Comorbidity of Physical and Mental Disorders Assignment Help
Comorbidity of Physical Illnesses for Persons Living With Mental Illness
The prevalence of comorbidity mental and physical disease has increased and reached epidemic proportions in the past two decades. Most people over the age of sixty experience the simultaneous presence of two or more diseases. As stated by Sartorious (2013) the prevalence of comorbid mental and physical diseases is increasingly affecting people of all ages but the elderly (60 years and above) have the highest number of victims. Comorbidity is a condition that worsens the prognosis of the diseases leading to increased complications and makes treatment impossible. Individuals with chronic diseases such as cancer, diabetes, and hypertension are at a high risk of experiencing severe depression which complicates their condition making it difficult for healthcare practitioners to provide better care. (Mental illness)
Patients with mental illness have a high risk of experiencing medical conditions including chronic diseases such as cardiovascular diseases (Scott et al., 2016). Goodell Druss, & Walker (2011) argues that chronic disease is a risk factor or mental illness and vice versa. Medical studies show that medical comorbidity in patients with mental illness has an extensive impact on their life and cost of care (Zolezzi et al., 2017). The co-occurrence of a mental and medical condition is prevalent among patient with mental or chronic illnesses; increasing the burden of symptoms resulting in high mortality among the population and decreased length and quality of life that requires a collaborative care approach to manage and treat since mental disorder is a risk factor for chronic condition and chronic condition is a risk factor for a mental disorder. Comorbidity of mental and physical has a direct impact on the quality of life and care and increases mortality rate (Merikangas et al., 2015). The use of a collaborative care model is effective and efficient in addressing the problem as well as solving the challenges experienced by healthcare workers.
Relationship Between Mental Illness and Chronic Diseases
The relationship between mental illness and chronic diseases is evident in patients experiencing chronic diseases such as cancer and diabetes. The comorbidity affects the quality of life and care which lowers the patient’s life expectancy and increases the cost of healthcare. As illustrated by Zolezzi et al. (2017), medical comorbidities among patients with mental illnesses cause premature deaths. Additionally, this population has a high risk of developing chronic diseases such as cancer, respiratory conditions, and heart diseases that cause mortality. Unfortunately, patients with medical comorbidity using the atypical antipsychotic medication are in danger of experiencing poor quality of life due to increased cases of cardiovascular complications (Zolezzi et al., 2017). The quality of life for mentally ill patients suffering from cardiovascular disease is poor given the lack of evidence associating screening or treating depression and anxiety with improved cardiovascular outcomes. Therefore, a patient receiving depression treatment is not prevented from a heart attack. Although managing the modifiable risk factors for cardiovascular diseases for patients with severe mental illness reduces the risk of premature mortality, this population experience discrimination in accessing healthcare services (Cohen, 2017). Consequently, they experience poor quality of life due to external factors beyond their control.
In addition to the poor quality of life characterized by chronic diseases and short life expectancy or premature mortality, this population experiences poor quality of care. As illustrated by Cohen (2017), people with mental illness are less likely to have access to high-quality primary care and seek healthcare services when the disease is at advanced stages. This affects the quality of life and the care they receive. In illustrating how comorbidity affects the quality of care, Cohen (2017) argues that mental disorder patients with cancer seek medical intervention when the cancer is at an advanced stage. Accordingly, this does not only affect the quality of care they receive but also leads to poor survival rate. In most cases, patients might require integrated, person-centred care approach which is unavailable in the health system. Diabetic patients are twice or thrice likely to have depression affecting glycaemic control resulting in a poor quality of life. Comorbidity of mental disorder and physical illness intensifies the burden of symptoms and causes functional impairment.
People with mental illness have a high mortality rate and a short life expectancy attributed to medical comorbidities among the patients. Walker, McGee, & Druss, (2015) reports that people with mental illness have a high mortality rate compared to the general population. He further states that the mortality rate among psychiatric patients is high due to comorbidity of mental and physical diseases. Specifically, he identifies cardiovascular diseases and other chronic illnesses as the major causes of death among this population. Zolezzi et al. (2017) identify heart disease, cancer, respiratory conditions, and metabolic disorders (obesity and diabetes) as the underlying cause of death among the population. Moreover, the mortality rate among mentally ill patients is increased by adverse health behaviours such as smoking, substance abuse, and poor diet. Poor diet, physical inactivity and use of atypical antipsychotic medication increase the risk of metabolic complications which increase the mortality rate (Zolezzi et al., 2017). Other factors promoting this scenario include poor quality of care among mentally ill patients affected by socioeconomic disadvantages and unhealthy lifestyles (Zolezzi et al., 2017). This shows the comorbidity of mental illness and physical disease, especially chronic conditions, increases the mortality rate of this patient population.
Hire Expert Writers at
Affordable Price
WhatsApp
Get Assignment Help
Acknowledging the challenges posed by the comorbidity of mental illness and physical disease, Cohen (2017) proposes the integration of a person-centred approach to the design, organization, management and improvement of health services. Although this approach is effective in a primary care setting, its effectiveness in this setting is questionable. Ivbijaro et al. (2014) advocate the collaborative care model which is a healthcare intervention approach that integrates behavioural (mental), physical, and social health care. The model acknowledges that mentally ill patients with physical illnesses require an extensive intervention that addresses all components of health. This involves the use of medication, therapeutic intervention, and social care such as housing, education, physical and mental health promotions and spirituality (Ivbijaro et al., 2014). Therefore, collaborative care is the integration of mental healthcare into primary care medical setting. Sanchez (2017) describes the collaborative care model to ideal for treating mental health patients in the primary care setting since it integrates behavioral health specialists, primary care provider, and psychiatrists.
Cohen (2017) notes that healthcare worker experience difficulties when working in teams and collaborative arrangements outside their area of specialities. Therefore, this might be a significant challenge affecting the medical intervention resulting in poor health outcomes. However, redefining the health workforce competence such as improving the knowledge and skills to identify and manage mental health conditions is important. Enhancing collaboration among the healthcare workforce will help in ensuring that the patient receives multidisciplinary care intervention that will improve the care experience and quality. Sanchez (2017) associates the collaborative care model with the Wagner’s Chronic Care Model of disease management which integrates behavioral health specialist, primary care provider, and psychiatric consultation to screen and treat common mental problems. He describes the essential components of the collaborative care model:
“1) mental health services located in the primary care setting; 2) systematic care management provided by a social worker, nurse, or other behaviourists; 3) symptom measurement and outcome monitoring by care managers during clinic visits or by telephone; and, optimally, 4) brief evidence-based interventions, such as behavioural activation and problem-solving therapy” (Sanchez, 2017, P. 71).
The collaborative care model is ideal since it helps the patient access comprehensive care from different practitioners. This includes access to primary care, monitoring, and follow-up to improve patient health and reduce remission. Ivbijaro et al. (2014) argue that the collaborative care model helps to improve mental health care in a primary care setting by integrating behavioral health and developing closer relationships between primary care (family doctors or GPs and practice nurses) and specialist health care (such as Community Mental Health Teams). However, it faces various barriers in a real-world setting which include clinical, organizational, and financial barriers. The clinical barriers interfere with patient treatment and adherence such as lack of knowledge by practitioner and absence of patient-centred communication to improve care intervention and outcome (Sanchez, 2017). Organizational barriers are the system-level obstacles in the implementation of the model such as shortage of professionally trained workforce. The financial challenges relate to the lack of funds to support the implementation of the model and lack of reimbursement. The solution to these problems is the education of the healthcare workers on the importance of teamwork and other professional-related training, and commitment by the government to finance the implementation of the model in the primary care setting.
Comorbidity of physical illnesses for persons living with mental illness is prevalent with chronic diseases being a risk factor for mental disorders and vice versa. The quality of life and care for people with medical conditions and mental disorder is poor. Additionally, the mortality rate for such patients is high due to the burden of symptoms, socioeconomic status and other related factors. The ideal nursing intervention for the condition is the use of the collaborative care model that integrates mental healthcare into primary care medical setting. This will help to address the problem from a different perspective; thus improving the quality of care and healthcare outcome.
References
Cohen, A. (2017). Addressing comorbidity between mental disorders and major noncommunicable diseases. World Health Organization (WHO). ISBN:9789289052535
Ivbijaro, G. O., Enum, Y., Khan, A. A., Lam, S. S., & Gabzdyl, A. (2014). Collaborative care: models for the treatment of patients with complex medical-psychiatric conditions. Current psychiatry reports, 16(11), 506. doi:10.1007/s11920-014-0506-4
Merikangas, K. R., Calkins, M. E., Burstein, M., He, J. P., Chiavacci, R., Lateef, T., & Gur, R. E. (2015). Comorbidity of physical and mental disorders in the neurodevelopmental genomics cohort study. Paediatrics, 135(4), e927-e938.
Sanchez K. (2017). Collaborative care in real-world settings: barriers and opportunities for sustainability. Patient preference and adherence, 11, 71–74. doi:10.2147/PPA.S120070
Sartorious N. (2013). Comorbidity of mental and physical diseases: the main challenge for medicine of the 21st century. Shanghai archives of psychiatry, 25(2), 68–69. doi:10.3969/j.issn.1002-0829.2013.02.002
Scott, K. M., Lim, C., Al-Hamzawi, A., Alonso, J., Bruffaerts, R., Caldas-de-Almeida, J. M., … & Kawakami, N. (2016). Association of mental disorders with subsequent chronic physical conditions: world mental health surveys from 17 countries. JAMA Psychiatry, 73(2), 150-158.
Unutzer, J., Katon, W. J., Fan, M. Y., Schoenbaum, M. C., Lin, E. H., Della Penna, R. D., & Powers, D. (2008). Long-term cost effects of collaborative care for late-life depression. The American journal of managed care, 14(2), 95–100.
Walker, E. R., McGee, R. E., & Druss, B. G. (2015). Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis. JAMA Psychiatry, 72(4), 334–341. doi:10.1001/jamapsychiatry.2014.2502
Zolezzi, M., Abdulrhim, S., Isleem, N., Zahrah, F., & Eltorki, Y. (2017). Medical comorbidities in patients with serious mental illness: a retrospective study of mental health patients attending an outpatient clinic in Qatar. Neuropsychiatric disease and treatment, 13, 2411.
