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Incorporating Dietitians into Primary Mental Health Care

The topic of mental health has received a huge surge of attention in recent years. The

World Health Organization defines mental health as “a state of well-being in which every

individual realizes his or her own potential, can cope with the normal stresses of life, can work

productively and fruitfully, and is able to make a contribution to her or his community” (1) .


Unfortunately, people across all ages, genders and backgrounds can struggle with mental health (1). In fact, by the age of 40, over 50% of the Canadian population will have, or have had, a mental health disorder (2) . Mental illnesses negatively impact health and life span, potentially reducing life expectancy by 10-25 years and significantly increasing proportion of years lived with disability (1). The Mental Health Commission of Canada also projects that mental health problems will impose a tremendous 2.5 trillion dollar burden on the Canadian economy over the next 30 years (1). These negative health, social and financial consequences of psychological disorders have caused a shift in health care focus from relying on treatment strategies for mental disorders, like pharmaceuticals, to considering preventative therapeutic lifestyle approaches, such as dietary interventions . The literature indicates numerous interrelations between diet and mental health (3) but dietetic services are not currently integrated within primary mental health care.


Therapeutic dietary intervention strategies can play an important role in preventing and

treating mental disorders, as well as, managing mental health (4). One comprehensive analytic paper, using high quality studies, found that an intake of nutritious fats, specifically omega-3,reduced individuals’ depressive symptoms . These results suggest that omega-3 may be a beneficial therapeutic agent for depression and an effective addition to the treatment of mental disorders. Another reliable review showed that adhering to a nutritious diet high in vegetables, fruit, fish and legumes, such as the Mediterranean diet, while avoiding foods that promote inflammation, like sweets and processed red meats, appears to protect individuals against depression and anxiety (5) . This finding further emphasizes the idea that adequate nutritional intake may be a critical lifestyle intervention for preventing development of mental disorders. Moreover, Dietitians of Canada (DC), which is the national professional association fordietitians, created several evidence-based information tools on the interconnections between nutrition and mental health. These resources were critically reviewed by a multidisciplinary advisory team consisting of dietitians, planning and policy analysts, and departments of community health, which reflects the reliability of the information. Although these toolkits were assembled in 2012 and may therefore not reflect the most recent state of literature on mood and food, they provide thorough summarizations of the science-based evidence on the intersections between nutrition and mental health. For example, micronutrients like niacin (vitamin B3) and folic acid (vitamin B9) are involved in synthesizing serotonin, a hormone that boosts mood and regulates anxiety (6). Therefore, a deficiency in these vitamins can negatively affect mental well- being and targeted supplementation may be beneficial for individuals with anxiety or depression

.

Although more research is needed in this emerging field of nutritional psychology, there is

already a large pool of evidence based knowledge that illustrates how diet can play a critical role in mental health promotion and lead to positive mental health outcomes.

Despite the evidence-based relationships between food and mood, dietitians are deemed

non-essential stakeholders in the mental health care process (7) . The Canadian Collaborative Mental Health Initiative believes dietitians are uniquely qualified to provide individualized nutrition interventions to people with mental health conditions, resulting in improvements in psychological well-being and mental functioning (8). The lack of dietetic services within primary mental health care teams highlights a significant gap in the mental health care system, resulting in unfavourable outcomes for mental health patients (6,7,8).


This discrepancy can be addressed through the incorporation of policy-driven changes to the mental health care process. More specifically, overcoming this gap in health care provision requires policy makers, at both provincial and federal government levels, to understand the interconnections between food and mood, and subsequently integrate dietitians into primary mental health care programs.

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