Mental health
“While psychiatric liaison exists in acute physical hospitals, there is no physical health liaison in mental health wards.” Darzi review
This is a fresh perspective. Can we refresh the way we provide care for physical and mental health conditions?
Can we refresh the way we provide care for physical and mental health conditions? We certainly need to. Because the Darzi review is full of look-away-now stats on mental healthcare. Such as.
“The prevalence of depression has shot up from 5.8 per cent in 2012 to 13.2 percent a decade later in 2022”. “Some 343,000 referrals for children and young people under the age of 18 are waiting for mental health services, including around 109,000 referrals waiting for more than a year.” “At the start of 2024, 2.8m people were economically inactive due to long-term sickness. That is an 800,000 increase on pre-pandemic levels with most of the rise accounted for by mental health conditions.” “In 2016, around 2.6 million people were in contact with mental health services; by 2024, this had increased to 3.6 million people.”
So how can we help? The BMJ Best Practice Comorbidities Manager gives guidance on managing patients with both physical and mental conditions. Here is one example of how to manage patients with a common combination - stroke and depression. • Prescribe the patient’s usual antidepressants, unless there are good reasons to change. • If antidepressants are stopped abruptly, the patient may develop discontinuation symptoms. • There is some evidence that selective serotonin- reuptake inhibitors (SSRIs) may cause spontaneous intracranial haemorrhage. But absolute risk is low. • SSRIs with anticoagulants and NSAIDs may increase the risk of spontaneous haemorrhage. • Certain antidepressants may cause respiratory depression – which can be a problem in stroke. • SSRIs and drugs used for hypertension can cause hyponatraemia. • Depression is very common after stroke and often missed.
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