Using Information to Span the Physical health/ Mental health Divide

Using Information to Span the Physical health/ Mental health Divide Michael Sharpe Reader in Psychological Medicine University of Edinburgh

The Problem

Mind the gap • Mind and body • The philosophical, conceptual and organizational division of services • This is philosophically, scientifically and practically outmoded

Some Facts ¼ to ½ of medical outpatients have significant depression and anxiety. Such comorbidity is associated with ….. • Poor quality of life • Medically unexplained symptoms • Worse medical outcomes • Higher use of medical resources

The Opportunity

Limitations of current ISD data • Psychiatric diagnostic recording LARGELY ABSENT • From ISD 0.1% of patients in general hospitals have recorded diagnoses of depression

Examples from Research Edinburgh University Psychological Medicine Research Group

Collecting routine psychiatric data – Depression in cancer patients • Screen all outpatient attenders using automatic system • Touch screen computers • Efficient and acceptable • But not fully automatic (funded by Cancer Research UK)

Collecting routine psychiatric data – the example of cancer • 20 % have significant psychiatric symptoms. • 150 consecutive patients with major depression. • ONLY 5% were receiving appropriate treatment

Collecting routine psychiatric data – the example of Neurology • A study of consecutive referral to OPD in Edinburgh found 50% with psychiatric disorder and 25 % with medically unexplained symptoms. • Now conducting a National Neurological Symptom Study of 5,000 patients to extend study and observe predictive importance. (funded by CSO and CRAG)

Using existing ISD activity data to identify patients with unmet Psychiatric needs Identify patients frequently referred to general hospitals with medically unexplained symptoms Three stages: • Identify NUMBER of referrals to hospital • Review records • Interview patients to get psychiatric diagnosis. (funded by CSO and MHDF)

Using existing ISD activity data to identify patients with unmet Psychiatric needs • Most of the patients with frequent referrals for medically unexplained complaints have unrecognized/untreated depression. • Pilot work suggests that recognition and appropriate management can be effective

What do we need ? Readily usable integrated medical/surgical and psychiatric diagnostic data to quantify and monitor the size of the problem of psychiatric problems in non-psychiatric patients.

How can we get integrated data • Joined up thinking • Linking medical and psychiatric databases • Making and recording of psychiatric diagnoses in medical patinets • Better primary care data

Barriers to integrated data • Major attitudinal blocks • Failure to recognize the importance of the problem • Failures in clinical practice • The amount of work involved

The way forward….. • Improved recording of psychiatric data • Recognition of the problem • Weight of evidence • Central requirement • Improved assessment of patients • Training • A PILOT STUDY – an “institutional audit”

Further reading • SNAP report on liaison psychiatry and psychology (psychological medicine) • Current BMJ series; ABC of psychological medicine (and book)

Using Information to Span the Physical health/ Mental health Divide