CorrectCare

Holistic Care Offers Promise of Positive Health Outcomes

By Heidi Bale, RN, CCHP, and Jane Grametbaur, RN, CCHP-A

In a society brought up with scientific medicine, holistic medicine is generally perceived as all smoke and mirrors. Although some types of holistic medicine, like acupuncture, have become more mainstream recently, many medical professionals regard holistic treatment as ineffective or downright dangerous.

Although often dismissed as quackery, holistic medicine has roots as far back in history as man has walked the earth. Before the great scientific discoveries of the past century, the ordinary man depended on the tribal priest or healer to provide relief from his ills.

The healer often used herbs, plants and spiritual methods to treat disease. Several botanicals that come to mind as effective today are the opium poppy, from which we derive morphine, and foxglove, which the ancient herbalist prescribed for cardiac problems and from which digitalis was later extracted.

As the only known antidote to poisoning caused by the death cap mushroom, which kills by destroying the liver, the herb milk thistle has great potential for use in treating liver damage caused by cirrhosis and hepatitis. European doctors frequently use milk thistle to treat patients with liver disease and numerous studies have shown it is effective. A number of other herbs and over-the-counter vitamins, such as those containing omega-3 fatty acids, may be of use in treating other chronic medical conditions such as arthritis.

The ancient Chinese believed sickness stemmed from the interruption of the flow of energy through the body and developed a system to clear the body of blockages. We know this form of energy healing as acupuncture. Some Chinese patients have major surgery with nothing but acupuncture for anesthesia. After surgery these patients simply get up and walk out of the operating room.

In India, meditation, a religious practice devised to help the practitioner become closer to God, has shown benefits for health. Patients who incorporate meditation into their daily activities become calmer and have better control in stressful situations. With time, practitioners can lower blood pressure and heart rate, diminishing the need for medication.

Several traditional Native American practices also may be useful as an adjunct with current medical treatment for cardiovascular disease. In addition, Native American community leaders have used medicine men and women and ancient traditions to treat drug addiction and alcoholism in at-risk youth. Some traditions and ceremonies, such as the sweat lodge ceremony, have shown promise in treatment of PTSD and drug and alcohol addiction.

Well-Suited to Corrections
Correctional medicine traditionally has focused on the conservative practice of scientific medicine so it would seem that holistic medicine would have no place in the correctional setting. Yet, in many ways, it is perfectly tailored for use in correctional populations.

Inmates suffer from varying degrees of anxiety due to the circumstances of their incarceration and to the stress of living in a correctional setting. Communal housing, disruption of sleep and daily routines, as well as loss of control in day-to-day decisions cause stress, behavioral outbursts and exacerbation of health problems.

Holistic medicine focuses on the treatment of the individual as a whole, encompassing care for not only the physical symptoms of illness but also the mental and spiritual symptoms. Meditation, relaxation techniques, Reiki, tai chi, guided imagery and gardening are methods most commonly used in corrections today.

A Sampling of Programs
 In 2003 and 2004, the San Diego County Sheriff’s Department instituted a program for psychiatric patients incarcerated in its facilities. The goals included identifying mental health inmates who did not require care by a psychiatrist, treating this population using holistic methods, reducing the number of patients who required treatment with mental health medications, increasing the efficacy of time spent with patients by psychiatrists and decreasing wait times for patients in need of psychiatric evaluation.

Specially trained registered nurses identified patients who met the criteria of sleep disturbance, anxiety, substance abuse concerns and depressive symptoms in patients not on psychotropic medications. These patients were referred to mental health clinicians who had completed special training. The patients also received handouts on improving sleep and reducing stress.

As reported in the July 2006 issue of the Journal of Correctional Health Care, a study to assess program outcomes found that approximately half of the inmates initially seen needed no further follow up after holistic treatment. A small group did require follow-up visits but were managed without medication. Approximately 30% of the group required referral to the psychiatrist.

Study findings also showed a significant decrease in the wait time to see a psychiatrist, as well as the time needed by the psychiatrist to evaluate the patient. The more efficient use of time by the psychiatrists allowed more time for the evaluation and care of acutely ill mental health patients.

A number of studies have examined the use of meditation in prisons and jails. One of the most recent was completed by a group from Old Dominion University in Virginia and published in the January 2009 issue of the Journal of Correctional Health Care. The researchers hypothesized that the use of meditation by inmate populations would be a cost-effective way for institutions to deal with problems from insomnia to conflict management. The primary focus of the study was to determine if participation in a structured meditation program would decrease medical symptoms, emotions and behaviors in a female population.

The study group received training in meditation practices by trained facilitators. Emphasis was placed on enhancing inner calm and learning to live in the moment, as well as discussion with other study group members and facilitators. Results showed that inmates who participated in meditation had fewer sleep problems, fewer problems with angry outbursts, and reduced feelings of stress and anxiety.

In San Francisco, the city and county jails implemented a meditation program through the San Francisco Zen Center for a number of years. This class lasted about 90 minutes, incorporating tai chi and yoga exercises to quiet the mind and body. This program was directed at women who were incarcerated for alcohol and drug crimes.

At the Hampshire County House of Correction in Massachusetts, inmates have been trained to practice Reiki on each other. Reiki is a Japanese technique for relaxation in which practitioners use their hands in positions over the patient’s body to sense energy centers, or “chi.” With intuition and training, the practitioners unblock trapped energy, thereby releasing stress, easing withdrawal symptoms and smoothing out emotions. Students are taught to practice Reiki on themselves before mastering higher levels and tending to other inmates.

In 2006, San Quentin State Prison in California established a gardening program for inmates through the Insight Prison Project, a not-for-profit organization that aims to provide unique rehabilitation programs for the prison. Participants were taught to cultivate plants and gardens on the grounds of the prison. As they learned to nurture flowers and vegetables, these men also learned to nurture positive responses to negative emotions and interactions. This program sought to plant responsibility, teamwork and appreciation through mindful gardening. Prison officials hope to expand this program, which now operates independently as the Insight Garden Project.

Insight Prison Project also offers a “mindful meditation” program. Increasingly popular in recent years, mindful meditation requires no special skills or training and instead simply focuses on being “in the present” and allowing the practitioner to let various thoughts surface while meditating. This form of meditation honors all belief systems and backgrounds and can be performed anywhere.

As more correctional facilities see the benefit of using holistic treatment as an adjunct to scientific practices, we can expect to see more innovative and creative solutions to medical and psychiatric issues. For instance, the San Bernardino County, CA, jail recently purchased a Wii play station by Nintendo for use in treatment of mental health patients.

“We added the Wii program to our mental health group sessions in an effort to engage more of our seriously mentally ill patients,” says health services administrator Kathy Wild, RN, MPA, CCHP. “We looked at the recent increase in the use of this equipment for nursing home residents and were impressed with the results. We do this group several times a week and include the mental health clinicians and our nurses during the sessions. This engages the patient with the staff. We are very impressed with the results we’ve seen so far. Inmates who rarely come out of their cells look forward to using the system and often are seen laughing and talking with staff during the course of the group.”

Significant Benefits
Whether it is through yoga, guided imagery (a form of guided meditation), tai chi, gardening or other means, the reduction of stress and anxiety is proven to reduce pain, improve sleep quality, calm emotions and produce a sense of well-being. This, in turn, decreases the need for expensive medications and reduces behavioral outbursts and assaults on staff. Given the escalating costs of health care and the difficulties in recruiting staff, the potential benefits of holistic care are significant.

With a little imagination and innovation, staff can blend holistic care with conventional medical treatment. The end result will benefit both the patient and the health care system by decreasing exacerbations of chronic illness, teaching patients new methods of coping with pain and anxiety, and providing patients with self-care practices that will last a lifetime.

— About the authors: Heidi Bale, RN, CCHP, is health services coordinator for the Washington State Department of Corrections, Raymond, WA. Jane Grametbaur, RN, CCHP-A, is the principal of Grametbaur & Associates Legal Nurse Consultants, Riverside, CA.

[This article first appeared in the Spring 2009 issue of CorrectCare.]