By Sanjeev Sockalingam
and Paul Kurdyak
University of Toronto
Our health system often puts mental and physical health into distinct silos of care, yet no such mind-body separation exists in actual patients. Many individuals with chronic physical conditions simultaneously experience mental health issues.
According to the World Health Organization, four of the six leading causes of disability are due to mental illness. Awareness campaigns have lately flagged the importance of mental health services as a critical part of the health-care system.
What’s less well understood is that individuals suffering from psychiatric illnesses also have high rates of physical health conditions, such as diabetes and cardiovascular disease. These individual, as a result of the care disconnect, live up to 20 fewer years than those without mental illness. And individuals with chronic medical conditions are at increased risk of mental illness, such as depression, in comparison to the general population.
Yet it is far too difficult for individuals with both psychiatric and medical illnesses to get care when and where they need it because of the way health services are delivered. In Canada, individuals with diagnosed physical illnesses often have their psychiatric illnesses go undetected and untreated. And individuals with diagnosed psychiatric illnesses are known to have poor access to medical care.
The impact of ignoring concurrent physical and mental health conditions is increased hospitalizations, poor adherence to treatment, social isolation and poor self-care. It costs the system and hurts patients.
It doesn’t have to be this way.
There are several well-studied models of integrated care where patients receive both physical and mental health treatment in family physician settings. The models include IMPACT (Improving Mood – Promoting Access to Collaborative Treatment) and COMPASS (Care of Mental, Physical and Substance Use Syndromes). Evidence shows that when nurses and consulting psychiatrists are available to patients when they visit their family physicians, they experience improved medical and mental health outcomes. Studies also show that such integration of mental health care directly into primary care is cost-effective.
Unfortunately, these evidence-based, integrated models of care have not been widely adopted across Canada.
The good news is that we are taking steps in the right direction. The Canada Medical Psychiatry Alliance (MPA), the first such group in Canada, was formed to address gaps in concurrent physical and mental health care in Ontario through clinical, research and education initiatives.
Its goal is long overdue, yet attainable: to create integrated practitioners who advocate and care for patients with complex physical and mental health issues. The goal is for patients to get seamless, timely and integrated care for mental and medical illnesses.
To that end, a cadre of experts gathered at the second annual Medical Psychiatry Alliance Conference recently in Toronto. They focused on transforming education across health-care professions to create future integrated care teams.
It’s a good start but much more needs to be done. Our health system needs to reflect the needs of patients and address fragmented care. Integrated care needs to become the norm rather than the exception.
So how can we get there?
For starters, all health profession educators must reform training to better reflect the common reality of co-occurring physical and mental illness. Imagine the medical student whose early clinical experiences allow him to better help a patient suffering from schizophrenia to engage in care for their untreated diabetes. Or the practitioner who can identify and treat depression in patients with heart disease before it impacts their medical care.
But we also need leadership from government to reshape the health system and help practitioners establish team-based models of care. We need to do a much better job of integrating care so that it is patient-centred and timely – and gives Canadians a better return on our health-care dollars.
It’s time to stop dividing the mind from the body and treat the whole patient.
Dr. Paul Kurdyak is the MPA director of Health Outcomes and the director of Health Systems Research at CAMH. Dr. Sanjeev Sockalingam is the MPA director of Curriculum Renewal and the director of Continuing Practice and Professional Development at the University of Toronto.
Paul and Sanjeev are Troy Media contributors. Why aren’t you?
The views, opinions and positions expressed by columnists and contributors are the author’s alone. They do not inherently or expressly reflect the views, opinions and/or positions of our publication.