How Functional Psychiatry Empowers PMHNPs

Findings from a large retrospective cohort study published in JAMA Network Open revealed that 7,252 patients treated within a functional medicine model at the Cleveland Clinic reported significantly greater improvements in both physical and mental health outcomes compared to matched controls in conventional primary care (Beidelschies et al., 2019). Complementary evidence shows that functional remediation strategies can enhance psychosocial functioning in individuals with bipolar disorder (Demetriou et al., 2023)—while integrated and functional approaches have demonstrated improved outcomes for depression and anxiety co-occurring with chronic physical conditions (Bhatta et al., 2024).

While the conventional model—often falls short. 

Despite decades of progress in neuroscience, psychopharmacology, and diagnostics, many patients remain trapped in cycles of persistent symptoms, treatment resistance, polypharmacy, and chronic comorbidities. For psychiatric–mental health nurse practitioners (PMHNPs) on the front lines working with patients, these challenges are particularly acute among those with complex or vulnerable presentations.

Traditional care focuses largely on symptom management through medications and psychotherapy. These tools are essential, yet for a significant proportion of patients, they fail to address underlying root causes of illness.

As Lake et al.  (2017) observed, “Current treatments and the dominant model of mental health care do not adequately address the complex challenges of mental illness… These circumstances call for radical change in the paradigm and practices of mental health care.”

Functional psychiatry expands the lens of care beyond symptom suppression to address biological, psychological, and environmental roots of illness.

This model empowers PMHNPs to lead in reshaping mental health care—assessing and treating nutritional, metabolic, immune, hormonal, and psychosocial imbalances that drive psychiatric symptoms.

Psychiatry at a Crossroads

Rates of anxiety, depression, trauma-related disorders, neurodevelopmental issues, and treatment-resistant mood disorders continue to rise. Despite broad access to medications and psychotherapy, many patients fail to achieve improved sustained outcomes.

Functional psychiatry expands the clinical lens to include:

• Nutrition and metabolic function
• Sleep quality, circadian rhythm, and light exposure
• Gut–brain axis integrity and microbiome health
• Mitochondrial and hormonal regulation
• Neuroimmune and inflammatory modulation
• Trauma-informed nervous system regulation
• Nature connection and sensory integration
• Biofeedback and autonomic rebalancing
• Biochemical individuality and epigenetics

The Whole-Person Paradigm: From Symptom Suppression to System Restoration

Mental health symptoms rarely arise in isolation. They emerge from complex, multifactorial interactions between genetic predispositions, biochemical individuality, neurobiology, early life adversity, inflammation, hormonal dysregulation, nutritional deficiencies, and environmental stressors.

Functional psychiatry equips clinicians to evaluate both non-modifiable vulnerabilities (e.g., ACEs, genetic factors) and modifiable drivers (e.g., diet, chronic stress, toxin exposure). This systems-based approach shifts care from reactive symptom suppression to proactive restoration of mind-body balance—resulting in improved recovery and patient empowerment.

At the Core: Epigenetics & Trauma

Functional psychiatry recognizes that many physiological dysfunctions are shaped by dynamic interactions among genes, environment, lifestyle, and behavior, with the epigenome serving as a modifiable driver of disease risk (Bland, 2022). Trauma, chronic stress, and Adverse Childhood Experiences (ACEs), can cause dysregulation in nervous, metabolic, endocrine, and immune systems that disrupt well being. A functional approach addresses these systemic imbalances—supporting mental health from a holistic, yet evidenced based lens.

Functional Psychiatry in Practice for PMHNPs

Clinical application includes:

• Root-cause assessment with history, labs, and genomics
• Nutritional psychiatry and micronutrient optimization
• Lifestyle medicine (sleep, exercise, circadian rhythm, nature exposure)
• Gut–brain axis interventions and microbiome repair
• Hormonal and mitochondrial support
• Trauma-informed psychotherapy and nervous system regulation
• Detoxification and environmental medicine

The Functional Medicine Matrix serves as a clinical framework, organizing patient data across domains such as assimilation, defense & repair, energy, communication, and psychosocial factors—allowing PMHNPs to systematically address complexity with precision.

Clinical Leadership: Psychiatry Redefined

Dr. James Greenblatt—integrative psychiatrist, educator, and author—founded Psychiatry Redefined to train PMHNPs and other clinicians in functional and integrative psychiatry. With academic appointments at Tufts University and Dartmouth, Dr. Greenblatt has spent over three decades pioneering the integration of nutrition, neurobiology, and personalized care in psychiatry.

The Psychiatry Redefined Fellowship provides:

• Functional lab interpretation
• Nutritional psychiatry and metabolic support
• Trauma-informed, nervous system–based care
• Case-based mentorship and peer collaboration
• Practical integration into clinical practice

The Future of Psychiatry Is Functional

When root causes are addressed, functional psychiatry delivers:

• More complete and lasting recovery
• Lower relapse and rehospitalization rates
• Reduced reliance on polypharmacy
• Greater patient engagement and satisfaction
• Enhanced clinical confidence and critical thinking

Functional psychiatry is not a rejection of conventional medicine—it’s an expansion of the clinical toolkit. It moves psychiatry beyond symptom suppression toward restoring balance across the entire mind-body system.

For PMHNPs and other clinicians, functional psychiatry offers a model of care that finally matches the complexity of today’s mental health crisis—grounded in science, guided by systems thinking, and sustained by hope.

It’s not anti-medication. It’s pro-whole-person care.
It’s not an alternative. It’s the clinical application of biochemistry and systems biology