Bridging the Gap Between Mental and Physical Health

6 min read

Today, we welcome John M. Samuels, MPH, and Lipi Roy, M.D., MPH, FASAM, to discuss the importance of addressing mental health and physical health.

Taylor Swift, Prince Harry, Ryan Reynolds, Selena Gomez, Michael Phelps. What do these high-profile figures have in common? They have all been open about their mental health issues. In fact, a worldwide survey published in The Lancet, covering 150,000 responses across 29 nations, revealed that one out of two individuals across the globe will encounter a mental health disorder in their lifetime. The burden on society of this unmet mental health need is unacceptable. We need urgent, evidence-based, and compassionate responses.

Poor physical health in individuals with mental illness is a global concern. The risk of medical conditions such as heart disease and cancer increases in people with depression, PTSD, and other mental health disorders. Healthcare access is also limited, leading to disparities worldwide. In the United States, African American and indigenous communities receive subpar healthcare compared to white populations in approximately 40 percent of healthcare indicators. Within the Latino community, this disparity rises to 60 percent. High medical and psychiatric comorbidity reduces life expectancy and escalates personal, social, and economic burdens.

Coordinated care between physical and mental health is clearly and urgently needed.

One solution? A health advisor acting as a quarterback or consigliere can help bridge this gap, fostering collaboration between medical professionals, therapists, and mental health experts to empower individuals and enhance their overall well-being.

As the leader of a health advocacy firm (JS), I have observed first-hand how mental health organizations seek assistance in addressing their clients’ complex and unmet medical issues. This intertwined need became vividly evident through the experience of one of my clients who was deeply anxious about seeing a doctor to get his relentless cough treated. I arranged an assessment and treatment by a specialist. Afterward, it was concluded that my client required treatment at an inpatient facility that specialized in both substance use disorders and mental health. Once his alcoholism and mental health condition were stabilized, further workup revealed a diagnosis of pulmonary fibrosis. Thankfully, my client received the comprehensive care that he needed.

Another client had a history of multiple hospitalizations due to severe stomach pain. During one particularly intense episode, my team and I had strongly advised him to go to the emergency department. Following admission, the medical team discovered he was struggling with alcoholism, which he had not disclosed to his family.

After discharge, my client made the courageous decision to enroll in an inpatient rehabilitation facility and, afterward, an outpatient program. Since then, I have facilitated regular sessions with a mental health therapist and a career coach. These steps have resulted in a profound life transformation. His stomach pain has subsided, and he has achieved significant milestones, including securing a full-time job and improving relationships with family and friends.

In the realm of healthcare, personal experiences like the ones shared underscore the importance of understanding the intricate connections between physical and mental health. Researchers have similarly shed light on these links, revealing significant associations between conditions such as depression and psoriatic arthritis, as well as their potential broader implications. This connection may extend beyond psoriatic arthritis due to elevated cortisol levels associated with depression, contributing to inflammation and related conditions like diabetes and heart disease.

The other key solution to the poor coordination between physical and mental health? Major investment in primary care.

As a former primary care physician (LR), I have diagnosed and treated a wide variety of acute and chronic conditions, ranging from upper respiratory infections to congestive heart failure. I have evaluated patients with weight loss and night sweats, ordered the appropriate lab and imaging tests, diagnosed them with cancer, and then referred them to specialists. Of note, before the last step, I reminded my patient that “we will get through this together.” I also diagnosed and treated many patients with depression and anxiety and referred countless others to psychiatrists and therapists. This level of coordinated care and compassion so expertly provided by primary care providers is sorely lacking in the U.S. healthcare system.

The principal task is finding a dedicated primary care physician (PCP) and visiting them at least once a year. A PCP is truly essential in first diagnosing and treating acute and chronic health issues and, second, in coordinating care with other specialists, including mental health providers. Another key factor is having appropriate health insurance coverage: understanding which mental health services are covered can alleviate financial concerns and any reluctance you may have about seeking assistance.

Access to timely mental healthcare remains a major challenge. A long under-addressed health issue, it that has garnered the attention of the White House amid the COVID-19 pandemic. Even access to overall medical care is shrinking. While urgent care centers are popping up across the country, the availability of primary care doctors is shrinking, further splintering any coordination between physical and mental health services.

When physical and mental health conditions (including substance use disorders) co-occur, treatment planning can become very challenging, leading to disease progression and higher morbidity and mortality. Conditions often go undiagnosed among patients with co-occurring physical and mental illnesses. For example, COPD and heart failure may mask or mirror symptoms of depression, anxiety, and post-traumatic stress disorder, making their recognition and diagnosis less likely.

In other circumstances, you might need to be your own care coordinator. You need to advocate for your own health and well-being by asking your doctors and specialists if they’re communicating with one another, especially during transitions in care. Maintaining readily accessible medical records is a key component of this. Fortunately, many hospital systems have established portals that allow you to access these records easily.

In case of an emergency, have a plan in place. The COVID-19 pandemic reinforced the need for contingency plans for both the general population as well as healthcare systems. Finding an expert advocate and PCP can assist with all of the above. They can coordinate care and find the right hospitals and doctors, rather than you resorting to nonspecific and not-always-accurate “Dr. Google.” They can also mitigate risk and may even be able to secure more reasonable rates at mental health and addiction facilities.

In today’s era of war, violence, job and food insecurity, and other traumas, we are all struggling in some way or another. We need to work together to get people the health and support they need and deserve… urgently.

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