Health is the level of functional or metabolic efficiency of a living being. In humans, it is the general condition of a persons mind and body, usually meaning to be free from illness, injury or pain. The World Health Organization (WHO) defined health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”. That means that we can’t judge a person’s health on one dimension only. In “good health” or “healthy” always means that a person is mentally, physically sound and has a good social wellbeing. The purpose of this paper is to highlight the prevalence of physical illnesses existing in individuals who are in mental hospitals and the factors responsible for ignorance of such illnesses. It also includes the strategies to uplift the physical health of patient’s in psychiatric ward.
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We can’t ignore the relationship between physical and mental health but when it comes to practice physical health is ignored in mental health and vice versa. Recently, I encountered a patient in Karvan e Hayat where I witnessed the true example of ignorance of physical illness in mental health. “A 36 year old male patient admitted in a private hospital is sickâ€¦ looking desperate and completely helpless. History reveals that he was admitted here three months back. During his stay in hospital he got loose motion and fever. It continued for a week and his health started deteoriating. The hospital management tried to call his attendants but they never came. Since, it was a mental hospital, nothing was done for his illness. Patient started showing hostile behavior towards the staff and other patients. Finally, he was restrained.” The scenario highlights some of the factors discussed below.
According to the World Federation for Mental Health (September 2010) “Physical and mental health disorders go hand in hand. Researches show that persons with severe or chronic physical illnesses often have a co-existing mental health problem. At the same time, persons with severe mental illnesses or substance abuse disorders have physical health problems that remain undetected or untreated.” Studies have shown that mental disorders almost always also have chronic physical conditions and it is most prevalent in older people such conditions can be hypertension, arthritis, diabetes. As people grow older, the risks of physical illness are increased and they are more prone to get physical illnesses. People with cardiac disease, dementia, Parkinson’s disease, and other serious illnesses are at greater risk of anxiety and depressive disorders and of cognitive impairment, sometimes of psychotic proportions. (Friedman 2009).
There are many factors that lead to poor physical health with mental physical illness. Firstly, mental hospitals in many countries are often lacking equipment that could help in making the diagnosis of physical illness as well as other materials that would make it possible to recognize and treat physical illness. Psychiatrists are concerned only with the mental illnesses of patients and in this way the physical illness are remained unrecognized and hence untreated. According to (Sartorius, 2007) physical diseases have a higher prevalence in people with schizophrenia than in persons without it. Large proportion of people die would have infectious diseases (e.g., tuberculosis). Second factor could be the side effects of certain psychotropic drugs and their poor monitoring. As in case of this patients he was getting certain psychotropic drugs and their side effect could have made him sick. Literature states that such medications not only contribute to poor physical health but can also sedate patients making it harder for them to keep active and motivated. (Collins et al, 2011). In addition, discrimination and stigma towards mentally ill patients is also a barrier to good physical health. Such attitudes do exist in our cultural context as well, patients in mental hospitals complaining of physical illnesses are not heard thinking that they are mentally ill and are lying. As far as I am concerned, I could see this situation where the staff seemed least bothered by the patient’s condition. According to literature unluckily stigmatizing attitudes towards mental illnesses are present within the mental health professions themselves. The staff usually stigmatizes the patients and treats them unfairly. Instead of paying attention they just ignore the symptoms reported by the patients like weakness, pain, loose motions, constipation etc. and label them as symptoms of mental health. Such symptoms may further worsen patient’s condition. (Cooper, 2010)
Thirdly, lack of access to primary care can also contribute to physical illnesses. There is strong evidence that people with a diagnosis of a mental illness have less access to primary healthcare and receive inferior care for diabetes and heart attacks (Druss 2001). This is despite the fact that rates of physical illness and poor dental health among people with severe mental illness are much higher than in the general population (Phelan 2001). Such conditions have fatal consequences that can lead to premature death. Lastly, the factor which leads to poor physical health are individual’s life style. Literature suggests that comparatively to the general population, individuals with serious mental illness on average, die 25 years younger, largely due to preventable health conditions (Parks et al., 2006). These conditions are due to lack of exercise, smoking, poor diets, and medication side effects, giving rise to cardiovascular disease, type 2 diabetes, hypertension, and liver disease.
According to Maslow’s hierarchy there are physical requirements for human survival. If these requirements are not met, the human body cannot function properly. Higher needs such as social needs and esteem are not felt until one has met the needs basic to one’s bodily functioning. Through this model we can infer that physical needs when met or not can ultimately affect mental health in both ways. In order to maintain a healthy lifestyle and preventing from serious consequences physiological needs should be fulfilled.
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As healthcare professionals we can improve the physical health of patients to a greater extent by closely monitoring the side effects of medications, training the staff about the association between physical and mental health. We will promote lifestyle interventions that combine exercise, dietary counseling, and help adults with serious mental illness lose weight and reduce some risk factors for cardiovascular disease. As mental health and physical are associated, for this reason integrated treatment of health and mental health conditions becomes increasingly important and we should try our best to provide holistic care to the patients. This can be done by incorporating mental health professionals into primary care practices. Moreover, enhancing the ability of primary care providers to identify and treat mental disorders. Proper screening and complete medical history should be taken for physical illnesses at the time of admission. Furthermore, psychiatrists need to make sure that they are also concerned for the physical illnesses of the patients. We should examine our own attitudes and capacity to deal with mental illnesses. Instead of discriminating and stigmatizing we should become active and speak for the rights of mentally ill patients. Moreover, patients feel uncomfortable because of the tagging of stigma, so efforts should be taken to inform public attitudes, such as anti-stigma campaigns e.g. ‘Changing Minds’. (Royal College of Psychiatrists, 2008).
In conclusion, many physical illnesses have been identified that exist in mental ill patients that are unidentifiable for one reason or the other. These illnesses are ignored and are remained untreated. In fact, there is a strong link between physical and mental health, they both go hand in hand and initiatives must be taken to enhance physical health in mental health setting. Maslow’s hierarchy also supports the fact that physical requirements should be met and fulfilled which are essential for human survival. Healthcare professionals should take measures in order to minimize factors like lack of knowledge, medication side effects, and lack of access to primary care, stigma and discrimination of mentally ill patients that leads to ignorance of physical illnesses.
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