Breaking a toxic relationship: The role nursing can play in helping patients with co-occurring mental illness and chronic disease

Friday, May 6, 2016

The mental health burden in Australia is significant and it is growing.

The National Mental Health Commission’s 2014 report Contributing lives, thriving communities1 , clearly sets out the burden associated with mental ill health, in terms of health outcome, quality of life, cooccurring illness, death and disability. Mental ill-health impacts on individuals, families and communities; and poses significant economic and social cost to the nation, with estimates in the vicinity of $40 billion a year or approximately 2% of GDP. These costs are projected to increase significantly, particularly as the population ages.

There is a well-documented but complex reciprocal relationship between chronic disease and mental health, which can represent challenges for nurses in terms of recognition and management. Many physical health conditions increase the risk of mental illness and poor mental health is known to increase the risk of diseases such as heart disease, diabetes, stroke and cancer (for example, depression as a risk factor for the development of heart disease is of a similar magnitude as smoking). Co-morbidity of physical illness and mental health issues impacts on whether people seek help, their diagnosis and their treatment. It also impacts on their physical and mental recovery2 , because it can reduce a person’s capacity to optimally self manage chronic disease, increase the burden of symptoms of the disease, and create additional functional impairment. Co-occurring mental illness and chronic disease also affects longer term health outcomes, morbidity and mortality e.g. patterns of depression predict mortality in people who have had a cardiac event up to 12 years after that event.

People with cancer who are depressed and/or anxious have a poorer quality of life, are less committed to treatment and have a diminished will to live. Half of all patients with terminal or advanced cancer suffer poor mental health and death rates are as much as 25% higher in cancer patients who are experiencing depressed moods and 39% higher in cancer patients who receive a diagnosis of clinical depression. Despite the fact that treatment for depression could improve a person’s quality of life and prolong life, less than half of cancer patients receive treatment for depression.

Conversely, people with mental illness experience poorer physical health and higher morbidity and mortality as a result of their poor physical health than people in the general population. This is evidenced by the fact that they die much earlier than the rest of the population — around 15 years earlier for women and around 20 years earlier for men34 — and for some groups of people, for example those diagnosed with of schizophrenia and cardiovascular disease, death rates are two to three times higher than in the general population5 .

The practice of nursing is frequently described as ‘holistic’ — in theory, this means we are addressing the mind, body and spirit. However, it is clear that the physical health needs of people with mental illness are often neglected6 and that the mental health needs of people with physical illness are also frequently ignored. This is an issue that the profession of nursing needs to address.

Every nurse will be working with clients who are at risk of developing, are developing, or are having early signs and symptoms, of mental health issue.7 As such, all nurses, regardless of clinical practice area need to identify those at risk of developing mental health issues and provide emotional support for people experiencing physical illness. For example, nurses working in cardiac care need to be able to identify the ‘Cardiac Blues’ (shock, denial, worry, guilt, anger, sadness and grief) which are common and normal in people who have experienced a cardiac event (see the Heart Research Centre) and differentiate this from depression, which is not. Similarly, nurses working with people who have mental illness need to ensure that clients are receiving the same level of physical health care (including health promotion, screening and early intervention) as all other Australians.

People with chronic disease want nurses to ask about their emotional wellbeing and to listen to what they are saying. People with mental illness want nurses to ask about their physical health and to take them seriously when they are experiencing physical symptoms. Regardless of whether the mental illness or the chronic disease is the primary diagnosis, physical health outcomes are better when a person’s mental health needs are addressed and worse when they are not, and it is our role as nurses to ensure our practice is truly holistic and to address both the physical and mental health domains for improved client wellbeing.

Nurses who are interested in undertaking free eLearning modules addressing mental health as it presents in chronic illness are invited to visit the Australian College of Mental Health Nurses professional development portal

This article was written by ACMHN Professional Development Manager Peta Marks for the April 2016 edition of The Health Advocate. To access all editions of The Health Advocate, click here.