Transcript What does it cost to ignore mental illness- CLMC 2014

WHAT DOES IT COST TO IGNORE MENTAL ILLNESS?
CHIROMO LANE MEDICAL CENTRE FORUM
ON
09th October 2014
Frank Njenga.
450 Million affected
Mental illness is common, with
approximately 450 million people
affected globally. It is prevalent in all
population groups however those
with psychosocial stressors such as
poverty and unemployment are
particularly at risk.

WHO
Mental illness Vs Poverty

Poor Mental health significantly
contributes to a cycle of poverty
where people who experience
social hardship and poverty are of
increased risk or mental illness and
conversely those with mental illness
are at increased risk of poverty.
Number One
Neuro-psychiatric conditions are
the number one contributor to noncommunicable disease burden
world wide.
2030
The WHO has projected that by the
year 2030, unipolar depressive
disorders will be the number one
cause of disease burden in highincome countries.
Burden of Disease
Globally, unipolar depressive
disorders will be responsible for a
greater burden of disease than
chronic lung disease, ischaemic
heart disease, diabetes, vision or
hearing loss, or stroke.
Coronary Heart Disease
For example, there is a strong
association between depression,
anxiety and coronary heart disease.
In an Australian study, death from
ischaemic heart disease was linked
to most mental disorders, especially
schizophrenia and other psychoses.
Stroke And Diabetes
For example, depression is noted
to be an independent risk factor for
stroke.
Further, the prevalence of diabetes
in patients with schizophrenia is at
least five times that of the general
population.
Accidents
Mental illness is also a risk factor
for accidental and non-accidental
injury.
Physical illness
Conversely, having a physical
illness can place an individual at
higher risk of developing a mental
illness.
Obesity and Smoking
Mood disorders and schizophrenia
are strongly associated with obesity
and tobacco smoking, both of which
are recognized as independent risk
factors for heart disease.
Infant Mortality
Maternal mental illness also affects
child health and may increase infant
mortality. For example, mother who
are experiencing psychoses during
pregnancy are twice as likely to
have babies that are still born.
Failure to Thrive
Further, maternal mental illness
such as depression may adversely
affect bonding between mother and
child, and may result in a child's
failure to thrive.
HIV/AIDS
Importantly, mental illness may also
increase communicable disease
transmission such as HIV/AIDS,
malaria and tuberculosis, the
leading causes of disease burden in
low-income countries.
MDG’s
Mental health affects progress
towards the achievement of several
Millennium Development Goals,
such as promotion of gender
equality and empowerment of
women, reduction of child mortality
improvement of maternal health,
and reversal of the spread of
HIV/AIDS.
The WHO proposition that there
can be “no health without Mental
health” has also been endorsed by
the Pan American Health
Organization, the EU Council of
Ministers, the world Federation of
Mental Health, and the UK Royal
College of Psychiatrists.
Suicide
Every year, about 80 000 people
commit suicide. 86% of whom are in
low-income and middle-income
countries, and more than half of
whom are aged between 15 and 44
years.
Family
It is estimated that one in four
families has at least one member
currently suffering from a mental or
behavioral disorder.
The Cost
Families in which one member is
suffering from a mental disorder
make a number of adjustments
and compromises that prevent
other members of the family from
achieving their full potential in
work, social relationships and
leisure. (Gallagher & Mechanic
Consequence
Consequently, health
professionals have trivialized
the issue of mental illness.
Research
It is essential that researchers
and public health professionals
work together to resolve the
enormous public health crisis
presented by mental disorders.
Brain Imaging
Modern brain imaging reveals that in
mental disorders, neural circuits
responsible for thinking, mood, sleep,
appetite, and behavior fail to function
properly and the regulation of critical
neurotransmitters is impaired.
$ 190 Billion
Serious mental illness in the
United States was associated with
more than $ 190 billion in lost
personal earnings in 2002, most
of it due to lost productivity in the
work place.
When people think of diseases in
the world, they immediately think or
cancer and heart disease, but when
you do a study like this on quality of
life, mental disorders consistently
come out to be considerably more
important than cancer and
considerably more important than
heart disease.
R. Kessler
Economic Loss Due to Reduced
Earnings in Workforce
 The researchers found that the
economic loss is not so much due to
unemployment as to reduced earnings
for those who work.
 Three-quarters of the total
association between serious mental
illness and earnings is from lower
earnings among employed people with
serious mental illness.
White Collar
Dr. Kessler noted that while some
people might assume that mental
illness is more a “white-collar” issue,
the surprising finding was that the
effects of mental illness were across
the board in the survey.
USA
In the United States, mental
disorders collectively account for
more than 15 percent of the
overall burden of disease from all
causes and slightly more than the
burden associated with all forms
of cancer(Murray & Lopez, 1996).
Percent of
Total DALYS*
All cardiovascular conditions
All mental illness**
All Malignant disease(cancer)
All respiratory conditions
All alcohol use
All infectious and parasitic
diseases
All drug use
18.6
15.4
15.0
48.8
4.7<
2.8
1.5
Unhappiness
The public was not particularly skilled
at distinguishing mental illness from
ordinary unhappiness and worry and
tended to see only extreme forms of
behaviour namely psychosis as
mental illness.
Disability
The disability caused by
depression and anxiety is just as
great as that caused by other
common medical conditions, such
as hypertension, diabetes, and
arthritis. Comorbidity of depression
with anxiety or medical illness
further increases the disability
experienced by sufferers.
Does diabetes cause depression?
At any given time, most people with
diabetes do not have depression.
But studies show that people with
diabetes have a greater risk of
depression than people without
diabetes.
Psychosis Causes – ICU
Environmental Causes
Sensory Deprivation
Sleep Disturbance & deprivation
Continues light levels – disturbed biorhythms
Stress and total loss of control
Lack of orientation – loss of time and
date
Medical monitoring machines creating
sensory overload
Common Causes of I.C.U.
Psychosis
• Alcohol withdrawal
• Drug withdrawal
• Encephalitis
• Meningitis – T.B.
• HIV
• Hypoglycaemia
• Malaria
• Renal Failure
Common Causes of I.C.U.
Psychosis
• Alcohol withdrawal
• Drug withdrawal
• Encephalitis
• Meningitis – T.B.
• HIV
• Hypoglycaemia
• Malaria
• Renal Failure
Prevalence - Psychosis
30% of all patients who last more
than 5 days in I.C.U.
Deep sedation in I.C.U. worsens
risk of PTSD.
Renal Unit
In Stenback and Haapanen’s
(1967) large consecutive series of
patients seen in a renal unit, mental
manifestations occurred in 60%,
rising to 75% when the blood urea
exceeded 250mg/100 ml. Mental
changes were as common in the
acute as in the chronic uraemic
patients.
Electrolytes
Changes in sodium, potassium,
calcium, chloride, phosphate, acidbase balance and osmolality can all
be blamed in individual instances.
Liver failure
It is now established that the
neuropsychiatric disturbances are
similar whatever the underlying liver
pathology
Epidemiology
Recent epidemiological studies
evaluating the relationship between
depression and CAD among healthy
and CAD populations consistently
demonstrate a significant prospective
relationship between the occurrence
of major depressive episodes and the
incidence of cardiac events.
Independent Risk Factors
Depression is present in over 45% of
patients admitted to hospital after a
myocardial infarction and is an
independent risk factor for increased
mortality and morbidity after
myocardial infarction. The risk
persists regardless of smoking status,
deprivation score, and presence of
diabetes or hypertension.
Recognition and treatment of
Oncology depressive symptoms in
oncology patients is very important,
and effective treatment may improve
the oncology patients' quality of life
and may also affect survival.
Cherry W.Jackson, PharmD, BCPP
Journal of Pharmacy Practice
Fact
Depression has a reported mean
prevalence of 24% in patients
diagnosed with cancer. However,
little systematic research on the
efficacy of antidepressants in
patients with cancer has been
performed.
CONCLUSIONS
There is a link between physical and
mental disorders.
Untreated mental disorder contributes
to excess Mortality/Morbidity.
Mental disorders impact Economic
Development.
Medical Personnel should;
–Familiarize themselves with these
facts.