Delivering behavioral health services requires a nuanced approach, where providers truly understand the needs of their patients. 

That’s especially true when delivering care to specialized and particularly vulnerable populations, including those living with cancer.

Dr. Guy Maytal serves as chief of integrated care and psychiatric services for Forge Health, an outpatient mental health and substance use care provider that just recently announced a strategic growth investment from MFO Ventures. Maytal is an expert when it comes to the intersection of behavioral health and cancer care.

Behavioral Health Business spoke with Maytal to learn all about the concept of psychosocial oncology during a recently released episode of the Perspectives podcast. During the conversation, Maytal discussed how Forge Health is expanding its offerings to help people and families going through cancer, while also offering his perspective on how psychosocial oncology differs from general mental health care.

Other topics addressed included common barriers to accessing this type of care and more. Highlights from BHB’s conversation with Maytal are below, edited for length and clarity.

BHB: I really wanted to dig into psychosocial oncology and what that means, and what Forge Health is doing in that space. To start, could you just define that terminology for me?

Maytal: ​​Psychosocial oncology is the aspect of cancer care that focuses on the psychological, behavioral, emotional, social issues that arise for people going through cancer – and their loved ones. It’s all of that world, as people are dealing with a serious illness. It’s typically delivered by behavioral health clinicians of a variety of disciplines, but that’s what it is.

I imagine this topic is becoming a more important and frequently discussed one, just considering some of the statistics out there.

Absolutely. You have something that’s treatable or not treatable – curable or chronic. It’s the sort of set of illnesses that really drives up a lot of distress for almost everyone who goes through it, and there are unique elements of it that need to be addressed through a particular behavioral health lens.

How does psychosocial oncology differ from maybe more generalist mental health care?

It’s a great question. It differs in a couple of ways.

There are unique stressors and unique distresses that people experience as they go through cancer – for a variety of reasons, which we can get into. But there is a particular knowledge and skill set that is required to address those issues that people deal with, whether they’re psychological, whether they’re social, whether they’re in the realm of communication with other people in your life or with your medical team.

So addressing all of those in a unique way is one of the one of the ways that psychosocial oncology distinguishes itself.

Another is having an intimate understanding of the experience, of the trajectory of people dealing with cancer. It is almost a world unto itself when someone is diagnosed with cancer, and that word “cancer” speaks to a category of illnesses. But by and large, it’s a world unto itself.

What is it like for a human being who, in the midst of all that happens in life, has to stop and deal with something that they don’t want? It’s terrifying. It’s highly impactful on their way of life, on their finances, on their social situations. So understanding all of that is another differentiator.

And to be pretty direct about it, it could be very provoking. It can be very triggering for people who are on the therapy side, such as therapists or other behavioral health clinicians, to work with people who are dealing with cancer. So having a handle on your own experience and your own reactions is another skill set that people in this field must consider.

Could you explain what some of the specific services or treatments look like, and how might those change over the course of one’s cancer treatment?

On the one hand, there is what you would expect. The treatments don’t change as much as the content.

For example, if someone is dealing with uncertainty and the anxiety that comes with “I don’t know what’s the diagnosis yet,” you might talk to a psychosocial-oncology-trained therapist, who can appreciate what you’re experiencing and help you cope with it. Later on down the line, when you’re dealing with distress around your family life being disrupted because of radiation therapy, you might be talking with the same therapist, but the content is different.

So one of the services is psychotherapy, either individual or in a group setting. Another set of services is the psychiatric care. There’s the illness itself, meaning the cancer illness itself, which can impact one’s psychology and emotional experience. There’s also the treatments. There are, for example, certain treatments that directly cause episodes of depression.

There’s also the factor of pre-existing psychiatric conditions. We must also understand how all the drugs interact. Those are all knowledge sets and skills that, on the psychiatric side of psychosocial oncology, we’re aware of and need to be thinking about all the time.

There are other components as well. If you’re in a hospital setting, there’s the social worker who may be doing crisis management, or there may even be a care management component – thinking about how somebody is getting to and from treatment.

And on the other end, there can be conversations, where the behavioral health clinician is inviting, I would say, the patient and their family to shift their focus from “doing everything to treat and cure the cancer” to transitioning to the next phase. By that, I mean either chronic illness or death.

How did this topic, specifically psychosocial oncology, become such a big focus for you?

It’s been a focus since my earliest days of being a psychiatrist, simply because I was always interested in the big questions of what it is to be human. How do we make sense of our existence? And one could argue that the reason we even have to make sense of it is because it’s finite, and none of us really knows when it’s going to end.

At the same time, I was always interested in how illness and medical treatment impact a person’s experience of their life, their thinking, their feeling. Psychosocial oncology brings all of it together and, in fact, expands it into the social domain – thinking about how social determinants of health impact people’s experience of cancer. So for me, this is a particular field where you really do have to think about the whole person, if you’re going to be providing good care.

And the one other aspect of the field that actually really draws me is the multidisciplinary nature of it.

How readily accessible are these services? Does an individual going through cancer typically have access to this kind of care – or is it hard to find?

I wish it was commonplace. It’s actually very pretty difficult to get services of this sort. There are a few institutions – kind of flagship, world-class cancer centers – that do this well. But in most places, if you have anything, it is usually very, very insufficient.

Most people aren’t even aware that such a subfield exists.