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Necessity to address unmet mental health needs of patients with chronic conditions

On 16 May, during Mental Health Week in the UK, members of parliament (MPs) in the UK will hold a debate on mental health and chronic physical health conditions.

Approximately 40% of people with depression and anxiety disorders in the UK have chronic physical health conditions, such as cardiovascular disease, chronic pain, and musculoskeletal disorders. Mental and physical health are intertwined, and those experiencing chronic physical health issues are twice as likely to be diagnosed with a mental health issue. Currently, there is a disconnect in the UK’s National Health Service (NHS) between treatments for chronic physical conditions and mental health conditions, meaning that patients are more likely to experience more severe mental health issues as a consequence of their physical health diagnosis. GlobalData epidemiologists anticipate that if MPs choose to encourage the discussion of mental health during medical appointments regarding a patient’s long-term physical health, the prevalence of mental health disorders such as anxiety and depression will decline in the UK, reducing pressure on mental health services in the UK.

Chronic physical conditions are those that last one year or more, and persist over time. They can be controlled, but most cannot be cured. Chronic physical conditions can compromise a person’s ability to work, exercise, and complete daily tasks. The NHS reports that patients with chronic physical conditions such as diabetes, may experience difficulty sleeping, disease-associated discrimination, long periods of social isolation, and subsequential loneliness due to either long stays in a hospital or staying home. All of these factors are likely to cause significant mental challenges and have a knock-on effect on the patient’s mental health. In turn, this can create a cycle where poor physical health affects mental health, and poor mental health creates challenges in improving physical health.

According to the Centers for Disease Control and Prevention in the US, diabetic patients are two to three times more likely to have depression than people without diabetes, but only 25%–50% of those with depression and diabetes have been diagnosed and treated. Those with untreated depression or other mental illnesses are likely to have an increased risk for diabetic complications such as heart disease and nerve damage.

There are currently several action plans in place to improve the physical health of people with severe mental illness, including annual check-ups and integrated care systems, but the same is not currently in place for those with chronic physical conditions. In 2017, NHS England and its partners set a “Five Year Forward View” to coordinate individual care teams (including primary care, community teams, mental health teams, and hospital services) to improve cohesion between all elements of patient care, with the ultimate goal of improving patient-targeted long-term care, as opposed to single unconnected episodes of care. There have been some improvements, such as the introduction of talking therapies, which bring mental and physical healthcare providers together. However, there is still a disconnect that means many patients are not being diagnosed and treated for mental health conditions alongside their long-term physical conditions.

GlobalData epidemiologists anticipate that there will be 4.4 million diagnosed prevalent cases of type 2 diabetes in the UK in 2024, which is expected to increase to five million cases by 2028. According to a survey conducted by Diabetes UK in 2018, 64% of the diabetic population in the UK will experience mental health problems as a consequence of their condition. If MPs chose to focus on encouraging the integration of mental health screening and treatment into care for patients with long-term physical conditions, GlobalData epidemiologists anticipate the prevalence of mental health conditions among those with long-term physical health conditions such as diabetes will decline.

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As patients with these chronic physical conditions can generally control, but not cure, their disease, it is of paramount importance to ensure there are steps in place to manage their mental well-being and quality of life throughout both community and hospital settings.