Many Patients with Chronic Health Conditions Also Have Mental Health Issues that Go Undiagnosed and Untreated

We need to better integrate physical and mental health services

Our health system often divides mental health from physical health into distinct silos of care and treatment, yet no such mind-body duality exists in actual patients.  Many individuals with chronic health conditions simultaneously experience mental health issues — and the reverse — and such “concurrent” health challenges are far from uncommon.   

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 healthcare 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, and as a result, 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 the care they need when and where they need it because of the way health services are currently delivered.  In Canada, individuals with diagnosed medical 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 the reality of concurrent physical and mental health conditions is increased hospitalizations, poor adherence to medical 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, such as IMPACT (Improving Mood – Promoting Access to Collaborative Treatment) and COMPASS (Care of Mental, Physical and Substance Use Syndromes) from the United States.  Evidence from these studies 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 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.  In 2014, the Medical Psychiatry Alliance (MPA) formed in a unique partnership between the Centre for Addiction and Mental Health, The Hospital for Sick Children, Trillium Health Partners and the University of Toronto with a $60 million dollar investment from the Ontario government, an anonymous generous donor and the four partners. The first of its kind in Canada, the partnership aims to address gaps in concurrent physical and mental health care in Ontario through clinical, research and education initiatives.

The goal of the MPA is long overdue, yet attainable: to create future integrated care practitioners in the province who are able to advocate and care for patients with complex physical and mental health issues. The goal is for patients to get seamless, integrated care for mental and medical illnesses when and where they need it.

To that end, a cadre of experts gathered at the 2nd annual Medical Psychiatry Alliance Conference last week in Toronto to focus on transforming medical education across healthcare professions to train future healthcare teams in medical psychiatry integrated care.

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, it is the responsibility of all health profession educators to reform training to better reflect the common reality of co-occurring physical and mental illness and to align with emerging integrated physical and mental health care models. 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 healthcare professional who is now able to identify and treat depression in patients with heart disease before it impacts their medical care.

But we also need leadership from the government to reshape the health system, to break down silos and help practitioners establish team-based models of care.  We need to do a much better job of integrating medical and psychiatric care so that it is patient-centred and timely – and gives Canadians a better return on our publicly funded healthcare dollars.  

It’s time to stop dividing the mind from the body and treat the whole patient.   

 Kurdyak_PaulDr. Paul Kurdyak is an expert advisor with, the MPA Director of Health Outcomes and the Director of Health Systems Research at CAMH.





Sockalingam_SanjeevDr. Sanjeev Sockalingam is an expert advisor with, the MPA Director of Curriculum Renewal and the Director of Continuing Practice and Professional Development at the University of Toronto.