The title is entangled, but it is worth delaying and analyzing it: "Management of physical health conditions in adults with severe mental disorders". This is the first guide of the World Health Organization (WHO) on this matter, presented this week and which offers an original cut in the approach to mental health. Because the guide is not focused on the most obvious, ie, the specific characteristics of this or that psychic condition, but it delves into accessory pathologies, those that pre-exist or, conversely, come hand in hand with mental illness. Those that redouble the patient's problem because they put their physical health in check and make the average mortality, for them, two to three times higher than in the general population. Smoking, tendency to obesity and more chances of heart disease are some of the problems that fall on the shoulders of those who suffer from mental illness, have moderate to severe depression, bipolar disorder, schizophrenia or other psychotic disorders. They are not a pair: these pathologies account for 14% of diseases globally, a percentage that, says the WHO, "is increasing."
In Argentina it is a subject. The Directorate of Mental Health of the Secretariat of Health of the Nation shared with Clarín the "National Epidemiological Study of Mental Health in General Population in Argentina", of 2015. Then, no less than one in three people had presented a health disorder mental throughout his life, since he was 20 years old. The prevalent ones were psychosocial: 16.4%, anxiety; 12.3%, mood disorders; 10.4%, substance use. Of the total, only 16% agreed to a treatment.
66% of people with severe mental disorders smoke.
In the social imaginary floats the idea that these people tend to die from "unnatural" causes: accidents, homicides and suicides. The WHO report demystifies it: "The majority of deaths are attributable to physical health conditions." A blunt data? Cardiovascular diseases confer a ten times greater risk of death than suicide in people with mental problems. What is the link between a mental disorder and, for example, heart disease? Experts know that the bridge between mental disorder and "noncommunicable diseases" (ENT) is there, like a transparent thread that does not finish revealing its material, which in the guide they define as a "complex" relationship.
But the numbers speak for themselves, says the WHO: "From an epidemiological point of view, the mental disorder itself is a well-known risk factor for NCDs." These people are added the risk 1.53 times greater than have cardiovascular diseases, and 1.85 times greater than death caused by one of those pathologies, also, a 1.85 times higher risk of having diabetes than the general population ". In addition, 61% of patients with mental disorders smoke, almost double the general average (33%) and 50% are more likely to suffer from obesity.The most critical point may be that of public policy, a message that flies over the entire WHO guide, since the severe mental condition It leads to worse access to health systems. In dialogue with Clarín, Shekhar Saxena, the former director of Mental Health and Substance Abuse of that agency, explained that "access to mental health, as well as to physical health services for people with illness Mental illnesses are particularly deficient in all countries, including Argentina. "All falls into a" lack ", a lack in all orders, said the expert:" Lack of information about their needs, lack of adequate and adequate services, Stigma, discrimination and fear among family and caregivers. But perhaps the most important reason is the lack of resources. Governments spend much less money on mental health; often less than 1% of their health budget, while needs are around 10%. "The consequences:" lack of adequate training for health care providers, lack of medication and time for psychosocial interventions, which has serious consequences for people with serious mental disorders, who usually die 10 to 20 years earlier than other people. "
The WHO Guide delves into the interaction of psychiatric medications with those to treat noncommunicable diseases.
In the same vein, Alberto Trímboli, President of the World Federation for Mental Health (WFMH) and coordinator of the Addictions Sector of Hospital Álvarez explained that "in Argentina, since 2010 a National Mental Health Law has been in place, which is an example in the world because it points to people with mental illness being considered subjects of rights and guaranteed full access to the health system. "However, compliance with the law is far from complete:" There are corporate and economic interests that they make the law look bogged down in many cases, especially with regard to hospitalization. "
"The law requires that general hospitals intern people with mental illness," he explained, but clarified that "there is a certain lack of interest on the part of the authorities of some jurisdictions." Thus, "many end up in a monovalent hospital or in a medical clinic, cardiology or traumatology room. Or, worse, sometimes they are weeks or months interned in the guards. "Intermediate devices are missing, concluded Trímboli:" Day hospitals, half-way houses, residential residences, among others "With the same sense, the guide published this week focuses on the "recommendations", and emphasizes the importance of close monitoring of the patient by a specialized team. Because, they say, people with mental disorders "are more likely to have a lifestyle that contributes to or exacerbates Noncommunicable Diseases." Risk factors that can be modified.