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Physical illness increases the risk of mental illness

Posted on November 12, 2012 at 10:15 AM Comments comments (2)
According to an article in the Times: "Doctors must give equal priority to mental cases"  the new NHS mandate will be to place mental health care at the heart of its new framework. The Centre for Mental Health produced a report (read it here in full), which highlights the prevalance of mental health illness among people with physical health conditions (two to three times higher than in the general non-clinical population, as well as the fact that medical staff are routinely over-looking this aspect of their patients care, or are simply not inclined to see it having a crucial influence over the patient's recovery rates.  

The Centre for Mental Health wants to see more liaison psychiatrists involved in the overall assessment and care management of patients. 

I have selected below a few paragraphs from the report. I have included subtitles and italics to highlight the most striking statements. 

"Physical health and mental health are inextricably linked. Poor physical health is a major risk factor  for poor mental health, and equally, poor mental health is a major risk for poor physical health. 

Despite this pervasive interplay, NHS services for mental and physical health are largely  commissioned, funded and provided in separate compartments. A heavy price is paid for this lack of integration in terms of poorer health outcomes for patients and in greatly increased costs of care to the taxpayer. 

The better management of co-morbid physical and mental health conditions probably offers more scope for contributing to the Quality, Innovation, Productivity and Prevention (QIPP) agenda of better health at lower cost than any other activity in the 
NHS."

Co-morbidity
"A recent review of the evidence on co-morbidities indicates that people with long-term physical health conditions, who together account for around 70% of all expenditure in the NHS, are two to three times more likely than the general population to experience mental health problems such as depression, anxiety or dementia (Naylor et al., 2012). In total, this amounts to some 4.6 million people in England with co-morbid physical and mental health problems.The prevalence of mental and physical health co-morbidities is particularly high among patients in general and acute hospitals. 

One reason for this is that a significant number of patients develop a health problem during their stay in hospital, in addition to those who are admitted with an existing condition. Another is the very high proportion of older people in the inpatient population."

Undetected mental health issues
"Many cases of mental illness among hospital patients go undetected by acute clinical staff. Estimates of detection rates vary between studies but are commonly put at around 50%, and may be even lower for some conditions such as delirium. There are various reasons for this. The presence of physical illness may make the detection of mental health problems more difficult. Hospital staff often have little training or expertise in the identification of mental health conditions. They may understandably focus attention on the primary health condition for which a patient has been admitted. And they may feel that a degree of mental distress is a natural reaction to illness and hospitalisation even though this may conceal more serious problems."

Poor health outcomes
"Co-morbid mental health problems lead to much poorer health outcomes for people with physical health conditions. For example, mortality rates for individuals with co-morbid asthma and depression are twice as high as among people with asthma on its own (Walters et al., 2011). Similarly, people with chronic heart failure are eight times more likely to die within 30 months if they also have depression (Junger et al., 2005). There is also evidence that co-morbid mental health problems can have a greater effect on the functional status and quality of life of people with long-term physical conditions than the severity of their physical illness (Yohannes et al., 2010; de Jonge et al., 2006), and that quality of life for those with co-morbid mental and physical health problems is considerably worse than among people with two or more physical health problems (Moussavi et al., 2007)."

Medically unexplained symptoms
"Medically unexplained symptoms are surprisingly common. For example, they account for about 50% of all first attendances at outpatient departments in general hospitals (Nimnuan et al., 2001), and patients with medically unexplained symptoms may be among the most frequent and intensive users of health services in both primary and secondary care settings. Medically unexplained symptoms are not covered in the cost estimates given in Naylor et al., but a separate study published in 2010 indicates that the overall cost to the NHS of medically unexplained symptoms is nearly £3 billion a year (Bermingham et al., 2010)."

Older patients
"Detection rates for mental health conditions among older patients are typically very low. For example, one study found that delirium was missed in up to two-thirds of cases (Inouye, 1994), while a meta-analysis of studies of depression in older medical patients showed a median detection rate of just 10% (Cole & Bellavance, 1997). And even when problems are identified, the treatment provided by clinical staff in acute hospitals is often sub-optimal, including over-use of psychotropic medication in the management of dementia and delirium (Holmes et al., 2003) and failure to provide anti-depressants for the majority of depressed older patients (Holmes & House, 2000). Psychological interventions are very rarely used."