Transcript Mental Health and Chronic Disease File

Mental Health and Chronic
Disease
GENERAL CONCEPTS
Gaspar A. Da Costa
Panamá
Mental Health and Chronic Disease
Key
concepts
Chronic diseases are non-communicable illnesses that
are prolonged in duration, do not resolve
spontaneously, and are rarely cured completely
Mental health disorders are medical conditions that
disrupt a person's thinking, feeling, mood, ability to
relate to others and daily functioning
Most people diagnosed with a serious mental health
disorder or a chronic disease can receive relief from
their symptoms by following a correct treatment plan
Depression and other mental disorders significantly impact
quality of life and the ability of patients to adhere to treatment
regimens - http://www.psychiatrictimes.com/articles/meeting-mental-health-needspatients-chronic-medical-illness-crisis-access#sthash.GcDmHta7.dpuf
Percentage of Adults with Mental Disorders and/or
Medical Conditions 2001-2003
Having a mental health disorder is a risk factor
for developing a chronic condition and vice versa
These comorbidities are
associated with a more severe
course of mental illness, reduced
quality of life, and premature
mortality.
Adapted from the National Comorbidity Survey Replication 2001-2003
The pathways causing
comorbidity of mental and
medical disorders are complex
and bidirectional
General Assistance-Unemployable (GA-U) Program in
Washington State
Comorbid Behavioral Health and Chronic
Medical Conditions
Chronic Medical Condition
% with depression/anxiety % treated for
depression/anxiety
Arthritis
32.3%
7.1%
Hypertension
30.5%
5.5%
Chronic Pain
61.2%
5.9%
Diabetes Mellitus
30.8%
5.2%
Asthma
60.5%
6.8%
Coronary Artery Disease
48.2%
5.7%
Cancer
39.8%
5.7%
2006 Milliman, Inc US Health Care Study
Personality Profiles traits and Reactions to Illness
Personality Patients who …
Dependent Ask lots of questions
Make it hard for you to end the
conversation or leave the room
Obsessive Are insistent
Are detail oriented
Often feel …
Afraid that you won't find them worthy
Afraid you won't want to care for them
Narcissistic Are self-centered
Criticize others
Believe no one is qualified
Are fearful, threatened, and vulnerable
Are angry when they can't control their illness,
the staff, and the schedule
Are helped by …
Offering regular, brief sessions
Setting tactful limits that reassure the patient
and do not annoy staff
Offering detailed explanations
Providing choices whenever possible
Trying to use patient input collaboratively
Suffering
Victim
Always have symptoms and
request much attention
No follow recommendations
Avoiding confrontation, emphasize they
deserve the best care we can provide
Keeping them informed (same message from
all staff)
Suffering is their role; illness punishes them (and Regular visits, no matter how varying the
sometimes physician) but hopes doctor will keep complaints. Encouraging them to “suffer”
trying
through treatments
Paranoid
Do not trust. Refuse to
participate in plans.
They are being taken advantage of by others or
purposefully neglected or harmed
Staying calm. Not arguing
Offering understanding of their position
Making clear recommendations
Histrionic
Are flirtatious
Want to call the doctor by his or
her first name
They want to be special in the eyes of the
physician. Illness will invalidate them or make
them unattractive
Encouraging the patient to verbalize concerns
Setting boundaries for the relationship
Remaining courteous and objective
Schizoid
Are very lonely
Tend to avoid medical care
Doctors are invading their privacy
Engaging them in helping to make medical
decisions
Motivational Interviewing…
Motivational Interviewing
Asking permission to discuss with the patient
Begin with an open-ended question
Reflect back the patient's opinion
Explore the importance of this topic from the patient's point of view
What would make that increase or decrease
How confident is the patient that if they wanted to make a change, they could
What would make that rise or fall
Expose the ambivalence
Reflect to them
When they are ready, work out a plan together
An Opportunity
Modifiable risk behaviors (i.e.,
tobacco use, physical
inactivity, and poor nutrition)
that contribute to reduce a
number of chronic diseases
and mental health disorders
Early detection and tretament
of comorbity of Chronic
Disease and Mental Disordes
Training of health teams
about integration of mental
health diagnosis and
treatment
Continous of care including a
stepped care
Use of Mhgap in patients with
chronic diseases and early
detection of chronic diseases
in patients with mental health
disorders
Links between mental disorders and other
chronic diseases
Risk factors for three chronic diseases
Build integrated health care:
• Care for chronic conditions needs
integration to ensure shared information
across settings, providers, and time.
Integration also includes coordinating
financing across different arms of health
care, including prevention efforts, and
incorporating community resources that
can leverage overall health-care services;
Support patients in their
communities:
• Health care for people with chronic
conditions needs to extend beyond clinic
walls and permeate their living and working
environments. To manage chronic
conditions, patients and families need
services and support from their
communities;
Centre care on the patient and
family:
• Because the management of chronic
conditions requires life long behaviour
change, emphasis must be upon supporting
the patient to self- manage his/her
condition in coordination and partnership
with the health-care team
Emphasize prevention:
• Most chronic conditions are preventable, so
too are many of their complications.
Prevention should be a component of every
health-care interaction
Integrating Levels
• Patient level
• Care pathways provide structured, multidisciplinary plans that focus on the
patient’s overall journey, rather than on the contribution of each specialty or
service
• self-management support is essential
• Health Care Organization Level
• Use of multidisciplinary teams
• Continuity of care between different health workers and system levels,
facilitated by common clinical information systems
• Links to social care and community services
Integrating Levels
• MENTAL HEALTH INTO PRIMARY CARE
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Advocacy: Advocacy is required to shift attitudes and behavior
Training: Adequate training of primary care workers is required
Roles: Primary care tasks must be limited and doable
Support: Specialist mental health workers and facilities must be available to support
primary care
Medicines: Service users must have access to essential psychotropic medications in
primary care
Engagement: Integration is a process, not an event
Coordination: A mental health service coordinator is crucial
Collaboration: Collaboration with other government non-health sectors,
nongovernmental organizations, village and community health workers, and
volunteers is required.
CONCLUSIONS
• We need think in Mental Disorders and use Mhgap in patients with
chronic diseases.
• We need think in all patients with Mental disorders in early detection
of chronic diseases, some of them related to treatment.
• We need integrate all resources of community to improve te diagnosis
and treatment of both conditions
• We need identify the personality profile traits in patients and families
for use the adecuate management of them.
• We need recognize the main rol of patient and families in each
moment of the natural course of chronic disease an mental disorders.