Monday, 23 July 2018

10 priorities for integrating physical and mental health, according to The King's Fund

Andrés Fontalba

The current health care model that classifies patients by system or medical specialty categorises care to for any health problem. The causal attribution to diseases according to the psychic vs. organic dichotomy inhibits seeing the process of the pathologies in their totality and contributes to the problem of patients taking their illness from one service to another, with the risk of overacting in some cases or of non-holistic intervention method of integrated solutions in other complex cases.

In the words of Luis Chiozza, a psychoanalyst with international references in psychosomatic medicine: "When we say, following Weizsaecker, that all the corporal has a psychological sense and all the psychic possesses a corporal correlate, we don’t presuppose that a psychic phenomenon becomes corporeal or vice versa, but the very existence of the somatic phenomenon can be understood in its sense and the very existence of the psychic phenomenon can be contemplated in its bodily aspect.”

Mental health problems are a risk factor in the development of cardiovascular diseases, diabetes, COPD and many other pathologies. It also increases the prevalence of suffering from alcohol and other substance abuse, smoking, worsening economic and employment prospects and an increasingly deficient social support network. Yet despite these evidences, the primary prevention programs target other priorities, therefore the promotion of mental health requires an important boost.

People suffering from serious mental disorders such as schizophrenia or bipolar disorder have a high risk of experiencing physical illnesses related to adverse effects to treatment, inadequate life habits, in addition to the socio-economic determinants leading to a dramatic decrease in life expectancy of 15 to 20 years for this population subgroup. In comparison with the general population, they are less likely to demand attention to their health problems and needs, which can cause difficulties in the detection and treatment of physical illnesses. These problems require special attention and should be the objective of joint programs between primary care and mental health.

One of the most interesting initiatives aimed at solving this problem forms part of The King's Fund, through the document “Bringing Together Physical and Mental Health”, which identifies 10 priorities that try to find integration between mental and physical health:

1. Incorporate mental health into public health programs
Some of these strategies are; the promotion of outdoor physical activity; the prevention of harmful alcohol consumption and interventions to improve social interaction; facilitate social cohesion and combat isolation.

2. Promote health in people with serious mental disorders
All mental health professionals should see the promotion of health as a fundamental part of their work. Among the proposed activities will be the provision of services aimed at reinforcing healthy habits, such as, for example, smoking cessation programs.

3. Improve the management of unexplained medical symptoms in primary care
Evidence suggests that the bio-psychosocial approach within a stepped intervention framework may be an effective approach for some people suffering from these symptoms.

4. Strengthen primary care for the physical health needs of people with severe mental disorder
The responsibility for supervising and intervening in the physical health of people with serious mental disorders should be shared between primary care and mental health services, based on clear local agreements.

5. Support the mental health of people with chronic diseases
People with chronic physical health problems can benefit from support in the psychological aspects related to their illness, as a standard part of their care.

6. Support the mental health and welfare of caregivers
It’s important to assess the physical and mental health needs of caregivers and family members as a routine part of the care provided to people with chronic health problems or terminal stages of disease.

7. Support mental health in acute hospitalizations
With this integrated vision, professionals working in emergency services and hospitalization should have, among their skills, the ability to identify and address situations such as dementia, delirium, autolytic ideation and acute psychosis.

8. Address physical health in mental health hospitalization services
The entry of a person into a brief mental health hospitalization service presents an opportunity to intervene and improve mental and physical health. 

9. Provide integrated support in pre and postnatal mental health 
All professionals involved in pregnancy and the postnatal period have an important role in ensuring the mental health and well-being of women throughout the perinatal process.

10. Support the mental health needs of people in residential facilities. 
Family doctors who work with older people in nursing homes could identify those who need mental health support and provide relevant education and counselling to the residency staff. Specialized mental health services will be available and accessible for example, to help staff manage residents who need intensive support or who exhibit challenging behaviours. 

A mind-body integrated approach allows us to holistically care for the person and understand their suffering, while improving the accessibility and the forecast of the care for any illness.

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