Comment Blog 13 February, 2019

Beyond ‘Blue Monday’: Why the divide between mental and physical health is artificial and unhelpful

Pressures on NHS hospitals during the winter have become a staple of media concern and political anxiety in recent decades. Fears about the impact of flu epidemics or very cold weather stalk health policymakers, not just in winter but all year round as the NHS and its partners seek to avoid getting overwhelmed.

One area of the NHS that does not experience the same seasonal variations in need or demand is mental health services. While much is made every January of so-called ‘Blue Monday’, mental health difficulties can affect people at any time of the year and the triggers for emotional and psychological distress tend to be quite different.

But could the NHS, if it was more cognisant of the impact of mental health on the wider health and care system, weather the storm of winter pressures a little more easily?

There is a growing realisation in both mental and physical health services that the separation of body and mind that has been perpetuated for centuries may in fact be both artificial and unhelpful. It is now clear that our mental and physical health are inextricable: that difficulties with one often affect the other, and that people with the most serious and ongoing health needs very often have problems with both.

Having a long-term physical condition, for example, doubles our risk of experiencing depression. And if someone with a long-term condition also has a mental health problem, they are likely to experience more ill health, more complications, more hospital admissions and an earlier death. The cost of (mostly unnoticed, let alone treated) poor mental health among people with long-term conditions is estimated nationally to be around £10 billion: close to £1 in every £10 of NHS spending.

We also know that people living with long-term mental health problems have much poorer physical health than average. A person living with schizophrenia can expect to live for 15-20 years fewer than average, most of which is a result of poor physical health. People living with a severe mental illness have higher rates of almost all long-term physical health problems as well, yet until recently these were barely recognised by the NHS and seldom treated.

In each case, the pernicious links between poor mental health and poor physical health contribute to a situation where health care costs (and pressures) rise while people’s quality of life suffers. Taking effective action to address these issues could help to reduce costs, improve lives and give the NHS a little more breathing space. For people with long-term conditions, this could include offering emotional support when it’s needed, more actively enquiring about wellbeing and providing structured support for those with the most complex needs. For people with mental health problems, it could include help with diet and physical activity, shared decision-making about medications with known effects on physical health, and tailored help with smoking cessation.

But to make a really big impact, we also need to look for much longer term solutions. There is growing evidence that our psychological wellbeing early in life has a profound impact on everything that follows, including both mental and physical health. And poor mental health during childhood is strongly related to economic and social inequalities. So investing in local authorities to take effective action in communities to prevent poor mental health, and developing policies nationally that will reduce risk factors such as poverty, homelessness and discrimination, will in time make a marked impact.

There is growing acknowledgement that for too long health policy has prioritised physical over mental health, health care over social care and treatment over prevention. The arrival of Integrated Care Systems could bring about a sea change in this situation, or it could repeat the same patterns under a different guise. The challenge for the whole system will be to commit to rebalance itself and use resources very differently to bring about better health for the long term for everyone’s benefit.