It’s time to abandon mind-body duality in medicine: we need psychiatrists in hospitals and better physical care for psychiatric patients, says Simon Wessely
Why do you think psychiatry needs to be better integrated with general medicine?
In the UK, psychiatrists tend to work out of separate mental health hospitals. If the goal were to split physical and mental health, the National Health Service could not be organised better. Yet most illnesses are not so easily divided. And the evidence that psychological treatments can have an impact on physical disorders is growing.
Could you give an example?
Take heart attacks. What could be more perfectly physical? But depression actually has a greater influence than smoking on your chances of surviving the following 12 months. Also, in cardiac clinics, many people come in with what looks like heart disease but turns out to be panic attacks.
So what needs to change?
We need liaison psychiatrists, which basically means you have an embassy of psychiatry in the middle of the acute general hospital. It deals with all the kinds of psychological and social problems associated with a busy hospital: depression in people with cancer, for instance, dementia in old people or problems in the accident and emergency department (A&E).
Do many people who go to A&E have mental health issues?
As many as 30 to 40 per cent. And among those who are not seen within the NHS target of 4 hours, most have mental health problems. One of the reasons we have A&E crises is that we’ve had insufficient mental health services in general hospitals. Liaison psychiatry may help.
Is there any evidence this approach works?
In diabetes, a trial has shown that when you bring psychological treatments into the hospital, not only do you get better mental healthcare, you get better control of diabetes. That was unexpected.
Wouldn’t setting this up be costly?
Actually, it saves money. A recent study of a rapid-assessment psychiatric liaison service at City Hospital in Birmingham showed that, per year, it cost less than £1 million and saved £3.55 million through reduced bed use.
Is more liaison psychiatry the answer, then?
We have to think about fully integrating services. Where I work, there is the Maudsley psychiatric hospital on one side of the road and King’s College general hospital on the other. It’s like Cartesian dualism running down the road.
We’re putting better psychiatric services in at King’s, but we also want to get more physical care to those on the other side of the road, because we know that people with severe mental illness are dying much earlier than they should.
Are you optimistic this can happen?
Things are already changing. The number of liaison psychiatrists is increasing and junior doctors are getting more training in psychiatry. But we still need to do more to bring psychiatry into the heart of medicine, where it belongs.