we created the integrative psychiatry program. Yeah, that sounds it sounds really unique. And I would love to first have you just kind of give us a baseline when you say integrative psychiatry, what does that mean? Right. So I, I like to say it’s the best of both worlds, we have the conventional psychiatry model meeting, an integrative medicine model. And so that the difference is instead of just a relatively small toolbox that conventional psychiatrists have, which is mostly just medications, and then referring to therapists and, and what have you, we also have the integration of natural medicine, functional medicine protocols. And we can get into exactly what that means. But I’d like to tell parents especially and providers who refer us are patients that were just were well grounded in both worlds, it’s not an either, or, it’s it’s a, it’s an kind of a blending of the two, because oftentimes, I’ll have parents say, you know, I’m going to send my child to you to take off, take them off on medications, and we absolutely do not do that, because that’s not safe. And so and we have to also learn about the patient and meet the individual where they are. So we very much treat individuals and not diagnose diagnoses. And that’s a big difference to and in what integrative psychiatry is. Right. And so given that you’re in Hawaii, and I hit hear the birds chirping in the background sounds amazing.
It just seems like such a great environment for healing. And I’m wondering if you could tell us a little bit about kind of the, everybody’s different, but maybe what a common scenario is when a young person comes to Pacific Quest, what you’re looking for from the integrative psychiatry standpoint and how you kind of go through that process with families?
Sure. I think at first we’d like to explain a little bit of the genesis of my time here at Pacific Quest and how the integrative psychiatry came to us as a program. So just briefly, in 2008, like I said, I was consulting and I started a wellness model, because here in Hawaii, it’s, you know, they’re outside 12 hours a day, and they’re getting direct sunlight, so vitamin D, and we get to eat the food from the land. So I just started a wellness program at Pacific Quest. And it’s very intuitive – eat well, sleep well, move your body every day, pay attention to the mind body connection. So I just enlivened that a little bit more for the program. And at that time in 2008, to around 2011, that the kids weren’t on a lot of psychotropic medications, and we’d have the Prozac Zoloff to SSRIs. And then, if they’re coming from a hospital setting, oftentimes they’d be on a little bit of Seroquel or Trazodone, but maybe 10 15%. By 2011, what I was noticing was over 50% of our participants were on some type of psychotropic regimen in some time, more than one up to five, up to six, multiple pharma pharmacological agents for their psychiatric conditions. And at that point, we always had a psychiatrist that worked with us. But at that point, I was hearing from the families a lot of confusion, and this is the whole different fragmentation – they had the psychiatrists, and they had their therapists, and they had the clinical psychologist who gave them the testing, and then they had the neurologists, and they had their their pediatrician, and everyone was helping them, but no one was integrating the treatment plan. And, and yet, their child still needed our, our resources. And even though they had all this team of great providers, and they were taking the four different medications, for example, they still needed Pacific Quest. And the parents were confused. They didn’t know what was working, what wasn’t working, if they needed to be on the medications. And furthermore, the providers were very, I think there’s a lot of fear of taking people off of medications, because what if something were to happen, it’s a liability. And there’s a lot of variables and outpatient practice, because if you change a medication, then you don’t know if they’re eating, if they’re not sleeping, type of technology, exposure, or peer pressure or stress. There’s so many variables. So what I saw at Pacific Quest that we have so many of the variables controlled for their eating the same diet, it’s anti inflammatory diet, and we can get into that if we have time. They have the same schedule throughout the day, they don’t have any technology. So it’s a really great environment to make changes safely to see what’s actually working. And so that’s when I brought it we had a psychiatrist who have been working with us for a long time, and she’s conventionally trained. So this is where I constructed this whole idea of an integrated model where there was myself and naturopathic physician, the psychiatrists and the therapist, and all three of us were in the room with the patient, actually doing the psychiatry appointment. So it was really truly integrated, because then we could bring the family system in and we weren’t making decisions out of context, because oftentimes, this is the other feedback I get from families, where their child will go back to see the psychiatrist and something just happened at school that week. And so they’re endorsing a lot of symptoms, and then another medications added.
It can be confusing. And so then as even higher percentage of the of our patients started coming in on multiple pharmacological agents, that’s when we actually found this wonderful integrative psychiatrist and he’s been trained in it.
And so now, we don’t need to have the three heads in there so to speak.
And, you know, it’s difficult to find it integrate integrative psychiatrist as someone who was trained in integrative psychiatry, which, like I said, was the blending of the two but we were able to find one and, and that’s what we have now.
Amazing. And was he in Hawaii, or did you have to bring him there becauseof a unicorn situation?
He wasn’t in Hawaii. So no, it’s not a tough sell.
Exactly. You know, at the time when I when I was, I didn’t really I thought I knew about integrative medicine. This is back in 2012 2013. I started researching integrative psychiatry and I actually went to a conference among integrative psychiatrists, and it was it was such an interesting, there was almost 50 Different psychiatrists there. And it was almost like they were trying to heal their profession, they were all frustrated that they weren’t getting the results they had expected. And they were trying to widen their toolbox, so to speak to I think they were, you know, they were frustrated with justkind of the shot in the dark approach to prescribing.
So, then this, this is how I found the integrative psychiatrist that we have, and this is a network of psychiatrists, DEOs, MDS, some nurse practitioners, all coming together to learn from naturopathic physicians, from nutritionists, from functional medicine, doctors, and then collaborating together to create this field of integrative psychiatry. And now fast forward to today, I mean, you’ll go to websites of different universities, and you’ll see they have an integrative psychiatry program, I can’t speak to all those different programs that they’re truly integrated or not. But nevertheless, they’re seeing the benefit of this type of model. So it sounds like that what you’re doing there is taking a broader picture of what’s going on with a young person who’s coming in. You’re not just saying, Okay, you’re on these three medications, we’re going to continue those and, and get rolling, you’re really looking at that. And like you mentioned sunlight, and being outdoors and simple foods and non inflammatory foods. So maybe talk a little bit about that aspect of it, because that sounds really unique as well. All right. I think that no matter what the treatment plan is, whether it’s just psychotherapy, or horticulture therapy, or pharmacological agents, it’s going to work better if it’s on a platform of wellness. And having been an outpatient practitioner, it’s very hard to get compliance with your patients, when you tell them to eat well sleep well move their body, it’s hard. We’re busy people,
young people, yes. So they come here, and they kind of don’t have a choice, because this is what we’re feeding them, you know, they have an extra, you know, they there’s a lot of movement and really paying attention to their sleep. So there’s almost 100% compliance in this wellness program. And so I think, honestly, you know, my job is a lot easier than a lot of outpatient practitioners, because they’re going to get better quicker when they have this. Having said that, there’s a lot of complexities and what they’re presenting with, especially if they’re on multiple psychotropic medications. And we have to figure out which ones are working, because oftentimes, one will be started in a little work. Meaning that, for example, an SSRI will be started in at first will work and the families will say, Oh, it’s a big, big difference. And then all of a sudden, it stops working. So the psychiatrist will up the dose, or they’ll add in another one. So there’s a lot of confusion of what really is working, what stopped working, what’s the right dose.
So that’s really what we want to do. First, we want to optimize the medication regimen. And in order to do that, one, one of these laboratory analyses that we use is called it’s a genetic test to it’s to determine the how your specific genes will metabolize a medication, you know, what what your predispositions are, depending on your genetic variations to, to have a certain class of psychotropic medications work or not. So for example, it will tell it’s it’s a, it’s this, this is a mucosa. It’s a cheek swab. That’s it. And I’ve been doing this for about 10 years. And at first, it was, I think, a little bit radical and rare. And now I would say 50% of their of our patients come in already having this type of testing done. So and it’s covered by insurance. And it’s, I’d say, becoming common, because what it is it doesn’t tell you which medication to give to the individual, it provides a guide. For example, if if they have a serotonin transporter issue, then then you know not to give them a certain class of SSRIs or you know, maybe they need a little bit higher dose or a lower dose. So it really helps take the guesswork out of psychiatric medication prescribing So that alone, it’s almost going in blind. Without that, of course, you need a lot of different data sets. You need to understand what their medication, medication history has been what the family history has been with medication, but this is just another data point that really helps us with the prescribing and maybe taking off one medication but increasing another to optimize it.
So we do first thing we do but we also do other type of blood tests to to determine if there’s any nutrient deficiencies, because what we know with a lot of people suffering from mental health is that they’ll have some basic vitamin and mineral deficiencies. And it’s really easy just to measure that on from a blood test, B 12, for example, zinc, copper, vitamin D. And the reason why these these particular vitamins are important, magnesium is another one mineral, is that they are, they’re necessary for neurotransmitter production and the proper functioning of neurotransmitters. So if the psychotropic medication is working, you know, theoretically working on a neurotransmitter system, then you need the nutrients to make those neurotransmitters behave, right. So it’s really just a practical biomedical model to get information from the blood. So we can then supplement any type of deficiencies and help the whole treatment plan work better.
What is the I’m trying to imagine what the young person’s responses to this? Because it seems like it just makes so much sense. And like you said, when somebody’s struggling with mental health, I can imagine and I’m just thinking of my own son who went through this nutrition was horrible. Sleep was horrible. Yes, no, basically no outside time. So let alone all of that. I’m trying to imagine like, what is their response? When you say, hey, we want to look at some of this baseline stuff, your nutrients, your nutrition, your, your time, your exposure to the sun? Is that kind of like a new concept to them? Or what’s the response?
Yes, I mean, it depends, you know, the varying degrees of insight, that that these individuals will have, depending on kind of developmentally where they are, because we know we have a 13 to 17 year old program, and then we have 18, to 25. So obviously, a 22 year olds going to experience this very differently. And, and our explanation of it can be very different for the 22 year old versus the 14 year old. But in general, they are very receptive, because I think they feel heard and that and that we’re really trying to individuate their treatment rather than than just, oh, you’re anxious here, here’s something to take or you’re depressed, here’s something to take, they’re really used to that approach.
And then sign these young people are just they’re so smart. And when you have a printout of the of the genetic testing, for example, it’s usually has colors and whatnot, and you can show them like this, this is what we’re seeing. And this is why we’re going to change this medication this way or that way. Because we really do want them to have ownership in their treatment plan, because we’re a container for a short amount of time, and then they need to go beyond there. And they need to really understand what they’re taking and why I think that’s that’s that kind of attunement to their own.
Protocol is important for ultimate success going forward.
Yeah, just giving them that agency to understand like, this is my body, this is how it’s working and functioning. And I would imagine, too, if you’re looking at those different levels, within their body to say, Hey, this is supposed to be at a 20. And yours is at a to like, let’s, let’s balance this out. It I think to me, what it does is it takes away some of the like, shame and the blame, like, oh, I shouldn’t be this tired, or oh, I shouldn’t be this depressed or whatever. It’s just Something’s really wrong with me. Only to find out yes, there is something like you need to eat differently, or you need to, you know, what I mean? It’s sometimes like simple stuff. What do you see when when kids start sort of having this new, you know, environment to be in and different food? What does that look like?
Yeah, I mean, it’s also this buying process, because they’re used to hearing from us moms eat better, and they don’t know why they don’t. They don’t care, honestly. So it’s nice to show that like, it’s not we’re not just this is not just the empty command. I mean, there’s a reason for this. And again, all these kids are taking science before if I sometimes I’ll show them the biochemical pathway, and they’re like, oh, and I see the zinc in the basics and magnesium and the different pathways and they say that this is why you need food that has these nutrients, and ultimately, I really want them to get their nutrients from food and not supplements, but we ended up supplementing them just replete their bodies back to it to a baseline.
So yeah, we definitely see I’d say a little bit more buy in, but with the pharmacogenetic testing, that that cheek swab that I was telling you about that’s really interesting. Especially in my young adult patients with addictions, for example, because there’s one variation that breaks down dopamine. And if it’s if it’s this this one enzyme, it’s called calm tea. But anyway, if it’s if it’s high activity, it will break down dopamine really quickly. So dopamine is your pleasure neurotransmitter and, and the individuals who have high activity, this enzyme will often have ADHD symptoms. And they often have addictions because they’re trying to increase dopamine in their body. But there’s genetic variation where dopamine has been broken down very quickly. So the the psychostimulants, Adderall, Ritalin, those types of medications will what work well for these people.
And then we can show them like, look, this, this is part of your genetic variation. It’s not your fault. But this is why you need to continue your sobriety, for example, because if you go back to college and try to dabble in with different substances, you have a predisposition to become addicted to it. And that’s why you’re different than your peer. And that’s okay. But this is just information to arm you to realize, you don’t have a lot of control over it.
And that, you know, your lifestyle choices make a big difference. And the way your body acts from the bio medical perspective,
Yeah, huge difference, and how empowering that must feel to them to have that information to know that they’re not broken to know that they’re not, you know, this isn’t all in their head. And I would think it would also provide them a little bit more rationale to continue medication. So not just, like, continue your sobriety. But also, there’s a reason why this medication is working. And it needs to keep working super hard.
That’s a great point. A lot of them feel very frustrated with all the different medication trials they’ve been through. I mean, you can imagine, I mean, everyone knows if you’re listening how, at what point most young people or startup started on psych, Psych, psychiatric medications, and how long they’re they remain on these
different medications, prescriptions, and just how long it gets it takes to kind of get the right combination. So there’s a lot of frustration. So when we do the pharmacogenetic testing, we can see, see, this is why you never felt good on Prozac. This is why you had those adverse symptoms and side effects. And there’s this very much of an aha moment for the patient and also for the family, you know, kind of this feeling of relief, like finally, like we understand that. This is why these trials weren’t successful. And we went through a lot of pain and suffering and frustration when we were trying to have these agents help. But they weren’t.
Yeah, the family part of that, I think would be huge. Do you also see family members starting? As they’re seeing changes happen with their child? Do you see them starting to maybe implement some of these changes as well?
Absolutely. You know, often, I say the most often is that will will have a certain supplement regimen for their one child. And then I say, Can I try some of these on my other child who’s not. And of course, we say it’s better to individualize but, you know, do ask, ask the pediatrician to do some of this testing, because it’s so simple just to correct a vitamin D deficiency. And then, of course, they use it on themselves. But yet we ask the family to parallel our process, while the the resident is with us at Pacific quest. So they can, you know, they get a cookbook, for example, so they can see what they’re eating, and they can try some of the recipes at home. And they, they they get information about some of the Mind Body practices we use for sleep restoration. So that those are just some examples of some of the parallel process the families go through as well. Yeah, you mentioned and I’d love to touch on it just before we have to wrap up the an anti inflammatory diet and why that’s so important. Because I see this in the parents that I work with, and we all just sort of like, close our eyes and shake our heads when we think about the foods that our kids are eating, whether that’s in school or at home, you know, just their diet can just be so bold.
And it sounds like that’s a pretty big part of what you’re doing there. So maybe you can talk a little bit about why that’s so important. And maybe is there anything that we could do if you’re if your kids not in treatment, if you’re at home with them, and you’re watching them eat this terrible diet? Yeah, we might be able to do.
Yeah, well, on a broader scale, since the infrastructure for good nutrition is just not there in this country. I mean, think about what hospitals speak ailing patients alone. Yeah, I mean, that that right there that model is is it’s broken. And you know, food. It is medicine and we really need every practitioner and medical system to, to embody that. And so it started starts there. And that’s a discussion of and then the schools, right?
What kind of nutrients are they having available to the children and what it was education there in the schools? And then it goes back to the pediatricians offices, you know, what, what are they telling the kids, you know, they have their basic script. But, you know, what, what, just blood sugar control issues alone with these young people when you know, they’re not eating in the morning, and then they drink, you know, a frappuccino and a very large muffin and their blood sugar spike, and then they crash, and they wonder why they’re moody and attentive and low energy. But yeah, just that alone of that. I mean, there’s what there’s two things I tell everybody before they leave, and anyone can can use this as do not drink soda, there’s so many better ways to get sugar taste your way, and sugar in your life. Fruit.
Just even how I’d rather brownie than a soda really, because it’s just it’s, yeah, that the high fructose corn syrup, and there’s it’s just empty calories and not really not good for you, and then eat protein with every meal, if we can just do that.
And so we tried to teach the patients you know, at Pacific Quest as they transition away from us just how to feed themselves at a buffet, Chipotle or whatever they they are to make it easy that they don’t need to have this amazing organic anti inflammatory food. So the education alone is really important. But just just to touch upon anti inflammatory inflammation in the body corresponds to inflammation in the brain, we know this now a science actually, when I was trained in medical school, this, we had an inkling of it, but there wasn’t any research to back it up.
So now there is, so we know, if we calm the inflammation in the body with an anti inflammatory diet,then, in turn, the brain will be calmer too, and be more balanced. And basically, anti inflammatory diet is no processed foods, no sugars, no trans fats, you know, all those foods that kind of sit in the middle of your grocery store for years.
I just say never expire, of your grocery store, all those are more the whole foods, and, you know, in organic foods, colorful foods, specially organic sources of fats and proteins, not everything needs to be organic, I don’t think that can be very cost prohibitive. But there’s certain if we talk about the certain foods that you really need to keep organic and other ones just don’t worry about it. So just trying to eat foods that are really nutrient dense. And have bioavailability of of anti inflammatory ingredients too.
Yeah, and do kids do they start to like, really see the benefits of that? Like, does it take a while? Or do they do they notice?
It depends, I think at some notice, but they don’t want to admit the notice. Because, you know, they they have, they have a they have a message they want to not convey to their parents, which this was a great idea, thanks for sending me away.
But, you know, they, they they are embedded in his experience, you know, their their body, and I can I can see it is one of the reasons why I just decided to leave my outpatient practice and stay at Pacific Quest because after two weeks, it’s almost like this veil is lifted, you know, and they look vibrant and healthy. So that doesn’t lie. Their their their their body language and their and their their wording might say I don’t like this food and I miss my you know, my my Oreos or whatever it is. But you can tell like just just the way they carry themselves how much more vibrant and healthy they are.
Yeah, well and it’s one of those building blocks that they may leave once they leave you guys and then go back to write later in life when they realize I remember I felt really good when I was there and start to use some of those same tools and bring those back in so amazing what does what does a treatment plan look like for for somebody who’s there somebody who maybe has been with you for a while and then is even leaving and you’re you’re doing some planning for that? What does that look like from an integrative psychiatry standpoint?
Well, honestly, if we’ve identified a lot of deficiencies, it’s going to be pretty heavy on the supplements. And again, in the end, I want people to get their nutrients from diet mostly. So we’ll have in our discharge summaries we’ll have a clear path, okay, you’re taking this much vitamin D but test vitamin D at this point, and then you need to get to this number. And so we will kind of detail that what that plan is moving forward so it will look like outline outlining the medic, the foods that we recommend they eat. What we’ve done for their sleep specifically,course are the movement and exercise is pretty standard, or what we recommend depending on the individual, although I have to say that some kids kind of push themselves too much. And we really want more of this Yin, more relaxing type of cortisol lowering exercise for them, believe it or not. And then of course, the nutrient supplementation plans will be really individualized for the person, but we have to be realistic, sometimes they just they’re not going to be compliant. They’re taking a handful of supplements every day. We have them do that here, but then we try to taper them off once they leave. Yeah.
Wow, it just sounds really smart and solid, and makes so much sense seems like a lot of common sense to to really look at it this in this holistic way. That isn’t too much, one way or the other, but But taking into consideration lifestyle and, and you know, risk for substance misuse and mental health and all of the different medications. And from a parent’s standpoint, I can appreciate that disconnection and that fragmentation of, well this doctor did this and this doctor did this, and then this therapist that and when when no one’s talking to each other, like how is this all working together? So I love the idea of having everything put together making so much more sense.
Well, thank you, this was super informative, really excited to think a little bit more about this and just even implementing some of it I’ve four kids, and you know, they’re all different stages of diet choices. So I’m gonna think a little bit about that and see if we can work in a little bit more a little bit more fruit, a little less Oreos, yeah, just do what you can do at home, we can’t control what they do outside their home.
So I’d say don’t have it available, you know, and, and because they, they still need to be kids. They do.
But you know, I have realized I keep a huge bowl of like grapes or blueberries or something in the middle of the refrigerator, like at eye level without a lid on it. That makes it go bad faster, not but if I do that, I realize that it’s gone. That’s the first thing they see when they open the fridge and and it’s easier to grab than taking the lid off something or going in the pantry. So I think just accessibility is often a really big part of it. Agreed? Absolutely. Yeah. Thank you so much. We appreciate it. And we can’t wait to get this out to families to hear and try to work some of it on their own and to know that there’s so many different options. I love the the genetic testing you’re talking about that sounds like something that’s really important to look into. Is that something that any Is that a thing that like only a psychiatrists can do or who would be licensed medical provider can can order that.
Yeah. Okay, awesome. Thank you. Okay. Thank you, Brenda. Thanks for having me.
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