Doc Talk: Psychiatric problems are a source of suffering
08/20/2012 11:45 PM
08/08/2014 10:11 AM
Throughout the world, psychiatric problems are among the most common medical problems. In fact, psychiatric disorders account for five of the top 10 causes of suffering for all ages in the world. Many of these disorders last a long time or reoccur.
In the U.S., door-to-door surveys reveal that 44 percent of Americans will meet criteria for a psychiatric diagnosis in their lifetimes, but the majority of them are never diagnosed or treated. Fifty percent of all psychiatric disorders start by age 14, 75 percent by age 24. No other area of medicine affects so many people during so long a period.
Suicide is in a close tie with homicide to be the No. 2 cause of death in youth ages 10 to 25. Only accidents kill more youth than suicide. If you eliminate accidents and homicide, suicide kills more youth than all other medical causes combined (cancer, cardiovascular, gastrointestinal, pulmonary, neurological). This is a quiet epidemic with very little public awareness. Many psychiatric illnesses have a 10 to 20 percent mortality rate from suicide.
People with psychiatric illness, on average, have a 20- to 25-years shorter life expectancy. These early deaths are related not only to suicide but also to cardiovascular diseases and other problems related to poor access to primary health care.
Psychiatric disorders can worsen the prognosis of other disorders. Unnecessary tests and procedures that result when psychiatric disorders are not diagnosed early cause increased health care spending and suffering related to these often invasive tests.
The good news is that psychiatric illnesses are highly treatable. If people will engage in treatment, they usually get better. To date, we cannot advertise cures — but we can show that our outcomes rival other areas of medicine.
There have been some concerns about the safety of psychiatric medications. However, they have risks similar to antibiotics. If you have the need for them, no one should be overly concerned about using them.
People are safer on psychiatric medications than when untreated. In fact, once a person is engaged in almost any type of treatment, his or her risk for suicide dramatically decreases. Treating not only decreases suicide and direct suffering from the disorders, but it also decreases costs related to missed work or school.
Lack of access to care is the major problem, here and across the nation. It is obvious that there are not enough child and adolescent psychiatrists to care for these patients. We are working on some collaborative care models where psychiatric professionals support primary care clinicians in providing good quality care for more people. In the future, we plan to offer a variety of supports for primary care clinicians to help improve care for these youth.
Lack of training on psychiatric problems is very common in primary care residencies, despite the fact that when surveyed, practicing primary care doctors have repeatedly stated it is in this area that they are most in need of additional training and help. Collaboration is key. Early involvement of psychiatric professionals in a collaborative care model can improve the outcomes of psychiatric and other medical disorders. Involving them in treating other medical conditions can mean the difference between good care and world-class care.