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Mental Health System 'Close to Fracture'

Joe Cantlupe, for HealthLeaders Media, July 7, 2011

Adding to the debate, a study reported in Health Affairs shows that mentally ill people may face "barriers" to receiving elective surgical procedures as a result of societal stigma and the cognitive, behavioral and interpersonal deficits associated with mental illness. Some of those barriers include the attitudes of the treating physicians, Yue Li, an assistant professor in the Department of Internal Medicine at the University of Iowa in Iowa City told me the other day.

Those disparities, he says, could be linked to communication difficulties as well as negative attitudes on the part of the physicians. So when medical issues revolve around people with mental illness who have physical conditions, patients can be shortchanged in the process. Li and his colleagues write in Health Affairs that mentally ill people are up to 70% less likely than others to receive high cost surgeries like hip and joint replacements, pacemakers, and other organ transplants, which often require referrals from physicians

As a result, Li says these patients are at a "heightened risk" for developing medical morbidities such as coronary heart disease, compared to other patients. In addition, mentally ill patients may have poorer outcomes following treatment of their medical conditions.

As Li sees it, the mental issues often conflict with the physical issues, and sometimes physicians have trouble ensuring that the mental aspect of care is fully covered.

The actual "presence of mental and behavioral abnormalities could complicate the physicians' referring decisions by distracting attention away" from the physical issues, Li writes. And that has a snowball effect, leading to a "negative attitude on the part of the referring physician," he says.

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