WHAT DOES IT COST TO IGNORE MENTAL ILLNESS?

CHIROMO LANE MEDICAL CENTRE FORUMON

09th October 2014

Frank Njenga.

450 Million affectedMental illness is common, with

approximately 450 million people affected globally. It is prevalent in all population groups however those with psychosocial stressors such as poverty and unemployment are particularly at risk.

WHO

Mental illness Vs Poverty

Poor Mental health significantly contributes to a cycle of poverty where people who experience social hardship and poverty are of increased risk or mental illness and conversely those with mental illness are at increased risk of poverty.

Number One

Neuro-psychiatric conditions are the number one contributor to non-communicable disease burden world wide.

2030

The WHO has projected that by the year 2030, unipolar depressive disorders will be the number one cause of disease burden in high-income countries.

Burden of Disease

Globally, unipolar depressive disorders will be responsible for a greater burden of disease than chronic lung disease, ischaemic heart disease, diabetes, vision or hearing loss, or stroke.

Coronary Heart DiseaseFor example, there is a strong

association between depression, anxiety and coronary heart disease. In an Australian study, death from ischaemic heart disease was linked to most mental disorders, especially schizophrenia and other psychoses.

Stroke And Diabetes For example, depression is noted

to be an independent risk factor for stroke.Further, the prevalence of diabetes in patients with schizophrenia is at least five times that of the general population.

Accidents

Mental illness is also a risk factor for accidental and non-accidental injury.

Physical illnessConversely, having a physical

illness can place an individual at higher risk of developing a mental illness.

Obesity and SmokingMood disorders and schizophrenia

are strongly associated with obesity and tobacco smoking, both of which are recognized as independent risk factors for heart disease.

Infant MortalityMaternal mental illness also affects

child health and may increase infant mortality. For example, mother who are experiencing psychoses during pregnancy are twice as likely to have babies that are still born.

Failure to Thrive Further, maternal mental illness

such as depression may adversely affect bonding between mother and child, and may result in a child's failure to thrive.

HIV/AIDSImportantly, mental illness may also

increase communicable disease transmission such as HIV/AIDS, malaria and tuberculosis, the leading causes of disease burden in low-income countries.

MDG’sMental health affects progress

towards the achievement of several Millennium Development Goals, such as promotion of gender equality and empowerment of women, reduction of child mortality improvement of maternal health, and reversal of the spread of HIV/AIDS.

The WHO proposition that there can be “no health without Mental health” has also been endorsed by the Pan American Health Organization, the EU Council of Ministers, the world Federation of Mental Health, and the UK Royal College of Psychiatrists.

Suicide Every year, about 80 000 people

commit suicide. 86% of whom are in low-income and middle-income countries, and more than half of whom are aged between 15 and 44 years.

Family

It is estimated that one in four families has at least one member currently suffering from a mental or behavioral disorder.

The Cost

Families in which one member is suffering from a mental disorder make a number of adjustments and compromises that prevent other members of the family from achieving their full potential in work, social relationships and leisure. (Gallagher & Mechanic 1996).

ConsequenceConsequently, health professionals have trivialized the issue of mental illness.

ResearchIt is essential that researchers and public health professionals work together to resolve the enormous public health crisis presented by mental disorders.

Brain ImagingModern brain imaging reveals that in mental disorders, neural circuits responsible for thinking, mood, sleep, appetite, and behavior fail to function properly and the regulation of critical neurotransmitters is impaired.

$ 190 BillionSerious mental illness in the United States was associated with more than $ 190 billion in lost personal earnings in 2002, most of it due to lost productivity in the work place.

When people think of diseases in the world, they immediately think or cancer and heart disease, but when you do a study like this on quality of life, mental disorders consistently come out to be considerably more important than cancer and considerably more important than heart disease.

R. Kessler

Economic Loss Due to Reduced Earnings in Workforce

The researchers found that the economic loss is not so much due to unemployment as to reduced earnings for those who work.

Three-quarters of the total association between serious mental illness and earnings is from lower earnings among employed people with serious mental illness.

White CollarDr. Kessler noted that while some people might assume that mental illness is more a “white-collar” issue, the surprising finding was that the effects of mental illness were across the board in the survey.

USAIn the United States, mental disorders collectively account for more than 15 percent of the overall burden of disease from all causes and slightly more than the burden associated with all forms of cancer(Murray & Lopez, 1996).

Percent of Total DALYS*

All cardiovascular conditions 18.6All mental illness** 15.4All Malignant disease(cancer) 15.0All respiratory conditions 48.8All alcohol use 4.7<All infectious and parasitic diseases 2.8All drug use 1.5

Unhappiness The public was not particularly skilled at distinguishing mental illness from ordinary unhappiness and worry and tended to see only extreme forms of behaviour namely psychosis as mental illness.

Disability The disability caused by depression and anxiety is just as great as that caused by other common medical conditions, such as hypertension, diabetes, and arthritis. Comorbidity of depression with anxiety or medical illness further increases the disability experienced by sufferers.

Does diabetes cause depression?

At any given time, most people with diabetes do not have depression. But studies show that people with diabetes have a greater risk of depression than people without diabetes.

Psychosis Causes – ICU Environmental Causes

Sensory DeprivationSleep Disturbance & deprivationContinues light levels – disturbed bio-

rhythmsStress and total loss of controlLack of orientation – loss of time and dateMedical monitoring machines creating

sensory overload

Common Causes of I.C.U. Psychosis• Alcohol withdrawal• Drug withdrawal• Encephalitis• Meningitis – T.B.• HIV• Hypoglycaemia• Malaria• Renal Failure

Common Causes of I.C.U. Psychosis• Alcohol withdrawal• Drug withdrawal• Encephalitis• Meningitis – T.B.• HIV• Hypoglycaemia• Malaria• Renal Failure

Prevalence - Psychosis30% of all patients who last more

than 5 days in I.C.U.

Deep sedation in I.C.U. worsens risk of PTSD.

Renal UnitIn Stenback and Haapanen’s (1967)

large consecutive series of patients seen in a renal unit, mental manifestations occurred in 60%, rising to 75% when the blood urea exceeded 250mg/100 ml. Mental changes were as common in the acute as in the chronic uraemic patients.

ElectrolytesChanges in sodium, potassium,

calcium, chloride, phosphate, acid-base balance and osmolality can all be blamed in individual instances.

Liver failureIt is now established that the

neuropsychiatric disturbances are similar whatever the underlying liver pathology

Epidemiology

Recent epidemiological studies evaluating the relationship between depression and CAD among healthy and CAD populations consistently demonstrate a significant prospective relationship between the occurrence of major depressive episodes and the incidence of cardiac events.

Independent Risk FactorsDepression is present in over 45% of

patients admitted to hospital after a myocardial infarction and is an independent risk factor for increased mortality and morbidity after myocardial infarction. The risk persists regardless of smoking status, deprivation score, and presence of diabetes or hypertension.

Recognition and treatment of Oncology depressive symptoms in oncology patients is very important, and effective treatment may improve the oncology patients' quality of life and may also affect survival.

Cherry W.Jackson, PharmD, BCPP Journal of Pharmacy Practice

FactDepression has a reported mean

prevalence of 24% in patients

diagnosed with cancer. However, little systematic research on the efficacy of antidepressants in patients with cancer has been performed.

CONCLUSIONSThere is a link between physical and

mental disorders.Untreated mental disorder contributes

to excess Mortality/Morbidity.Mental disorders impact Economic

Development.Medical Personnel should;

–Familiarize themselves with these facts.