According to World health organization, Health is a state of complete physical, mental and social well-being not merely the absence of disease and infirmity. From this definition it can be inferred that health includes three major aspects and consideration of all aspects of health while providing care to the patients is very important. This definition applies on both psychiatric and medicine field because without holistic care it is impossible to achieve a complete state of wellbeing. The health care professionals taking care of physically ill patients also consider their mental health (Sturgeon, 2007). On the other hand physical health of patient’s with serious mental illness is neglected which leads to high premature mortality rates in this population group (brown, 2012).Writing on this topic will help in understanding about importance of holistic care in mental health care setting.
According to (Thornicroft, 2011) “20-year mortality gap for men, and 15 years for women, is still experienced by people with mental illness in high-income countries. The combination of lifestyle risk factors for chronic diseases, higher rates of unnatural deaths and Poorer physical healthcare contributes to this scandal of premature mortality”. It shows that high mortality rate in mentally ill patients is due to the ignorance of physical health so it is important to consider the physical health of such patients to maintain good quality of life.
Likewise, I have witnessed the ignorance of physical health during clinical in Karwan-e-Hayat.18 years old female was admitted in Karwan-e-Hayat with diagnose of schizophrenia. On clinical day I saw that she was sitting in her bed shivering and constantly going to wash room. I informed staff about her condition but they ignored and say she will be all right. Next day she was in same situation, looking very tired and anxious again I informed staff but they did not do anything. Next week when we went there I asked staff about her condition they told that she was suffering from severe diarrhea and was admitted in Zia-u-din hospital.
Reflecting on this scenario it’s very upsetting that staff are ignoring physical health of patients which leads to more distortion of their health, economic burden, and many other unexpected out comes such as death and serious illnesses.
Mentally ill patients are more prone to physical illness then the general population because of many reasons such as lack of exercise, high rates of smoking and poorer diet contributes to higher rates of hypertension, high plasma cholesterol and triglycerides, diabetes, obesity, cardiovascular disease, cancer, and respiratory illness etc. (Chacon, 2011). Moreover some researches also show that there is strong genetic relationship between some psychological and physiological illness such as diabetes and schizophrenia that people with diabetes have the tendency to get schizophrenia. Patients with severe mental illness are unable to maintain a healthy behavior which leads to many serious physical illnesses. So it is the duty of health care professionals to provide holistic care to these patients. Further somatic pain is also a reason for example, when such patient complains about pain staff perceives it as somatic delusion and they did not do any assessment which leads to further consequences.
Thornicroft (2011) states there are many barriers which contribute to physical illness. He gives the concept of “diagnostic overshadowing” that people with mental illness receive worse treatment for physical disorders. For example people with co-morbid mental illness and diabetes that presented to an emergency department, were less likely to be admitted to hospital for diabetic complications than those with no mental illness. It may be also due to the negative stereotyping and stigma related to the illness. Furthermore workload and shortage of staff is a factor because of workload the staff is unable to give time to individual patient. On the other hand lack of trained staff, lack and ignorance of daily assessment by trained staff leads to various physical health problems in mentally ill patients. For example in the above mentioned scenario the patient was shivering and was frequently going to washroom but the staff did not take notice of it and later it was found that the patient was having severe diarrhea. Brown(2012) added that health disparities experienced by these people is due to poverty, social isolation, problems accessing health assessment or lack of resources from management like tools and equipment’s to assess the physical symptoms of patients e.g. there is no BP cough to assess the BP of patients. Moreover mentally ill patients are unable to identify problem in their own body because of altered thought process and side effects of psychotic medication such as seizures, hypotension extra pyramidal symptoms these all factors contribute to serious physical illnesses.
According to Maslow’s Hierarchy of Needs physical needs and health are most important to be fulfilled. He says that physiological needs are deficiency needs, meaning that these needs are important in order to avoid unpleasant consequences. These physiological needs include the most basic needs that are important to survival, such as the need for water, air, food, sleep, and health. So from this model we can infer that physical health and needs are very important in order to maintain a healthy life.
Mentally ill people are appearing to give less priority to their physical health needs. Health promotion for such people should aim to raise awareness of variable high-risk lifestyle factors and their control (Buhagiar, 2011). For example it is the responsibility of health care providers and family members to provide awareness to the clients about reducing risk factors that cause physical illness such as sedentary life style, smoking, drug abuse, and consumption of unhealthy diet. Additionally (Buhagiar, 2011)added that locus of control in mentally ill patients is external as compared to physically ill patients, so here comes the main role of health care providers and family members to change their behavior and performing daily assessment of such patients. The timely assessment will help care givers to act pro-actively and take prophylactic measures to control behaviors and diseases in mentally ill patients.
Furthermore (Tsay, 2007) explain that we need multidimensional strategy to reduce disparities in physical health of mentally ill patients. For example integration of mental and physical health services will be of some benefit like in above discussed scenario the patient was only receiving care for mental illness, so to provide holistic care the management of such organizations should focus on both mental and physical aspects of health and make sure the availability of physicians and equipment’s needed for the assessment, treatment and health promotion of such patients.
In addition (brown, 2012) mental health nurses and clinicians should play an active role in health promotion, primary prevention and the early detection and management of physical health problems. This would only be achieved when the health care providers are trained and competent in their skills such as therapeutic communication, proper physical assessment, and other psychomotor skills. So the management of any health care organization should arrange different training sessions for providing latest and reliable information that will help staff to provide holistic care, to refresh their knowledge with new researches and make sure the ongoing evaluation and analysis of training sessions. Thus the improvement in all these aspects will help care givers to provide holistic care to mentally ill patients and contribute to complete state of wellbeing.
In conclusion, the physical health of mentally ill patients should be part of the field of action of psychiatric practitioners. Health consists of physical, mental, and social aspects, consideration of all three aspects is very essential; change in one aspect will lead to distortion of health. There for it is the duty of health organizations and health care providers to prevent illness promote and restore health and to do screening, diagnosis, and treat physical illness of mentally ill patients. Here my suggestion is that as health care professional we have to consider all three aspects of health and it is our duty to provide holistic care to the patients to achieve a complete state of health.