|Seeing the entire person in the patient |
Better minds better living with Dr. Yansie Rolston Monday, July 17 2017
HEALTH as defined by the World Health Organization (WHO) is “a state of complete physical, mental and social well-being”. However, for most people when they think of good health they are referring to an absence of physical diseases or impairments, often times to the exclusion of mental, emotional and social wellness. Unfortunately, this interpretation, which negates the magnitude of patient complexities and lacks a holistic perspective is also evident in public health discourse and chronic illness management processes.
Often the services provided by healthcare personnel is impersonal –they do not see the entire person in the patient, so when the patient presents with physical illnesses and diseases their emotional, social and mental well-being is not recognised as important even though a period of illness is a time when they are most vulnerable – a time when they are experiencing discomfort, fear and anxiety. Let me be clear –I am not advocating for every aspect of a person’s being to be pathologised, but rather I am making the point that feelings, needs, thoughts, cultures and emotions of patients do play a significant role in their overall well-being and should not be ignored during clinical interactions.
Mental and emotional health discussions are problematic and therefore treated like that family member or friend we don’t really get along with and try to avoid at all costs. But the UK Department of Health notes that “mental health is central to our quality of life, central to our economic success, and interdependent with our success in improving education, training and employment outcomes and tackling some of the persistent problems that scar our society, from homelessness, violence and abuse, to drug use and crime”. In other words, it is the core of life and well-being, and as it will affect one in four people during their lifetime, it is paramount that any healthcare interaction and support include an element of emotional and mental engagement.
Another reason for considering a patient’s mental and emotional well-being is because mental health is the largest cause of disability worldwide (WHO). This may come as a surprise to many because when most people speak of disability they are more than likely referring to physical impairments and not those that affects the mind.
However, Trinidad and Tobago has ratified the UN Convention on the Rights of Persons with Disabilities and therefore has an obligation to address the mental health of its population in the context of human rights or face the consequences.
Nowadays people are living longer and they are doing so with a myriad of chronic illnesses, including comorbidity i.e. where a person has more than two disorders or illnesses which may affect each other.
According to WHO reports, the presence of mental illness increases the risk of other illnesses such as cardio-vascular disease, HIV and diabetes, and that people with longterm health conditions are two to three times more likely than the general population to experience mental health challenges.
An example of this is that depression frequently occurs in patients with diabetes, and that the presence of diabetes can double the chances of comorbid depression. Studies also show that there is a significant economic cost to diabetes and depression comorbidity – in that it has been found to increase healthcare costs over a six-month period by between 54 per cent and 88 per cent depending on the severity of the depression –a point worth noting given the financial and resource constraints at State-run health institutions.
In addition, there are also people living with chronic illnesses with unendurable pain, suffering and disability who also display suicidal behaviours (ideation, plans and attempts).
Another indication of possible co-existing mental, emotional and physical health comorbidity which should not go unnoticed.
There is much to be done to improve healthcare outcomes for people with chronic long-term illnesses and mental health challenges, but it is achievable with the right primary care interventions and community support. Policy-makers, healthcare professionals, staff and stakeholders need to be more aware of the complex dynamics of good health and work towards a sustainable integrated mental and physical health approach in primary and social care –an approach, that sees the entire person in the patient, in which they are treated with care, consideration and compassion and that emotional, social and mental health are normalised as part and parcel of all patient interfaces.
Dr Yansie Rolston FRSA is a UKbased disability and mental health specialist advisor. She is a social strategist and trainer who works internationally at various levels of government, business and civil society.
Contact her at yr@efficacyeva.