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LISTEN ACKNOWLEDGE RESPOND “MIND THE GAP” TREATMENT GAP Responding to the Mental Health concerns of people living with an advanced chronic and terminal illness and their family and care givers The LAR project has been funded by the Commonwealth Government under the Public Health Chronic Disease and Palliative Care Program. “MIND THE GAP” THE TREATMENT GAP A simple definition of the Treatment Gap: is the number of people with an illness, disease or disorder who need treatment but who do not get it. (Rajendra Kale, The Treatment Gap. Epilepsia Vol 43, Issue Supplement S6 pg 31-33,July 2002) “MIND THE GAP” Mental disorders are highly prevalent and cause considerable suffering and disease burden. To compound this public health problem many individuals with psychiatric disorders remain untreated although effective treatment exists… The Treatment Gap (Kohn,R. et al The treatment gap in mental health care. Bulletin: World Health Organ vol 82 n.1 “MIND THE GAP” Having a life limiting illness does not preclude the possibility of having a pre-existing mental illness or one developing as a result of the psychological impact of the diagnosis or the prognosis “MIND THE GAP” Whilst mental illness does not threaten life or decrease life expectancy of itself, it can have a severe impact on a person’s health and wellbeing “MIND THE GAP” Traditional mental health responses and mental health systems may not work quickly enough to be of primary therapeutic value for patients with life limiting illness coping with limited and uncertain life expectancy. Delivering an evidence based therapeutic response to this population group needs specialised training and understanding that takes into account the impacts of chronic illness and treatments. “MIND THE GAP” Depressed people were particularly at high risk of suicide ideation and are four times more likely to report a high desire for hastened death than those who were not diagnosed with major depression Hopelessness is significantly related to suicide ideation and is a stronger predictor than severity of depression Pre existing psychiatric issues/ disorders increases the risk for hastened death and suicide ideation “MIND THE GAP” A diagnosis of mental illness in people with a life limiting illness cannot be treated separately from the nature and impact of the person’s illness and the reactions of the family and care givers to the realisation of impending death and bereavement “MIND THE GAP” Chronic illness makes up more than 70% of Australia’s overall disease burden1. Chronic mental illness is estimated to effect one in five Australians,2 and is defined as mental illness that lasts for 12 months or more. There is growing concern about the impact that a co-morbid mental illness can have on the patient approaching end of life Ref: Vos T, Goss J, Begg S, Mann N. Australian burden of disease and injury study: projected health care costs report. Brisbane: University of Queensland and Australian Insitute of Health and Welfare; 2005. “MIND THE GAP” For those patients with heightened symptoms of their mental illness such as delirium, delusions, and hallucinations - specialist psychological support and care is critical when receiving palliative care. Ref: Vos T, Goss J, Begg S, Mann N. Australian burden of disease and injury study: projected health care costs report. Brisbane: University of Queensland and Australian Insitute of Health and Welfare; 2005. “MIND THE GAP” Individuals with a serious mental illness are: • at greater risk of poorer physiological health and increased mortality. A person’s negative belief about their mental health is known to be significantly predictive of a poor physical health outcome. People with mental illness are also less likely to seek regular check-ups and less likely to report early symptoms to a medical practitioner often resulting in a diagnosis not being made until the disease state has become terminal Ref: Baker A. Palliative and end-of-life care in the serious and persistently mentally ill population. Am Psychiatr Nurs Assoc 2005;11: 398–03. Scott D, Happell B. The high prevalence of poor physical health and unhealthy lifestyle behaviours in individuals with severe mental illness. Issues Ment Health Nurs 2011;32(9):589–97. Lobban F, Barrowclough C, Jones S. The impact of beliefs about mental health problems and coping on outcome in schizophrenia. Psychol Med 2004;34:1165–76. Disability Rights Commission. Equal treatment: closing the gap. A formal investigation into physical health inequalities experienced by people with learning disabilities and/or mental health problems. 2006. “MIND THE GAP” Mental illness complicates many normal interpersonal and cognitive functions and some patients with a serious mental illness will also have reduced insight and comprehension. Patients may also be dealing with the effects of psychotherapeutic medications, such as anti-psychotic, anti-depressant, and anti-mania drugs. The symptoms of the mental illness and the treatment regime, when mixed with the symptoms of the life-limiting illness and its treatment regime, create a psycho/physiological state that is difficult to exist in for the patient, The care of a person who is dying and who has a serious and is equally complicated for the clinician. and persistent mental illness requires a different approach, which not only meets the person’s current needs, but also anticipates future mental health needs that may manifest as a result of a life-limiting diagnosis.4 “MIND THE GAP” What about families and care givers? Families/carers of people with a MH issue - may have spent lifetime co-existing with their loved one’s mental illness – this can create considerable social and familial challenges. While many take on the role of carer because there is a societal expectation that they do so their desire/willingness to continue in this role now that the person is dying from a physiological illness may not be so clear cut, needs to be determined. Aoun S, Kristjanson L, Currow D, Hudson P. Caregiving for the terminally ill: at what cost? Palliat Med 2005;7:551–5. Rowe J. Great expectations: a systematic review of the literature on the role of family carers in severe mental illness, and their relationships and engagement with professionals. J Psychiatr Ment Health Nurs 2012;19(1):70–82. “MIND THE GAP” MENTAL HEALTH COMMISSION… Even the most disadvantaged Australians should be able to lead a ‘contributing life’, whatever that means for them … Prof Allan Fels AO Chair: National Mental Health Commission (2015) “MIND THE GAP” Why should we do this? The National Mental Health Commission stated in their 2015 National Mental Health Survey… “people with a MH conditions were twice as likely than those that didn’t have a MH condition to develop a serious chronic illness and to die earlier form the disease”. “People with chronic illness were twice as likely than people without a chronic illness to develop a MH condition or psychological distress.” “MIND THE GAP” People with a terminal illness deserve to live a “Contributing Life” as defined by the MH Commission "When we talk about a contributing life, we mean a fulfilling life - recognising that those people who live with mental health difficulties want and need the same things as everyone else.“ Prof Allan Fels. AO. Chair - National MH Commission “MIND THE GAP” REFERENCES Contributing lives, thriving communites – Review of Mental Health Programmes and Services http://www.mentalhealthcommission.gov.au/our-reports/contributing-lives,-thrivingcommunities- review-of-mental-health-programmes-and-services.aspx Davies, J., A Manual of Mental Health Care In General Practice. National Mental Health Strategy Comm Dept of Health & Aged Care 2000. ISBN 0 642 41587 0 http://www.health.gov.au/hsdd/mentalhe Kale, R., The Treatment Gap. Epilepsia Volume 43, issue Supplement s6, pages31-33, July 2002 http://onlinelibrary.wiley.com/doi/10.1046/j.1528-1157.43.s.6.13.x/full Kohn,R., Saxena, S., Levav, I., & Saraceno, B., The treatment gap in mental health care. Bull World Health Organ vol 82 n.11 Genebra Nov. 2004 http://dx.doi.org/10.1590/S0042- 96862004001100011 http://www.who.int/bulletin/volumes/82/11/en/858.pdf “MIND THE GAP”