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Psychiatrists can care for the ‘whole’ patient with serious mental illness

Psychiatrists and other mental health professionals can address both the physical and mental health needs of individuals with serious mental illness, according to a JAMA Network Insight.

Evidence has shown that people with serious mental illness (SMI) have premature mortality of 10 to 20 years, Martha C. Ward, MD, and Benjamin G. Druss, MD, MPH, from Emory University, wrote.

“Comorbid medical diseases are the most common cause of death in individuals with SMI, with cardiovascular disease the most frequent cause of mortality,” they explained. “Because individuals with SMI experience psychiatric symptoms, social stigma, and health care system fragmentation, they obtain fewer routine preventative services, experience lower detection of existing conditions, and receive fewer treatments of known benefit for established health conditions.”

The first step for clinicians, according to Ward and Druss, is to ensure patients with serious mental illness receive optimal treatment for their mental health conditions by following evidence-based treatment guidelines and by trying to minimize the dosage and/or switch from psychotropics to safer medications.

In addition, mental health professionals should screen for adverse health behaviors, like for tobacco use and high-risk sexual activity, and for existing medical comorbidities, like metabolic abnormalities in patients with psychosis. Because tobacco is a main contributor to poor health and premature death in those with serious mental illness, Ward and Druss recommended that mental health professionals ask their patients about tobacco use at each visit and consider counseling for tobacco cessation.

“Mental health professionals are well positioned to deliver behavioral counseling for lifestyle modification, including healthy diet and increased physical activity,” they wrote. “Such counseling should be tailored to the life circumstances and cognitive abilities of the patient. For greatest effectiveness, these interventions should be of longer duration — at least 4 months — and use frequent contact between patients and clinicians.”

Social support strategies and programs that emphasize self-management techniques (like individualized action planning for goals and patient-centered decision making) should be considered, Ward and Druss advised.

Coordinating care with an existing primary care physician is also important, but if a patient does not have access to primary care, psychiatrists may be able to prescribe common medication treatment, like statins. Training is available for mental health professionals to improve their proficiency in addressing physical health comorbidities. – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.