Bridging the Gap between Mental and Physical Health
"There is no health without mental health."
Despite the mental health crisis around the world and the understanding that mental and physical health are correlated, the communication between institutions and healthcare professionals remain poor and many relationships between the two are missed (i.e., anxiety disorders and heaart conditions, obesity and mental disorders) or are treated separately.
There have been substantial efforts in reducing the gap (i.e. EMR) and yet patients are still unable to receive proper multidisciplinary and multiprofessional care.
What else can we do to address this issue?
The occurence of mental disorders or mental related risk factors to physical health is a challenge because of failure to recognize its presence due to overlapping presentation of symptoms of then psychosomatic disorders from that of organic brain syndromes, inability to illicit a very good history which may be due to unreliability of data of symptoms collected from the patient, or the patient is not willing to assume a sick role due to this reason. The patient or client is pivotal in its proper diagnosis.
As we put it in Evidence Based Medical Practice, any medical scenario is converted into a problem, and in this case whether the symptoms are due to mental / psychological disorder or physical disorder? We need to know what are the patient;s expectations by investigating on his perception of his current situation, his willingness to divulge salient data without fear of being "branded" or "stigmatized" as having "mental illness" which would help the physician in diagnosing and giving treatment. The next factor is the physician's expertise to recognize the correlation of symptoms to psychological and physical manifestations of diseases. There are interlinkages how a patient behaves based on chemical derangements in the body, which may be a metabolic or physical problem and most of the time it is cyclical in nature wherein a physical risk factor may lead to a behavior which would make the patient act in a detrimental manner which will further hasten or make the disease worse. Let us take Chronic Fatigue Syndrome. A patient may be having depression but since nothing is asked about the occurence of social problems, the physican might be running a series of tests and will have normal findings. The third factor is the input from literature or research. Physicans need to be updated on the latest trends in the medical field. In this case, what is the criteria from the Diagnostic and Statistical Manual of Mental Disorder, Fifth Edition (DSM V) for a certain mental disorder? There is also a possibility of mislabelling of a physical disorder with a mental disorder and vice - versa.
I also add TIME, which should be adequate in order to bridge the gap, from history taking special consideration on the socio - economic history and environmental factors and a comprehensive physical examination, to include psychiatric component. A thorough investigation to rule out all medical causes should be done.
Educate the patient and the inner circle about the condition of the patient and refer accordingly.
If we adapt the principles of why placebos work, this can help.
Reduce stress chemistry
Fully explain what the pill does
Encourage visualization of the pill working - esp using all senses
Make a formal pattern to follow - take green pill with 4 ounces of water at 8, 2 and 6
Offer a "reward". By fillowing this program, you will be well in time to take your vacation.
These actions enable the neuro system to aid in the healing.
It is the neuro system that enables the red pill (containing placebo) to cause the identical reaction as the real red pill - the neuro system is engaged. Irrespective of the illness, if you say - just learn to live with it - the depression and lack of input of the neuro system makes the conditon worse. Why does the patient who was expected to expire in February defy science and lives to July when her first grandchild is born? Her neuro system was engaged. Today we can measure the parts of the neuro system when the placebo give exactly the same result as the real pill. Therefore, let's assist this process. Whether we reduce stress chemistry by stressing humor, or special breathing techniques - inhale count four, exhale count six, or yoga exercises or special postural exercises, reduced stress chemistry aids healing. It is the principle of why Dr. Josephson in a five doctor specialty group, where all five a equally competent and skilled, gets his patients well faster with less narcotics. His explanation is more complete, better understood, he manages to get his patients to engage their neuro system. It is also the reason why Dr. Blake is useless for experimentation/research: whatever he give the patients makes them feel better.
More Details at:
Medication Enhancement Archives of Otorhinolaryngology-Head & Neck Surgery. 2017;1(2):4
The "EMR" is only a very small part of the answer. It will take years for it to be truly functional to use as a "health tool" and be an electronic health record (EHR) and not primarly medically focused. Multi-disciplinary care doesn't happen on its own so the focal point becomes the provider's role. Education and funding are needed to make this happen.
Advances in studying the brain and the way neurotransmitters operate in mood, apetite, motivation etc. will help to refine the correlation between mental and physical. With this progress we will be able to treat a host of problems with skill and precision. Medicinal cannabis is another resource that is being embraced. We are on the cusp of tremendous potential.