Wednesday, November 04, 2009

Mental Health Problem Under Diagnosed - bernama

Mental Health Problems Under Diagnosed
By Soraya Jamal

KUALA LUMPUR, Oct 29 (Bernama) -- About 450 million people worldwide suffer from some sort of mental illness such as depression, schizophrenia and bipolar disorder but fewer than half receive the help they need, according to World Health Organisation(WHO).

WHO also estimated that by 2020, mental illness could comprise 15 percent of global disease.

Mental health disorders are more common than you think. Last year, 400,227 patients sought psychiatric help in Malaysian government hospitals, a 15.6 percent increase from 346,196 patients in 2007.

The Third National Health and Morbidity Survey in 2006 indicated mental health disorders among teenagers as increasing.

Females are also more prone to mental health problems at 12.1 percent compared with 10.4 percent for males.

Five out of 10 leading causes of disability are related to mental illnesses. Major depression is fourth most disabling disease in the world and is expected to be the second leading cause of disability worldwide by 2020.


Despite being a common and serious problem, mental health is still not widely accepted as critical public health problem and often under diagnosed by primary care specialists.

The ASEAN Federation for Psychiatry and Mental Health (AFPMH) president, Professor Dr Mohamad Hussain Habil said this is mainly attributed to two factors.

First is the lack of knowledge or understanding in diagnosing or treating the ailment while the second factor is directly related to the stigma associated with mental health disorders that is rife even amongst the medical practitioners.

Early detection in the community by primary care specialists can yield numerous benefits relating to costs and productivity, and in some cases preventing the problem from becoming full-blown disorder.

According to the report of the National Advisory Mental Health Council, treatment outcomes for people with even the most serious mental illness are comparable to outcomes for well-established general medical or surgical treatments for other chronic diseases.

The early treatment success rates for mental illnesses are 60-80 percent, well above the 40 to 60 percent success rates for common surgical treatments for heart disease.

For individuals who have mental health problems, not getting the help that they need can cause social distress as it can lead to isolation and cause strain on their finances as they keep on seeking medical opinions or consultations, not to mention loss of job due to reduced productivity.

Struggling with the situation also diminishes the patients' and caregivers' quality of life. Even worse, under diagnosis can end tragically if patients commit suicide.


AFPMH and the Malaysian Psychiatry Association (MPA) commemorated the 2009 World Mental Health Day on October 9 by addressing the important role of primary care specialists in identifying and treating psychiatric disorders.

This year's theme is "Mental Health in Primary Care; Enhancing Treatment and Promoting Mental Health".

Many people will not think of consulting a psychiatrist as most will not even consider that they have a mental health issue. And those who do are generally too embarrassed to visit a mental health specialist and often more at ease with their neighbourhood doctors.

These primary care specialists are the front liners of the public health care system and are familiar with their patients' medical history. Therefore the need to be well equipped to identify the symptoms and have the necessary knowledge in psychiatry to administer treatment," Professor Dr Mohamad Hussain said in a press conference recently.

Professor Dr Mohamad Hussain, who is also Addiction Specialist and Consultant Psychiatrist at the Department of Psychological Medicine, Universiti Malaya Medical Centre, said early detection and proper diagnosis enable patients to receive appropriate treatment.

It also prevents more debilitating disorders and ultimately enables the patient to continue with a normal life and integrate with society while undergoing treatment, he said.


Professor Dr Mohamad Hussain also said, there are only 200 psychiatrists in Malaysia while the ideal number is 2000.

"An integrated collaborative approach involving primary care specialist will lessen the burden faced by psychiatrists and provide patients, especially those from the low-income group affordable and accessible treatment.

"This approach ensures that patients do not have to travel far to get their medication from psychiatrists, which considerably reduces the burden on their caregivers," he said.

Primary care specialist must realise that psychiatric patients deserve access to the best form of treatment and at the same level of priority within the primary health care system alongside other medical disorders such as heart disease, diabetes and cancer.

Despite the fact that mental and physical health is highly interconnected, mental health issues have been treated more of social issue, he said.


Stigma that persists amongst the public and even primary care specialists is the greatest barrier to successful treatment leading to many psychiatric cases being undetected and untreated.

"Psychiatry has come a long way. The latest medications make mental disorders highly treatable. However many still refuse to seek professional help because they fear being labeled as 'crazy' and being discriminated if they are diagnosed with a mental illness," noted President of MPA Dr Yen Tech Hoe.

This issue is further compounded when some primary care specialists also subscribe to this misconception and consider mental health issues a less important component of the medical profession.

Many primary care specialists are unaware that most psychiatric illnesses can be presented through physical symptoms and they usually treat the pain without further examination.

This low awareness of mental health in primary care setting brought on by a lack of interest amongst primary care specialist to acquire latest knowledge and clinical skills in psychiatry, said Dr Yen.

"When patients express or exhibit psychiatric symptoms such as feeling unusually lethargic or sad, having poor concentration or loss in appetite, primary care specialist tend to disregard this signs," added Dr Yen.


Mental illnesses usually occur alongside chronic disorders such as heart disease, diabetes, cancer and stroke, highlighting the significant co-morbidity of mental and physical disorders.

Research has shown that patients with severe mental illnesses are often twice as likely to have multiple physical health problems. Untreated psychiatric symptoms can worsen the pain and exacerbate psychiatric and medical outcomes as well as prolong the years of unnecessary suffering, said Dr Yen.

Many primary care specialist also believe it is difficult and time consuming to treat mental health patients who are then referred to psychiatrists.

"Many mental health can be diagnosed and treated effectively at the primary care level. Early detection and treatment can also help minimise the problem while enhancing the potential for recovery and productivity," he said.

Dr Yen said for every dollar spent on treating mental illness, the outcome is much better than any other illness especially since the treatment available is very good.


Meanwhile, Associate Professor, Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Dr Noor Zurani Md Haris Robson said a proactive and mutual commitment by the government, non-governmental organisations, families, caregivers and medical fraternity including nurses and paramedical staffs, were vital in facilitating the integration of effective mental health services in primary care environment.

"The government should develop a framework that advocates the need to incorporate primary care for mental health. Psychiatry, like other fields in medicine is constantly evolving and we need to train and educate primary care specialist in order for them to gain better understanding of mental health problems.

I believe there are many primary care specialists who are interested in treating psychiatric patients and we should offer them the opportunity to get the latest updates on the developing areas in psychiatry. These can be achieved through continuing medical education programmes," she said.

Dr Noor Zurani said primary care doctors play a central role in treating mental health disorders such as depression and anxiety.

Continuous communication between primary care specialists and psychiatrists are essential in avoiding any misunderstandings when coordinating treatment for patients with severe mental health illnesses.

The patients' well-being should be the underlying concern and both parties must be willing to share information and understand each other's role in treating patients.


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