11 November 2021
The Health system has a major divide that is not often spoken about- the divide between mental health and physical health.
Physical health tries to be a science and likes to think that its diagnoses and treatments are based on sound experimental evidence. If someone is sick and there are not enough facilities there is a fair effort from the medical profession and relatives to get more resources and they are mostly successful. There is a highly respected system and career structure.
Mental health has similar endeavours, but has less of a scientific base for its diagnoses and treatments. There has been a lot of work on neurotransmitters associated with depression and drugs that supposedly increase the good ones, but no single test is associated with a diagnosis, and diseases are defined. It gives it a lingering stigma of imprecision.
The workforces in mental and physical health have relatively little crossover, even isolated within the same hospital. When I last worked in the health system 9 years ago in a hospital that had both an active ED and a mental health facility, patients were triaged as physical or mental, different teams saw them, and neither team wanted much to do with the other stream’s patients. There was a shared waiting room, but different personnel, assessment areas, practices and wards. Getting one of the other team to assess someone was an afterthought, or only when the pathology was fairly gross.
When I was in tobacco control, there was a lot of reluctance to try to get mental health patients to stop smoking as ‘they needed it’, which was another way of saying that to add the nicotine withdrawal to their generally stressed situation was merely making trouble. But the public health statisticians said that people with mental health problems had a lot of physical problems and died about 14 years earlier (AIHW). So glossing over the physical health of mental health patients is not without consequence.
It was interesting to note recently that a COVID-19 infection in a mental health inpatient went undiagnosed for 4 days, and drew attention to the fact that mental health patients had a poor vaccination rate also.