To maintain our wellbeing we need to look after both our physical and mental health. But for those with chronic physical or mental illness, treatment can be complicated, inconsistent, and can feature lengthy hospital stays that are frustrating and disruptive for both the patients and their loved ones.
Fortunately, one Australian researcher has been investigating the care of patients in Australia with coexisting physical and mental health issues, and her findings could change the way the health services industry treats patients with multiple types of conditions.
Dr Nazlee Siddiqui from the Tasmanian School of Business and Economics is leading this research with a cross-disciplinary team at University of Tasmania.
“When I migrated here as an international student and moved into academia, it was a surprise for me to find that in a developed set-up, you have a lot of support for your physical aspects, but still somehow the mental issues are not well taken care of,” she said.
That’s where it started, by asking the question, ‘Why would we accept that a person with mental illness would have to stay longer in the hospital?’ Nobody really likes to stay in hospital for a longer time.
Dr Siddiqui looked at the top five chronic diseases affecting Tasmanians between 2010 and 2015, and discovered a unique demographic of patients who were dealing with both chronic physical disease and mental illness.
“One of the things we found, which was new, was that for each of these five chronic diseases, whenever people had mental illness as well, they were relatively younger than the people without mental illness,” she explains.
“A lot of the existing research in mental illness and chronic disease focuses on the aged care sector, but if you do that, you miss this under-65 group who are caught into these complex conditions earlier.”
According to Dr Siddiqui, the increased length of hospital stay that these patients often experience comes from treating their physical and mental health issues separately.
When clinicians focus on the physical issue first, and call in a psychiatric team later in the patient’s stay – often once they realise that the patient’s case is more complex than originally thought – this draws out the length of treatment significantly.
But Dr Siddiqui says clinicians could be trained to treat both at once, if they’re flexible.
“Regardless of whether I’m working with a stroke or diabetes patient, for example, from day one I’ve looked into this patient and understood that it’s a combination of chronic and mental illness,” she explains.
“This gives me the flexibility and the basic training to take steps right away to treat both, rather than waiting for the psychiatric team to be called in.”
“From the perspective of the patients who are having comorbidity [one or more additional diseases or disorders co-occurring with a primary disease or disorder], what they get is a more flexible care pathway from the beginning, and that should help in their recovery and their overall satisfaction with the treatment.”
Using this approach, Dr Siddiqui says we can improve treatment for mental illness by helping patients manage it when they are relatively younger.
“Because this is happening even with people below the age of 65, we need to deal with the problem early, rather than leaving it for a longer time, when with progressed age it becomes a more uncontrollable issue.”
This integration of mental and physical healthcare is likely to have benefits for more than just the comorbid patient – other patients could see a benefit, too.
What it would mean for a state like Tasmania, is that over the course of five years, we would be able to save around 3,000 bed days, which could be given to new patients.
The next step for Dr Siddiqui is to help train the health service managers in providing integrated care for the physical and mental health of their patients.
“I will be developing a specialisation of integrated care within the Master of Health Service Management program at the University of Tasmania, with all this learning around how to integrate physical and mental illnesses,” she said.
“And because all our health managers are experienced people, with 70 to 80 per cent of them sponsored by organisations, whatever we give them in terms of management education is channelled back to the workplace right away.”
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