Authors: EUFAMI and GAMIAN-Europe

Depression, like all mental health problems, does not exist in a vacuum. Poor physical health exacerbates the risk of poor mental health, and vice versa. Yet society’s notion of a healthy person is almost always a physical picture.

It is important to recognise that physical and mental health are closely related – and this is why we need to integrate mental health into all health services – treat the mind and body together, and thus the person as a whole.

Recognising the link between depression and physical health

Even when the term ‘health’ is inclusive of mental health, the general misconception that mental and physical health do not affect one another often remains. However, a person’s physical health can cause them to suffer mentally, and poor mental health can manifest itself into physical symptoms. Nearly 30% of all people who suffer from long-term physical ill health also suffer from mental ill health, of which the most common conditions are depression and anxiety.

For example, depression and anxiety are linked with higher rates of mortality from cancer. There is also evidence to suggest that people who are living with both depression and diabetes are more likely to experience more diabetic symptoms than people with diabetes who do not have depression.

Yet, despite these strong mutual impacts, depression that comes with chronic physical illness is likely to be missed by healthcare professionals, because the emphasis is typically on the physical illness. A reason for this may be that a physical illness is easier to see, diagnose and treat than depression. However, it is important to recognise and appropriately manage depression as well. Not doing so can seriously affect a person’s physical as well as mental recovery, regardless of their original diagnosis.

Redefining primary healthcare

A key rationale for integrated mental health services is that they can help address mental ill health in primary care settings. Current mental health services are mostly aimed at secondary acute care, coming into play only after a person has already been impacted by their symptoms. In addition to this not being best for the person seeking care, it can also place significant burden on already strained health systems. This is not a sustainable financial model for operating mental health services.

We need to redefine primary care to include stronger preventive mental healthcare. Primary care practitioners can be given the necessary training and tools to recognise symptoms, provide care and refer to specialists as needed. It’s not just about having guidelines for primary care; it’s also necessary to ensure that all relevant professionals have the proper training to raise awareness of the need to address mental ill health at the first level of care.

There are many reasons why integrated primary mental healthcare is useful. This includes the decrease of stigma related to mental ill health. Stigma sets the tone that people with depression are uninterested and difficult to talk to, and can make people feel hesitant to seek help. People affected by depression may also be averse to the term ‘mental illness’ and using different terms, such as ‘wellness’, can help to better engage them. By integrating mental health with other services, it can help to alleviate stigma, normalise mental health as an integral component of well-being, and improve access to care and quality of life as a result.

An integrated healthcare system can help ensure that people at risk of, or with depression receive preventive and timely care. It also means that they can obtain the necessary referrals without having to jump through hoops. This benefits not only the individual but also healthcare providers and the system, leading to fewer people falling through the gaps and a reduced burden on urgent care.