Psychiatry and health costs

THE neglect of psychiatric conditions by health funders, health insurance companies and most wellness programmes is a clear indication of lack of understanding of the health cost management systems. With clear statistics that one in four people will experience a mental health problem in any given year, research suggests, with 90 percent of these making primary care their first port of call for help. It is not surprising then, that as many as 40 percent of GP and primary care daily consultations involve a mental health component.

This is usually ignored and misdiagnosed.

This leads to five negative and costly outcomes:

1. Multiple consultations for same issues

2. Progression and complication of the mental condition 3. Increased cost of medical treatment 4. Persistent suffering and decrease quality of life for patients

5. Loss of productive time costing the economy

You probably won’t see patients with a serious mental illness as they tend to be treated a referral centres. Rather in GP, occupational and primary care clinics one will see a lot of people with low to medium grade mental health problems, in which could include loneliness, misery, insomnia, substance abuse, depression and stress

It is people’s life experiences that affect their mood and thinking. These so-called mild to moderate psychiatric disorders will manifest as what I call psychogenic symptoms. These are psychical signs and symptoms without a traceable physical abnormality but rather a manifestation of psychological conflict and problems. They are usually in the form of: ◆ Headaches ◆ Backaches ◆ General body weakness ◆ Body aches ◆ General abdominal pains ◆ Tiredness ◆ Poor appetite ◆ Lack of sleep, among others. The solution is to devote time and resources to training and increasing awareness to the most common psychiatric conditions to the GPs and the individuals in the first line of contact in clinics. The correct identification of a psychiatric condition is paramount in cost management in the health system.

Many strategies have ben employed to contain costs in the medical industry but I am of the opinion that mental health awareness is a low hanging fruit that will yield fruit with minimum costs. Ignoring mental health like it has been the case will ensure that an effort to decrease unnecessary consultations is unlikely to happen - a dream that will never come true.

There is no health cost management without focusing on mental health issues that is a fact.

I do not see patients with a serious mental illness all that frequently (they tend to be managed in secondary care), but I do see a lot of people with low to medium grade mental health problems, in which I would include loneliness, misery and stress; it is people’s life experiences that affect their mood and thinking. I also see a lot of people whose stress levels affect their physical health.

DISCLAIMER: This column contains information about mental health related issues. However, the information is not advice, and should not be treated as such. The writer accepts no responsibility for misuse and misrepresentation caused by the use or misunderstanding of this article. No liability is accepted for any consequences arising from this article. Dr S.M. Chirisa is a passionate mental health specialist who holds an undergraduate medical degree and post graduate Master’s degree in psychiatry both from the University of Zimbabwe. He is currently working as a Senior Registrar in the Department of Psychiatry at Parirenyatwa Group of Hospitals and is also the current national treasurer of the Zimbabwe Medical Association (ZiMA). He can be reached at drsmchirisa@yahoo.com