Mental health treatment is often provided in mental health centers and in stand-alone psychiatric hospitals. The general medical care in these facilities is limited, and often necessitates referring the patient to another facility for treatment of physical problems. Communication between psychiatrists, other mental health professionals and physicians from other specialties is often limited. This separation of psychiatric and physical treatment has many consequences for patients, most of them adverse.
Missing Medical Causes of Psychiatric Symptoms
The mind and the body are not separate entities. Psychiatric symptoms can be caused by an underlying medical problem, and vise versa. In a split system, where treatment of psychiatric problems and other medical problems don't occur under the same roof, this connection can be missed. Psychosis, for example, a state of detachment from reality, can be the first symptom of a neurological disorder such as a brain tumor. It is essential to do a complete medical workup upon the appearance of new psychiatric symptoms. If this is not done, diagnoses of medical problems can be missed and treatment delayed. Proper medical workups are difficult to do in the separated system. Stand-alone psychiatric hospital have no neurologist or capability to do exams like brain imaging. Transfers to general medical hospitals can be difficult to arrange.
Inadequate Treatment of Medical Problems
Patients with severe mental illness are more likely to be in poor physical health than that general population. They tend to smoke heavily, they don't exercise, their nutrition habits are generally poor, and their medications can cause weight gain, diabetes and high lipid levels. They often have no primary care doctor. The mental health facilities where they are seen for psychiatric care may not have the resources to deal with these medical problems. As a result, they often fall by the wayside.
Inadequate Treatment of Psychiatric Problems
Many people with psychiatric problems are treated by their primary care doctors and never get to see a psychiatrist. The family doctor is often forced into treating psychiatric conditions himself because he can't find a psychiatrist to refer to. Lack of access to psychiatrists and inadequate communication with them can lead to both over-treatment and under-treatment of psychiatric problems. One example is a hastiness to medicate mild depression, a condition in which symptoms often remit on their own, and where supportive talk therapy is a much more appropriate treatment. Conversely, family practice doctors might not be fully cognizant of the extent of a patient's psychiatric difficulties and might treat a physical problem without addressing the complicating psychological factors. This would occur less frequently if there was a psychiatrist in the office next door who was easily accesible for a consultation.
Stigma
Mental illness still carries with it a stigma that no physical illness does. According to the Surgeon General's Report, this stigma has increased over the past 40 years. The report views the separate treatment of mind and body, in different facilities, as one cause of this stigma. This separation decreases the willingness to seek help---sitting in an internist's waiting room is not a shameful experience; sitting in a mental health center's waiting room can induce feelings of shame. Stigma can also lead to increased stress and can exacerbate the symptoms of the illness. It also leads to discrimination in many areas. All these are, to some degree, a consequence of treating mental disorders as distinct from physical ones.
References
- The Surgeon General: Mental Health
- "Kaplan and Sadock's Comprehensive Textbook of Psychiatry"; Virginia Sadock and Ruiz Pedro; 2009
