Healing A Broken Mental Health System: Holly MacKenna Of Dara Wellness On 5 Things That Can Be Done To Fix Our Broken Mental Health System
An Interview With Stephanie Greer
We need to return to the basics by refocusing our efforts on the relationship between patient and healer in the exam room. In medical school, I returned to my father’s village in Ireland and shadowed the general practitioner there. One morning, he paused before we entered an exam room and told me it would be best for me to wait outside, as the woman who was there came in at his request because her husband had died earlier that week. He said, “We’re just going to have a cup of tea and a chat,” so there was no need for me to be there as an observer. This was over 20 years ago and the impact of his care model still guides me in my interactions to this day. His taking time to just be present for a woman’s grief likely helped her to avoid developing depression, anxiety, insomnia, and countless other health concerns that can accompany stress and heartbreak.
The current state of the mental health system is a conversation that echoes in the halls of policy-making, the corners of social advocacy, and within the private struggles of individuals and families. As we continue to witness an unprecedented need for robust mental health support, the shortcomings of the existing system become more glaring. It is within this backdrop that we seek the insight of those who are at the forefront of behavioral health. In this interview series, we are talking to behavioral health leaders, policymakers, mental health practitioners, advocates, and reformers to share their perspectives on healing our broken mental health system. As a part of this interview series, we had the pleasure of interviewing Holly MacKenna, MD, ABPN, ABOIM.
Dr. Holly MacKenna is a dual board-certified physician and psychiatrist with over 20 years of healthcare experience in various settings, serving in leadership positions throughout her career. Before that, she was a patient who learned firsthand how integrative medicine approaches lead to more comprehensive and substantive healing.
A graduate of the Andrew Weil Fellowship, the leading integrative medical education program in the world, Dr. MacKenna founded Dara Wellness to expand the integrative psychiatry model to all areas of the Gulf Coast, utilizing methods of integrative medicine such as nutrition, sleep management, lifestyle modification, and mind-body modalities including reiki and mindfulness. She is consulted worldwide for her expertise on brain health and the effects of hypermobility on mental well-being.
Thank you so much for joining us in this interview series. Before we start, our readers would love to “get to know you” a bit better. Can you tell us a bit about your background and your childhood backstory?
I am a child of Irish immigrants. I grew up in rural North Carolina, where my father served as a specialist physician to women during their high-risk pregnancies. From a young age, I became aware of the need to bring high-quality care to all patients, no matter where they live, which inspired my interest in telemedicine. My desire to pursue Integrative Psychiatry developed from observing the Irish model of care, which involves house calls and genuinely meeting the patient where they are at both physically and psychologically. Early in my medical training, I encountered the limitations of traditional, modern-day medicine as a patient with evolving symptoms, including chronic pain and inflammation. My experiences as an Ehlers-Danlos Hypermobile patient helped me learn firsthand how integrative medicine approaches lead to complete whole-person healing.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
“Caring for myself is not self-indulgence. It is self-preservation, and that is an act of political warfare.” Audre Lorde’s writing inspired and motivated me during my early adulthood when my health was in jeopardy. Just six months into my medical school training, I developed arthralgia and extreme fatigue, which led to my needing to take time off. A few months into my illness, I was invited to leave school and return to start over the following year. Around that time, I also experienced kidney failure. I remember my mother saying she would give me her kidney if needed, and I came face to face with my possible mortality. Upon recovery, when I returned to school, my symptoms and my need to draw boundaries to stay healthy were minimized and ignored by several staff and classmates. This quote resonates with my continuing need to balance the rigors of medical training and career with my evolving role as a female patient with a chronic health condition.
Let’s now shift to the main part of our discussion. It is often said that “the mental health system in America is broken”. What does that statement mean to you? From your perspective what is “broken” today?
Medicine has evolved beyond focusing on the patient-provider relationship to become business and profit-driven. Treatments and session lengths are determined by insurance executives rather than the needs of the patient, their family, and the community. Those fighting to offer the best care feel forced to provide band-aids rather than address the underlying cause of symptoms. Shortened visits force healers to become more specialized and siloed in their approaches, further moving treatment away from whole-person and patient-centered care.
What about any bright spots? Do you think there are any elements that we get right in today’s world that we wouldn’t want to reverse unintentionally?
Medicine is complex, and those driven to pursue it do so because they feel called to offer healing. Relationships between patient and doctor or therapist are essential factors in patient outcomes. Adherence to recommendations is much more likely to occur when the person being treated feels their doctor or therapist is invested in their care and well-being.
In your opinion, what are the 5 most impactful things that could help heal the broken mental health system? These could be on any level including training, workforce, policy, culture, equity etc.
1 . We need to return to the basics by refocusing our efforts on the relationship between patient and healer in the exam room. In medical school, I returned to my father’s village in Ireland and shadowed the general practitioner there. One morning, he paused before we entered an exam room and told me it would be best for me to wait outside, as the woman who was there came in at his request because her husband had died earlier that week. He said, “We’re just going to have a cup of tea and a chat,” so there was no need for me to be there as an observer. This was over 20 years ago and the impact of his care model still guides me in my interactions to this day. His taking time to just be present for a woman’s grief likely helped her to avoid developing depression, anxiety, insomnia, and countless other health concerns that can accompany stress and heartbreak.
2 . Mental Health needs to be rebranded as a vital aspect of whole-person care. It is essentially an additional vital sign that should be asked about and discussed at each visit with every physician and healthcare provider. The integrative medicine approach recognizes that our mental well-being affects all aspects of our health whether it be heart, gastrointestinal, joint health, and more. I work closely with the #SameHere Global Mental Health Organization, which works closely with people from all aspects of life to decrease mental health stigma. Instead of emphasizing that one in five people is diagnosed with a mental health condition, we need to recognize that five in five deal with stress and life circumstances that may negatively affect how they interact with and view the world.
3 . We need to return to truly patient-centered care. Large health organizations have become increasingly focused on outcomes that are financially driven. This adds undue burden on medical staff in the form of unnecessary administrative tasks, including numerous reminders and boxes to check, which seep into the exam room. I’ve been present in leadership meetings where it is obvious the focus has become so numbers- and money-driven that the patient’s needs are entirely abandoned to the point that one wonders if they want the actual person to be present for visits.
4 . Integrative medicine has given us a real opportunity to meet patients where they are. At least 80% of adults in the USA use supplements, but they rarely discuss these with their conventional mental health providers due to the lack of training and willingness of those prescribers to meet them where they are and learn the evidence present for the use of supplements, nutrition, movement, and mind-body medicine. Psychedelics offer an expansion of our minds and bodies, which is in the early stages of being fully realized. Conventional medical training must include these evidence-based healing modalities. With that, physicians and healthcare personnel can be in better positions to offer evidence-based care to patients seeking answers so that these same patients are not victims of those who lack the training needed to keep them safe.
5 . The siloing of specialty care has made it too difficult for patients to find answers. It took me until the age of 50 to be diagnosed with Ehlers-Danlos Syndrome despite having symptoms since I was 15 years old. I even had to take a year off medical school and experienced many limitations and interruptions. I was a member of many healthcare systems and teams, but no one diagnosed me because no one took all my symptoms that multiple excellent specialists treated and put them together. Since I opened my integrative psychiatry practice, I’ve helped women realize when symptoms are related to their menses, thyroid dysfunction, or hypermobility. More traditionally trained providers may view what I do as not “staying in my lane,” but if I did, how much longer would these women have to suffer for someone to hear them?
If all of the items on your list were magically implemented tomorrow what change might we see in the world? What are the signs (big and small) that would show us that the system is being healed?
We would see a genuine movement towards wellness and whole-person care. That relationship is central, and having relationships with healthcare professionals can be a determinant of mental well-being. We would also see the elimination of stigma so that when we ask one another, “How are you?” we want to hear the answer.
What is a project you or others are working on today that gives you hope? How can our readers learn more about this work?
My learning and training with Andrew Weil and his staff at his Center for Integrative Medicine has deeply affected me and changed my practice as a healer. Integrative medicine and psychiatry go hand in hand to treat the person fully — mind, body, and soul. I would be remiss not to acknowledge that my journey as a patient within the broken medical system has influenced who I have become as a healer. I am excited to be in the process of completing a book about my journey as a chronic pain patient, mother of children with chronic health concerns, trainee, and physician. I hope that by sharing my story and the lessons I’ve gained, I can help others more easily navigate the system and advocate for themselves so their needs can be heard.
How do you see technology shaping the future of mental health care and its accessibility?
Telemedicine has allowed access across miles and boundaries. Medical licensing and regulatory boards must acknowledge this need and make cross-licensure more easily accessible. The Interstate Medical Licensure Compact was formed to ease medical coverage between states through reciprocity of state medical licensure. As this compact expands, other areas of medicine must catch up. Malpractice coverage must be adjusted to lessen the economic burden for providers wanting to offer care to anyone requiring it. Health insurance also needs to improve payment for services provided via telemedicine so access can be improved most affordably.
In your view, how do social factors like poverty, education, and culture affect mental health care and its effectiveness?
Stigma and poverty both affect access to mental health care. Stigma is found in various cultures and can be lessened and potentially eliminated through education and advocacy. With that, stigma within the medical system has led to patients feeling dismissed and unheard when their reported symptoms are not easily classified into a diagnosis. Women are frequently told their symptoms are all in their heads instead of being partnered with to seek answers.
In light of the growing mental health crisis among young people, what innovative approaches or interventions have proven most successful for children and adolescents?
I recently wrote a children’s book with my 11-year-old daughter Maeve, who has dealt with anxiety since she developed autoimmune thyroiditis at age eight. It introduces the power of mind-body techniques to help children overcome stress and anxiety. I am also working to build a community for others who feel unseen and unheard by our current medical system.
We are very blessed that some very prominent names in Business, VC funding, Sports, and Entertainment read this column. Is there a person in the world, or in the US with whom you would love to have a private breakfast or lunch, and why? He or she might just see this if we tag them. 🙂
I am a full-on fangirl of Kelly Clarkson. Not only is she beautiful and monumentally talented, but she is willing to be vulnerable and real at any given moment. Many may recall her interview with Demi Lovato during the pandemic, in which they both openly discussed their mental health and the need to embrace well-being. She uses her platform to encourage self-care and happiness, and I am here for it.
How can our readers further follow your work online?
My website, hollymackennamd.com, is updated with my writing, speaking, and media engagements. Those seeking consultation can find me through my practice website, darawellnessnola.com. Both websites include free courses in integrative psychiatry and self-care for those with physical and mental pain or hypermobility.
Thank you for your time and thoughtful answers. I know many people will gain so much from hearing this.
About The Interviewer: Stephanie Greer, PhD is the Co-founder and CEO of Akin Mental Health — a company dedicated to guiding families on their journey supporting a loved one with mental health challenges like bipolar disorder, schizophrenia and severe depression. Stephanie is passionate about this topic from her own personal experience growing up with a mother who struggled with bipolar 1 disorder and found a path forward to overcome the obstacles and live well. Stephanie’s professional experience includes a doctorate in neuroscience as well as design research roles at Hopelab and Apple. Stephanie brings this personal passion together with her world-class science and technology background to support families across the US in their personal journeys supporting loved ones with mental illness. To learn more about Akin Mental Health and join our community, visit us at akinmh.com.
Healing A Broken Mental Health System: Holly MacKenna Of Dara Wellness On 5 Things That Can Be Done… was originally published in Authority Magazine on Medium, where people are continuing the conversation by highlighting and responding to this story.