Attending to the biopsychosocial approach in Australia’s mental health agenda

To the Editor

The Australian and New Zealand Journal of Psychiatry recently noted that the incidence of mental disorders in Australia might be reduced by a dual strategy that places a symptom and risk reduction prevention strategy (‘reducing what is not wanted’) within a context of mental health promotion (‘focusing on what is wanted’; Stallman and Wilson, 2018). The risk associated with over-emphasising specific symptoms or risk factors is the potential for under-identifying individual needs and overlooking opportunities for growth and strength, particularly when aiming to prevent suicide among young people (Surgenor et al., 2016).

Mental health practitioners generally agree that using a biopsychosocial approach – one that systematically considers biological, psychological and social factors and their complex interactions (Engel, 1980) – to assess, understand and accurately respond to community and individual mental health needs is fundamental for promoting mental health and preventing mental illness. This agreement assumes that the application of a biopsychosocial approach is central to the content and delivery of all mental health programmes and services.

We explored the accuracy of this assumption by searching peer-reviewed, English language, publications in PsycINFO. The search parameters were articles published in 2017 that included ‘biopsychosocial’ (AND ‘program*’ OR ‘intervention’) in title, abstracts, heading words, key concepts, tests or measures.

The search returned 44 results; full papers identified six studies that described an intervention targeting some aspect of mental health. Of the six, only one described the intervention as biopsychosocial, two described psychosocial interventions, one described a psychological-only intervention and one described a social-only intervention. One study provided insufficient detail to know what content and delivery was used for the intervention. Further complicating the results, the social intervention used measures described as ‘biopsychosocial’, but that were only psychosocial.

Although not a formal review, which may uncover more optimistic results, this snapshot suggests that while ‘biopsychosocial’ is commonly used to describe what mental health practitioners do, reality may not be synonymous. Yet, addressing the widely reported and validated biological drivers of mental health problems – poor sleep, nutrition, physical activity and physical illnesses – determines the efficacy of psychological and social intervention. This snapshot reminds practitioners that implementing psychological and social symptom and risk reduction strategies within a context of strategies to address the biological drivers of mental health problems is likely to improve the efficacy of mental health intervention to reduce the incidence of mental disorders in Australia.