Issue 35 / 14 September 2015

IF you ask people if they regard their mind as the driver of their body most would generally agree. And yet the inextricable link between physical and mental health often seems to catch policymakers by surprise.
Important discussions are currently under way as the government-appointed Primary Health Care Advisory Group considers possible reforms to primary health care. Quite appropriately, the group’s recent discussion paper identifies tackling chronic conditions in primary health care as a key priority. This is a good step in the right direction.
However, although the prevalence of mental health conditions is acknowledged in the paper, there is little mention of the role serious mental illnesses plays in chronic conditions, and the potential gains in years of life if the needs of people with mental illness are addressed as a specific priority.
The paper identified the increased incidence of multiple chronic diseases as a particular challenge for doctors and the health care system. The most recent statistics identified 50% of Australians having one chronic condition, and one-in-five having at least two.
This is not news to doctors, who would say that many patients who visit them for one condition are also on first-name terms with many other conditions. And the impact of having more than one chronic condition is profound.
Rather than acting like two separate problems affecting different parts of the body, the combination of schizophrenia and diabetes can strip years from a life. In fact, the frequency with which people with mental illness also experience life-threatening physical health conditions is alarming.
People with serious mental illness commonly live 15 years less than others in the community.
What is often not recognised, even by clinicians, is that most do not die as a result of their mental illness, but from the very same chronic physical conditions that are successfully treated in their neighbours and friends.
It is always distressing to spend years working with someone to help treat their bipolar disorder only to have them succumb to serious physical illness such as cancer within months of diagnosis.
The cause of this is correctly identified in many government publications, but there little seems to be done to find a solution. It is nothing less than the system itself that insists on dividing people’s health into manageable portfolios which do not connect and, in many ways, prevents effective treatment.
People with serious mental illness are by default already on the radar of health services, and yet they receive less screening for cancer and diabetes, less follow-up by hospital and GP services, and less encouragement to stop smoking, eat well and exercise — all important actions known to improve life expectancy.
A suspicious mind might suspect a conspiracy, but my many years of experience in mental health care recognises that even with the best of intentions, health care professionals are hamstrung by limited time and limited funding.
Recommendations made in the primary health care discussion paper for the development of care coordinators, to better identify complex conditions, and patient “enrolment” schemes, are both ideas with merit.
In addition, I believe that GPs and psychiatrists have a shared responsibility to improve communications and ensure regular monitoring and follow-up on physical health issues, where appropriate.
Doctors working in the primary health care system do an amazing job under difficult circumstances. It is timely that policy attention is now focused on how to better support them and their patients.
Consumer segmentation is popular policy in many areas, and recognising the need to treat priority groups differently is not new.
The shortened lives of people with serious mental illness not only deserve greater attention but should be a priority.
Hopefully, the reforms envisaged by the Primary Health Care Advisory Group will address this.
Professor Mal Hopwood is the President of the Royal Australian and New Zealand College of Psychiatrists.

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