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Mind The Gap: How Descartes' Philosophy Is Hurting Healthcare

27/01/2017 11:56

It's fair to say that most of us don't consider René Descartes to play an important role in our day-to-day lives. Yes, he gave us 'I think therefore I am' in a misquoted sort of a way, and in the 17th century he meditated extensively on what we can - rationally - know, but his philosophy doesn't seem to bear much relation to the 'real world' he was so concerned about understanding.

That is, of course, until you look at our healthcare system, where Cartesian thinking has led the charge on the treatment of physical and mental health, often to the detriment of patients with complex medical needs.

Chronic Illness

Across England, around 15 million people - myself included - live with at least one long-term health condition. A long-term or 'chronic' condition can mean a whole host of things, from diabetes to fibromyalgia, and from neurological illnesses to muscle-wasting diseases. Because of this, the experience of people living with chronic illness also varies widely, from severe disability to minor inconvenience, and everything in-between.

But despite the high prevalence and wide breadth of chronic illnesses, western healthcare systems still struggle to provide the appropriate care for patients like me. In particular, the link between chronic illness and mental health problems is often widely ignored, and poorly treated.

Mind and Body

"The problem we have in healthcare today, which is very similar across the western world, is that we end up having a Cartesian split between physical and mental health support," says Dr Sean Cross, the Clinical Director of the Mind and Body Programme at King's Health Partners.

"[Mental and physical health] are commissioned for separately, delivered separately, and educated for separately. As a result, patients can often fall between the cracks, with either physical or mental health treatment being poorly served".

Thankfully, since the 17th century when Descartes claimed the mind and body were two separate entities, our knowledge has moved on. Statistics collated by the King's Fund and Centre for Mental Health, reveal that 46% of people with a mental health problem also have at least one other long-term physical condition. People with chronic illnesses are also 2 - 3 times more likely to experience mental health problems than those who are able-bodied, with depression and anxiety disorders being particularly common.

Charity Support

These statistics are echoed in the daily reality of healthcare charities across the country, including Muscular Dystrophy UK, who have set up their own Bridging the Gap team to try and address the gap in care. Their research shows that of the 48 neuromuscular teams currently operating in the UK, there are only 7 neuromuscular psychologists working within them.

This means that if someone has a neuromuscular condition and is also struggling with their mental health, they are often referred to general psychology, where they face long NHS waiting lists and a referral to a psychologist who doesn't fully understand their illness. The impact this has on patient wellbeing can't be underestimated.

Last year, the charity responded to more than 25,000 requests for support through their Care and Support team. As a result, they are calling for organisations like the Royal College of Psychiatrists to work more closely with healthcare charities, to ensure chronically ill patients receive better mental health support.

A new approach to combined care is also being trialled by Dr Cross and his team in South London:

"Our Mind and Body Programme is trying to provide better integration of mental and physical healthcare for patients. Although patients often don't talk about it in these terms, what they'll often ask is for their healthcare to be 'joined up' - for their mental health needs to be taken into consideration when they're discussing chronic pain, for instance".

NHS Spending

The divide between mental and physical healthcare isn't just an issues for patients, but for NHS spending as well. Co-existing physical and mental health problems lead to increased hospitalisation rates, increased outpatient use, increased mortality rates, and more time off work for those affected.

Overall, £1 in every £8 spent by the NHS on long-term conditions is linked to poor mental health, which is about £8 - 13 billion of NHS spending every year. Dr Cross believes that it's this economic argument, more than anything else, that has the potential to drive a change in culture.

"There's so much separated work going on at the moment, and it's so widely accepted that - for instance - a consultant in an acute hospital won't need to consider a patient's mental health, that patients don't even expect them to ask.

"But if you can improve adherence with medication, or reduce the amount of unscheduled inpatient care because people are looking after themselves better, then you start to free up a lot of money because budgets aren't so stretched. That is what happens when chronically ill patients are properly supported with their mental health".

Redesigning Healthcare

Recommendations for integrated care have been prevalent throughout the healthcare system for years. Unfortunately, without funding being ring-fenced for integrated physical and mental health support, and without a change in the expectations of doctors and nurses, who currently aren't trained in a 'whole-person' approach to care, systems similar to the Mind and Body programme simply can't be rolled out nationwide.

But despite how far away it may be, Dr Cross does believe that it's possible for people with chronic physical health problems to receive psychological support as a standard part of their care:

"What I'd like to see is for our patient group - everybody - to have higher expectations when they come in front of a healthcare professional, and I want every healthcare professional to think it's absolutely normal that they need to think about this person's mental and physical wellbeing in tandem, depending on where they are in the care pathway."

It seems obvious that if someone is unwell for a large portion of their lives then their mental health will suffer. But thanks to the Cartesian notion that says mental health doesn't interact with physical health, our western support systems are built on a false premise. Sadly, it's often the patients with the most complex needs, who are let down the most drastically by our archaic approach to healthcare.

You can find out more about the Mind and Body Programme here

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