The mind-body connection is powerful; one depends on the other for optimal existence and survival.  Most of us would not disagree with this statement.  Yet, until recently, our health care system has been designed in such a way that makes integration between mental health and physical health extremely difficult and cumbersome.

I have worked in the mental health field as a psychiatrist for almost a decade.  During this time, I have come to understand and appreciate the importance of treating both physical as well as psychological symptoms.  People with a mental illness often have concomitant medical illnesses that also need to be timely diagnosed and properly treated.  A recent research study has shown that people with psychotic disorders are significantly more likely than those without mental illness to have heart disease, asthma, gastrointestinal disorders, skin infections, acute respiratory disorders, diabetes, hypertension, or malignant neoplasms. Concomitant substance abuse adds to the risks for the first five of these eight conditions.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) wisely recognizes the important significance of mind and body connection.  It lists a myriad of mental disorders that are due to general medical conditions such as neurological disorders, brain tumors, infectious diseases, endocrine disorders, metabolic disorders, vitamin deficiency states, and substance abuse.

Research has also shown that people with psychiatric illnesses are at higher risk for the development of medical problems, and those with more severe psychiatric illnesses often encounter barriers to promoting good health and to obtaining good health care when co-morbid illnesses do occur.  In fact, the Emergency Department of a hospital is what many psychiatric patients rely on solely to receive their medical care, since routine access to a primary care provider (PCP) is often limited.  This lack of primary care access inevitably leads to worsening medical symptoms, which in turn lead to worsening psychiatric symptoms, and the vicious cycle continues.

This is why I believe that integration of primary care and mental health care is necessary, and crucial, for the well-being of our patients.  We all know that prevention, early detection, and timely treatment of medical illnesses have the best outcomes for the general population, and this is even more true for people with a mental illness.  We need to pay attention to and treat people as a whole.  The traditional and historic separation of physical and psychiatric healthcare is no longer meeting people’s needs.  Too many individuals with a serious mental illness suffer substantial physical illnesses and even premature death as a result of not receiving adequate medical care.

We need to bridge the gap between primary care and mental health care by improving bi-directional communications between psychiatrists and PCPs.  Prior to attributing a patient’s symptoms to psychiatric reasons, medical disorders must be investigated.  It is prudent to not only obtain a thorough psychiatric consultation but to also get a comprehensive physical examination with relevant blood tests from the primary care physician.

We need to work more collaboratively with colleagues across the different medical specialties, and to encourage formal consultations and better coordination of care among interdisciplinary teams.  Co-location of health services in either direction can also serve to improve patient access to care, hence bridging the gap even further.

With integrated primary care and mental health care, the quality of life for hundreds of millions of patients and their families can be improved.