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Can you describe your symptoms? The blurred lines of mental and physical health

Authors: Karen Steadman Karen Steadman

29 November 2012

Last week’s expert roundtable ‘Acting on the double burden of chronic disease’ jointly organised by the Centre for Mental Health, the Kings Fund and The Work Foundation, investigated the relationship between mental health and physical long-term health issues, and their impact on employment.

More than four million people in England with a long-term physical health condition also suffer from depression, anxiety or another mental health problem.  Compared to those without a mental health problem, this group has both worse clinical outcomes and a lower quality of life. They are less likely to be in employment than those with the physical illness alone, and are more likely to take time off sick.

As outlined in a report by the Kings Fund and the Centre for Mental Health earlier this year, this combination of mental and physical conditions also has significant cost implications. For those experiencing both a physical long-term condition and a common mental health condition, such as depression or anxiety, the healthcare costs can be doubled from those with just a physical condition. Research suggests that such co-morbidity cases are associated with an increase of up to 75% more in healthcare costs per patient.

The inter-relationship between long-term physical and metal health conditions and the impact of such co-morbidities on productivity and workforce participation is often not recognised. This line between physical and mental health is particularly blurry when we look at MUS – Medically Unexplained Symptoms. This term is used to describe the existence of physical symptoms for which no evidence is found of any underlying physical disease or disorder, such as chest, back and abdominal pain, fatigue, dizziness and shortness of breath. Such symptoms can be seen as a physical representation of psychological distress – otherwise known as ‘somatisation’.

This is regarded as a considerable problem. It is estimated that experience of these symptoms account for 40% of all GP visits, while a physical cause for them is identified in only 25% of cases. Importantly in terms of employment, it is estimated that nearly 25% of all sickness absence from work is attributable to MUS.

Michael Parsonage, of the Centre for Mental Health, raised the concern that the complexities of mental health conditions and the difficultly in identifying causation mean that action to prevent and to treat them are often put aside to focus on easier to interpret physical conditions.  Our lack of understanding of MUS in particular means that many people are receiving treatment for conditions they do not have, while the real cause of their symptoms remains unidentified and untreated. 
Raising awareness and increasing understanding about mental health as a potential cause for physical symptoms is the first step towards addressing them. This needs to be taken on board not just by policy makers but also by clinicians, patients and employers.

A follow-up roundtable to progress discussions on how the actions of policymakers, healthcare professionals and employers can improve work outcomes for people with co-morbidity health conditions will be held early in 2013.