Author: Mary Harasym
Every year, more people are recognising that mental health problems can be just as serious as physical health problems. Globally, both cause a huge burden of disability and human suffering. But how much do we understand the link between mental and physical health conditions?
In the past 10-15 years, investments were put towards researching the links between Mental Health Conditions (MHCs) and Non-Communicable Diseases (NCDs). A decade later, a “5×5 model” for tackling NCDs was adopted by the United Nations (UN). This highlights five major disease categories and risk factors that overlap and interact in different ways. The latter typically refers to diseases you can’t transmit to another person, such as cancer and diabetes. In 2007, The Lancet commissioned a series on global mental health, which synthesised interdisciplinary and international research. The commission dives into a diversity of issues, with titles like “Stigma and mental health”, “Mental health and the mass media: room for improvement” and “Mental health systems in countries: where are we now?”
The UN came up with this 5×5 model after delving into the research on the overlapping determinants of health. The relationship between NCDs and MHCs are often bidirectional and complex. For example, a 2017 World Health Organization (WHO) technical report elucidates how depression can lead to and worsen the development of coronary heart disease, and having coronary heart disease can lead to and increase depression. These types of associations between NCDs and MHCs are accepted, but their causal mechanisms are not yet fully understood.
Another example of a well-known bidirectional association is that of people diagnosed with a ‘severe mental disorder’ and cancer. The WHO report illuminates how people with ‘severe mental disorders’ are less likely to access healthcare services. So, if they have cancer, they may be diagnosed at a more advanced stage, leading to a lower chance that the cancer can be treated. Poor access to healthcare services can often be attributed to stigmatisation of people with MHCs.
Stigma can be broken down into different types of categories but fundamentally, they are either self stigma or public stigma (including those embedded in societal structures). A study in the UK on stigma found public perceptions of people with eating disorders and “problematic use of alcohol and other drugs” are often viewed as the individual’s fault and “needing to pull themselves together”. Another study in Sri Lanka found doctors’ and medical students’ holding stigmatising attitudes towards MHCs and see patients as blameworthy. With public perceptions like these, its no wonder why people with MHCs are less likely to utilise healthcare services. Stigma prevents health seeking behaviours and influences how care is provided. Stigma often bears weight beyond our comprehension.
In addition to stigma, childhood adversity is a risk factor for health problems that is often overlooked. Adverse childhood experiences (ACEs) like domestic violence, death of a parent, physical or sexual abuse, and parental alcohol abuse increase the child’s risk of physical and mental health conditions later in life. Some research advocates for the inclusion of childhood adversity within environmental risk factors as it’s a risk for both mental and physical health conditions and has evidence-based interventions that target the individual level, healthcare policies, and societal systems.
Pathways between MHCs and NCDs exist at an individual, neighbourhood, and societal level. As we continue to understand that many of the links are bidirectional, the case for robust integrated care pathways is strengthened. How an integrated care pathway manifests will vary depending on the community’s needs. Still, there needs to be investment in culturally relevant research of the causal mechanisms underlying the comorbidities, as this is currently lacking. What’s more is the need to better communicate around MHCs. Too often, MHCs are lumped into one category, when their complexities are just as broad as those of physical illnesses.
MHCs being pigeonholed into a fifth NCD category may not be a perfect solution to increasing awareness, research, and services but it’s a starting point. Merely having mental health on the agenda of large intergovernmental and humanitarian organisations show the growing understanding of the global mental health field. Mental health advocates must continue to support the research and development for care of MHCs and one way this occurs is through being understood in conjunction with physical illnesses. It is invaluable for global health to embrace a more holistic understanding of human health and develop policies and implement practices that recognise the complex relationships between body, brain, and mind.