biopsychosocial model of mental health essay

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Understanding the Biopsychosocial Model of Health and Wellness

A holistic approach to well-being

Dr. Amy Marschall is an autistic clinical psychologist with ADHD, working with children and adolescents who also identify with these neurotypes among others. She is certified in TF-CBT and telemental health.

Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.

Maskot/Getty Images

• The Three Aspects of the Biopsychosocial Model

How the Biopsychosocial Model Impacts Mental Health

• Criticism of the Model

How Healthcare Professionals Use the Biopsychosocial Model

How clients and patients can use the biopsychosocial model.

The biopsychosocial model is an approach to understanding mental and physical health through a multi-systems lens, understanding the influence of biology, psychology, and social environment. Dr. George Engel and Dr. John Romano developed this model in the 1970s, but the concept of this has existed in medicine for centuries.

A biopsychosocial approach to healthcare understands that these systems overlap and interact to impact each individual’s well-being and risk for illness, and understanding these systems can lead to more effective treatment. It also recognizes the importance of patient self-awareness , relationships with providers in the healthcare system, and individual life context.

Dr. Akeem Marsh, MD , physician and author of Not Just Bad Kids , described the biopsychosocial model as “at its core, centering around social determinants of mental health in connection with the ‘standard’ biomedical and psychological models. One of the more common ways in which it is represented when using the model is through the four ‘Ps’ of case formulation: predisposing, precipitating, perpetuating, and protective factors.”

Learn more about how providers can use the biopsychosocial model to offer holistic care and how clients and patients can benefit from this approach.

What Are the Three Aspects of the Biopsychosocial Model?

When understanding an individual’s physical and mental health through the biopsychosocial model, we consider physiological factors such as genetics and illness pathology (biological); thoughts, emotions, and behavior (psychological); and socioeconomic components, social support, and culture (social). How do each of these components inform the model as a whole?

“Biology” refers to our genetics , physical health, and the functioning of our organ systems. Our physical well-being impacts our mental health for multiple reasons. First, our brain is an organ and can become unwell just like any other organ. Second, physical health conditions can wear on mental health. For example, chronic pain can lead to symptoms of depression.

Additionally, just like we can have genetic predisposition to a physical disability, mental health has genetic roots as well. According to Dr. Marsh, “Genetics are the most basic level by which mental health is influenced, and on some level has an impact for everyone.” In other words, “Whatever the phenotypical expression, genetics does play a role to some degree.” The expression is in turn influenced by the environment.

Psychological

Mental health is health, and one’s psychological well-being impacts both mental and physical health. Unhealthy and maladaptive moods, thoughts, and behaviors can all be symptoms of mental health conditions, and in turn can contribute to our overall health. Mental health and behavior can be cyclical; for example, an individual who self-isolates as a symptom of depression may experience increased depressive symptoms as a result of isolation.

Routine physical activity is known to promote positive mental wellness, while inadequate or excessive physical activity can contribute to different types of mental health struggles.

Addressing these symptoms is key in improving mental health.

Dr. Marsh shares the impact of external factors on health: “The expression [of genetics] is in turn influenced by environment.” Changes in one’s environment can impact mental health, both positively and negatively. In the previous example of depression and isolation , individuals who have appropriate social support experience fewer mental health issues compared to those without this support.

An individual who is struggling with their mental health might need social support and environmental changes just as much as they need therapy or medication intervention for their symptoms.

Traditionally, healthcare has focused primarily on the medical and biological side of the patient’s needs, and mental health care has focused on the psychological side. While it makes logical sense to address manifesting symptoms, a holistic approach to care that aims to address the social as well as the psychological and biological contributions to illness can be more health-promoting.

Sometimes, for instance, addressing an underlying social need or environmental stressor can improve mental health more effectively than other psychological or biological treatments. This may allow for less-invasive treatments and interventions, and it can improve the individual’s well-being in a way that non-holistic models overlook.

Criticism of the Biopsychosocial Model

Although many providers support a holistic approach to care and implement the biopsychosocial model in practice, like any model it has limitations. Dr. Marsh notes that there are concerns about its evidence backing: “Some people believe that [the biopsychosocial model] is not scientific, as in it has not quite met the ‘gold standard’ of being validated through multiple randomized trials, as it is a uniquely challenging study prospect.” How can researchers study controlled variables in a model that requires holistic care that takes individual needs into account?

At the same time, the model has many strengths and can benefit patients in the healthcare and mental health systems: “It has been researched extensively and shown positive results when applied in different ways,” Dr. Marsh said.

Mental health professionals who utilize the biopsychosocial model in practice include extensive medical history, family history, genetics, and social factors in assessments in addition to psychological information.

Additionally, they use this information to ensure that all of the client’s needs are met , as many medical issues can manifest with mental health symptoms. Therapy services to treat, for example, depression caused by an under-functioning thyroid is unlikely to be effective.

When adopted appropriately, health professionals conceptualize patients that they work with in a broad context that attempts to understand and see patients as a whole person—complex human being with nuance, so much more than just a cluster of symptoms or diagnosis.

This model lets providers see the whole person beyond their presenting symptoms.

While the biopsychosocial model has its place in the healthcare and mental healthcare systems, individuals might also implement tenants of this model in their own lives. This means being aware of how environmental factors impact their mental and physical health, as well as how their genetics and medical history in turn influence behaviors, thoughts, and emotions.

It can help individuals better understand themselves as complex, whole beings as well. “I believe that [the biopsychosocial model] could enhance their self-awareness and understanding of themselves, along with broadening their personal sense of what issues or challenges may be going on with them," says Dr. Marsh.

Engel GL. The need for a new medical model: a challenge for biomedicine .  Science . 1977;196(4286):129-136. doi:10.1126/science.847460

Soltani S, Kopala-Sibley DC, Noel M. The co-occurrence of pediatric chronic pain and depression: a narrative review and conceptualization of mutual maintenance .  The Clinical Journal of Pain . 2019;35(7):633-643. doi:10.1097/AJP.0000000000000723

Alsubaie MM, Stain HJ, Webster LAD, Wadman R. The role of sources of social support on depression and quality of life for university students .  International Journal of Adolescence and Youth . 2019;24(4):484-496. doi:10.1080/02673843.2019.1568887

By Amy Marschall, PsyD Dr. Amy Marschall is an autistic clinical psychologist with ADHD, working with children and adolescents who also identify with these neurotypes among others. She is certified in TF-CBT and telemental health.

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Biopsychosocial Approach in Mental Illness

Introduction, psychological.

Biopsychosocial approach in mental illness requires that the health care professional considers the biological, psychological and social aspects of the patient. The approach operates under a principle that the mind, the body as well as the environment interact and cause diseases. The biological aspect refers to microorganisms that cause diseases while the psychological are behaviors that can precipitate in a mental disorder. On the other hand, the social aspect deals with the influence of the community members on mental illness. Therefore, healthcare professional should assess a client from a biopsychosocical perspective. This is because, biological, psychological and social aspect of a patient predisposes, precipitate and perpetuate mental illness. Additionally, they protect one from mental illness. Therefore, this paper will examine the assessment of a mental health client from a biopsychosocial perspective.

According to Plante (2008), biological factor consists of predisposing, precipitating, perpetuating and protective part. The mental health nurse needs to consider these parts during the patient assessment. To begin with, Predisposing factors include medical, psychiatry, medication, family and genetic history (Altmaier et al, 2009). According to the case study, the psychiatry history shows that the patient is a known psychiatric client with learning disability and bi-polar. Besides, she has had several admissions under section 3 of the Mental Health Act. The medication history reveals that she is on antidepressants and antipsychotics. According to the family history, she has a husband and parents. Besides, she is 21 weeks pregnant. The psychiatry, medication and family history are important in the management of the patient. For instance, the medication history will assist the nurse to determine the kind of treatment to offer. On the other hand, family history assists in determination of support factors. According to the case study, the mental health nurse did not assess the medical and the genetic histories yet they are of great value. For example, the patient’s mental health illness could be running in the family. Moreover, the patient can have a medical condition that leads to learning disability. For example, Down syndrome is a medical condition that affects the brain, thus, leading to learning disability.

Hamid (2009) states that precipitating factors that the mental health nurse should consider during the assessment include a new medical problem, relapse of sickness as well as non-compliance. According to the case study, the patient has been having relapses because of on and off treatment. Furthermore, she has poor compliance to medication. Unfortunately, the mental health nurse did not assess the history of a new medical problem. This makes it hard for the bioposychosocial approach to be of use. For instance, the client can have a new medical condition, which worsens while on antipsychotic and antidepressant treatment, thus, leading to poor compliance. Furthermore, the client could be taking some medication for the new medical condition that antagonizes the antipsychotics and antidepressants thus relapse of sickness.

Perpetuating factors to mental illness involve medication use, chronic conditions as well as non-compliance ((Chamorro, 2008). According to the case study, the mental health nurse assessed the medication as well as non-compliance histories. Although the medication that the client uses is evident, the mental health nurse did not detect the reason for non-compliance. As a result, the patient is likely not to adhere to the treatment regimen if given a different type of medication. Moreover, the assessment of chronic condition did not take place. Thus, the probability of the patient not complying with the use of medication is high because there could be an underlying condition that makes her non-compliant.

Ghaemi (2009) states that biological factors that protect one from mental illness include the health, the acquiescent, proper respond to medication as well as temperance. In the case study, the pregnancy state of the patient exposes her to bi-polar. This is because she is anxious that the social service will take her baby away. Furthermore, improper respond to medication, which is evident by poor drug compliance, will aggravate her mental illness. Besides, poor temperance enhances bi-polar. For example, the possession of the thought that she is not beautiful can lead to depression. On the contrary, her acquiescent state protects her from mental illness. For instance, she is striving to be independent by attending parenting courses and studying living as well as garden skills at community college.

Psychological assessment also falls under four categories that include predisposing, precipitating, perpetuating and protecting. Predisposing factors include adaptation to stress, trauma as well as stages of development (Doherty et al., 2010). According to the case study, the patient has poor adaptation to stress and this is evident by the fact that she avoids people. For example, she initially refused her photo taken so that she could use the public transport. This shows that she had not adapted to the stigma associated with mental illness. Moreover, she segregates herself from the few friends that she has at the group. This stigma can lead to relapse of mental illness especially the bi-polar because of the stress and depression associated with it. On the other hand, the trauma assessment reveals that she has a grafted burn on the left leg. This state could also predispose her to bi-polar. For instance, her grafted leg can make the society segregate her because they think she has an incurable disease. This leads to psychological trauma, thus, relapses of the mental health illness. Lastly, the mental health nurse did not assess for the stages of development. This is an important aspect in the assessment because a problem in the development milestone can interfere with the learning ability of a person. As a result, it will be difficult to know the cause of the learning disability of the patient thus inappropriate management.

Ghaemi (2008) states that grief, new conflict, recent trauma as well as impaired reality testing are precipitating factors to mental illness, thus, the mental health nurse needs to assess for them. In the case study, the client has a conflict because she is undecided as to whether she should report about her pregnancy or maintain silence. This state of conflict creates anxiety in her, thus, precipitating the mental illness. On the other hand, her reality testing is intact and this enables her to cope with the condition despite the social discrimination. For example, her acceptance of the photo shows that she knows the benefits associated with public transport. Finally, the mental health nurse did not assess for grief and recent trauma. This can lead to inappropriate management because trauma affects the patient adherence to medication. Moreover, grief accelerates mental illness. This is because grief leads to sadness, stress, depression and finally bi-polar. Additionally, the grief could be the reason for the patient segregation from the society through having few friends and not seeing them regularly.

Abuse, poor judgment, the patient position as well as impulsivity are some psychological factors that perpetuate mental disorder, hence, the mental health nurse needs to pay close attention to them during the assessment (Engel, 2009 ). To begin with, poor judgment interferes with patient treatment. According to the case study, the patient anxiety has increased because she thinks that the social worker will take her baby away. Besides, it increases the chances of labeling by the society. For instance, her refusal to associate with other people will make the society label her leading to stigmatization. On the other hand, the mental health nurse did not consider the assessment of abuse history, the patient position and impulsivity. As a result, the mental health nurse might have missed out something significant. Freeth (2010) explains that abuse perpetuates mental illness through psychological disturbance. This could be the reason for the patient on and off admission under section 3 of the MHA.

Lastly, protective factors include adequate coping mechanisms, positive therapeutic corporation and good insight (Frankel et al., 2008). According to the case study, the client has a poor copping mechanism and, for that reason, the mental health nurse reduced her visits to fortnight so that she can become independent. Besides, she has a negative therapeutic corporation as evidenced by poor medication compliance, hence, relapse of sickness. On the contrary, she has good insight. That is why she attends friendship and integration group sessions in the community.

Altmaier et al (2009) explain that social factors that fall under the predisposing group include family conflict, limited support, religious as well as education conflict. According to the case study, family conflict and limited support do not affect the progress of the patient. This is because the patient has a good relationship with the husband and the parents. Although, the case study does not mention it, education conflict plays a role in the patient mental illness. For instance, the patient has a learning disability, thus, she cannot perform well at school. This can lead to stigma as the other student refuses to associate with her, hence, precipitating in the mental illness. Lastly, the case study does not portray the association of the patient with her creator. As a result, we may not know whether a religious conflict that leads to relapse of illness exists.

Legal issues, relationship conflict and unemployment precipitate mental illness (Hamid, 2009). In the case study, the assessment shows that legal issues put the patient in a state of anxiety, thus, aggravating the bi-polar state. For example, the client is confused as to whether she should report her pregnancy at a gestation of twenty four weeks. Besides, the patient has a relationship conflict because she does not relate well with the group members. For that reason, she has few friends, hence, social segregation. Therefore, the society labels her as antisocial because she does not want to associate with other people. Finally, the unemployment state of the patient contributes to the illness because she feels that she is of no use to the society. Since the society does not associate with lazy people, the patient decided to learn living skills so that she can provide for the family.

In a recent research, Chamorro (2008) explains that limited resources as well as social barriers perpetuate mental disorders. According to the case study, the patient has some social barriers and that is why she does not associate with most of the people in the society. This can be because the society stigmatizes people with mental illness. For example, the patient did not want the public to see her photo because of the fear of segregation. On the other hand, the mental health nurse did not assess the accessibility of the patient to resources like medication, money and food. Therefore, it is difficult to claim that the patient is a poor compliant because of inaccessible resources.

Finally, protective factors are important for the recovery of the patient and they include support, finances and availability of resources (Ghaemi, 2009). The case study states that the patient has a strong social support. To begin with, the husband is supportive because apart from accepting to marry her, he made himself known to the mental health services that he is responsible for the client’s life. Secondly, the parents and the care coordinator act like her support group. Lastly, the client belongs to a support group that guide and counsel her. These social supports are imperative because they help in stigma reduction by letting the patient understand her condition and integrate with other people in the community. Finally, resources like colleges that help the client become independent play a role in social inclusion. This is because it is easier for a society to accept a hardworking person.

In conclusion, the assessment of a mental health client from a biopsychosocial approach is important because it leads to holistic management. According to the case study, the mental health nurse tried to follow the approach. The only problem is that there was omission of some important aspects. Therefore, mental health nurses should learn the biopsychosocial approach of assessment of a mentally ill patient.

Altmaier, J., & Hansen, C. 2009, The Oxford Handbook of Counseling Psychology. Oxford, Oxford Publisher.

Chamorro, T. 2008, Personality and Individual Difference. New Jersey, Willey Blackwell.

Doherty, J., & Mcdaniel, S. 2010, Madical Familiy Therapy: A Biopsychosocial Approach to Families with Mental Health. New York, Springer.

Engel, E. 2009,The History of the Biopsychosocial Approach in Medicine. American Journal of Psychiatry , 5 (7), 1-20.

Frankel, R., Quill, T., & McDaniel, S. 2008, The Biopsychosocial Approach: Past, Present, Future. New York, University of Rochester Press.

Freeth, R. 2010, Humanising Psychiatry and Mental Health Care: The Challange of the person. New York, Radclife Publishing.

Ghaemi, N. 2008, The Concept of Psychiatry: A Pluralistic approach to the Mind. Oxford, Oxford Publisher.

Ghaemi, N. 2009, The Rise and Fall of the Biopsychosocial Model. British Journal of Psychiatry , 195 (10), 3-4.

Hamid, R. 2009, A Closer Evaluation of Current Methods in Psychiatric assessments: A Challange for the Biopsychosocial Model. Psychiatric Matrix Medical Communication , 6 (2), 25-30.

Plante, T. 2008, Contemporary Clinical Psychology. New Jersey, John Willey and Sons.

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