Understanding emotional wellbeing and physical health care

Knowledge summaryThis knowledge summary provides an introduction to understanding emotional wellbeing and physical health care. It covers physiologically explainable symptoms, the impact of emotional wellbeing on physical health and physical care for people with severe mental illness.

The information presented here is adapted from fully referenced source material at Emotional Wellbeing.

Physiologically explainable symptoms

Physical symptoms which are not caused by physical disease or injury are very common, and can become very distressing and disabling.

Commonly people present and re-present to primary care or emergency departments because of concern that these physical symptoms may be caused by a physical disease.

19 per cent of new primary care GP appointments, especially frequent attenders, were found to be for people whose symptoms were previously described as ‘medically unexplained’ (MUS) but may be better described as physiologically explainable 1-2.

In secondary care (physical health trusts/services), a number of studies in both the UK and the United States have shown that up to 50 per cent of sequential new attenders at outpatient services have MUS.

Estimated cost to the NHS associated with PES (‘MUS’) of £3.1 billion 3. However, about half the cost (£1.2 billion) was spent on the inpatient care of less than 10 per cent of people with PES (‘MUS’) – a relatively small number of people receive very expensive and inappropriate care.

What works

  • Primary care interventions focus on the consultation style adopted by professionals rather than defined psychological interventions
  • Specialist services where persistent symptoms present are more successful where they focus on specific syndromes, e.g. chronic fatigue syndrome or irritable bowel syndrome.
  • Liaison teams provide multidisciplinary care for patients presenting with more complex problems including associated high levels of disability and high levels of distress

Useful resources

The impact of emotional wellbeing on physical health

25% of GP’s patients will need treatment for mental health problems at any time 4.

Best practice in primary care involves a multi-professional approach to patient care provided by a case manager working with the family doctor under weekly supervision from specialist mental health medical and psychological therapies clinicians.

At least 25% of patients with a physical illness admitted to hospital also have a diagnosable mental health condition.

Best practice in secondary care involves liaison psychiatry services that are often based in general hospitals, but increasingly work with primary care in the management of comorbid medical and psychiatric illnesses.

Useful resources

Physical care for people with severe mental illness

Having a severe mental health illness increases the risk of physical ill health.

There is a high incidence of cardiovascular disease (CVD) causing premature death in people with severe mental illness (15 years for bipolar disorder and 25 years for schizophrenia). This is largely due to a combination of lifestyle factors and the side-effects of antipsychotic medication.

In people with severe mental health problems, there is increased occurrence of:

  • Diabetes (prevalence of, at least, 15 per cent in people with schizophrenia, 5 per cent in the general population)
  • Cardiovascular disease
  • Hyperlipidaemia
  • Chronic obstructive pulmonary disease (COPD)
  • Bowel cancer
  • Venous thrombosis and pulmonary emboli

What works

  • NICE clinical guidelines for schizophrenia and bipolar disorders 5-6 include recommendations for physical healthcare, and within regular case reviews, community mental health services are expected to ensure access to regular physical health checks and healthcare.
  • Primary care management of ‘active monitoring’ and positive diagnosis, management of common mental health problems, guided self-help strategies and programmes, motivational interviewing.
  • A comprehensive physical health check carried out by a competent practitioner will also provide the opportunity to offer education regarding lifestyle and ask about other physical conditions.
  • Psychological interventions at the primary / secondary care interface, including integrated / stepped / collaborative care models with planned and coordinated care, interdisciplinary working and clear access points to services.

Useful resources

References

1. Nimnuan C., et al (2001) Medically unexplained symptoms: An epidemiological study in seven specialities. Journal of Psychosomatic Research 2001;51(1):361-67. https://www.ncbi.nlm.nih.gov/pubmed/11448704

2. Peveler R., et al (1997) Medically unexplained physical symptoms in primary care: a comparison of self-report screening questionnaires and clinical opinion. Journal of Psychosomatic Research 1997;47(3):245-52. https://www.ncbi.nlm.nih.gov/pubmed/9130181.

3. Bermingham, et al. (2010) The cost of somatisation among the working age population in England for the year 2008-2009. Mental Health in Family Medicine 2010;7(2):71-84.

4. Joint Commissioning Panel for Mental Health (2012) Guidance for commissioners of primary mental health care services. London: The Royal College of Psychiatrists. www.jcpmh.info/good-services/primary-mental-health-services/

5. National Institute for Health and Care Excellence (2006) Clinical Guideline 38: The management of bipolar disorder in adults, children and adolescents, in primary and secondary carer. London: National Institute for Health and Care Excellence. www.nice.org.uk/cg38.

6. National Institute for Health and Care Excellence (2009) Clinical Guideline 82: Core interventions in the treatment and management of schizophrenia in primary and secondary care. London: National Institute for Health and Care Excellence. www.nice.org.uk/cg82.