Cardiovascular Disease and Mental Health
Integrating physical and mental health care pathways
Case of Need
 Mental health problems are the
largest single source of
disability in the United Kingdom
 Patients with lo...
Case of Need
 International research shows that
mental health co-morbidities are
associated with a 45-75%
increase in ser...
Meet Jeremy*
• 55 year-old male
• Had an acute heart event 1 year ago
• He experienced another heart attack a month later
...
Jeremy’s outlook
 50 % more acute exacerbations per year
 Twice as likely to have further cardiac events
 His anxiety i...
Screening
 During the last month have you been feeling down, depressed or
hopeless?
 During the last month have you ofte...
Assessing
Bio-psychosocial assessment
MANAGEMENT
Treatment options for mild-moderate-severe
depression group
Treatment options for mild-moderate-severe
depression group
Collaborative Care
 Consider referral to secondary
services for:
 Patients with moderate or severe
depression & anxiety ...
Jeremy
 Assessed by primary care services
 Seen by psychiatric team
 Referred for psychology- CBT
 Started on Sertrali...
Key Leadership Actions
 Early screening for depression
 Patients undergoing heart surgery should receive screening for
a...
References
 The Centre for Economic Performance’s Mental Health Policy
G. How mental illness loses out in the NHS London:...
Upcoming SlideShare
Loading in …5
×

Golnar aref - cardiovascular and mental health

1,024 views

Published on

Better outcomes, better value: integrating physical and mental health into clinical practice and commissioning


Tuesday 24 June 2014: 15 Hatfields, Chadwick Court, London

Published in: Healthcare, Health & Medicine
  • Be the first to comment

  • Be the first to like this

Golnar aref - cardiovascular and mental health

  1. 1. Cardiovascular Disease and Mental Health Integrating physical and mental health care pathways
  2. 2. Case of Need  Mental health problems are the largest single source of disability in the United Kingdom  Patients with long-term conditions are 2-3 x more likely to experience mental health problems  Prevalence of depression in cardiovascular disease is 10 to 20% and this is approximately 3 x more common than in the general population Figure 1: Morbidity among people under age 65 Physical illness (e.g. heart, lung, musculo- skeletal, diabetes) Mental illness (mainly depression, anxiety disorders, and child disorders)
  3. 3. Case of Need  International research shows that mental health co-morbidities are associated with a 45-75% increase in service costs per patient.  The LSE report estimates that extra physical healthcare caused by mental illness now costs the NHS at least £10bn a year.
  4. 4. Meet Jeremy* • 55 year-old male • Had an acute heart event 1 year ago • He experienced another heart attack a month later • He had heart surgery following this and was hospitalised for one month • He has been signed off sick for the past year • He rarely leaves the house and feels low most days • Jeremy has undiagnosed and untreated anxiety and depression *Name changed to protect confidentiality
  5. 5. Jeremy’s outlook  50 % more acute exacerbations per year  Twice as likely to have further cardiac events  His anxiety is one of the strongest predictors of in-hospital complications  Treating depression and anxiety has the potential to improve;  His quality of life  Functioning  Physical health outcomes
  6. 6. Screening  During the last month have you been feeling down, depressed or hopeless?  During the last month have you often been bothered by having little interest or pleasure in doing things?  During the last month, have you often been bothered by:  Feelings of worthlessness?  Poor concentration?  Thoughts of death?
  7. 7. Assessing Bio-psychosocial assessment
  8. 8. MANAGEMENT
  9. 9. Treatment options for mild-moderate-severe depression group
  10. 10. Treatment options for mild-moderate-severe depression group
  11. 11. Collaborative Care  Consider referral to secondary services for:  Patients with moderate or severe depression & anxiety who have not responded to initial interventions  If the patient is assessed to be at high risk of suicide  Self harm or self-neglect  Close collaboration is required between physical health services and specialist mental health services for long-term follow-up
  12. 12. Jeremy  Assessed by primary care services  Seen by psychiatric team  Referred for psychology- CBT  Started on Sertraline- after discussion with cardiology team  Close liaison with primary care services  Jeremy started back at work after 8 months Everyone was so busy treating my heart no one stopped to think about how I was feeling…
  13. 13. Key Leadership Actions  Early screening for depression  Patients undergoing heart surgery should receive screening for anxiety and depression  Accurate auditing of the numbers of patients with cardiovascular disease screened & treated for depression & anxiety  Ensure local expertise for delivery of psychiatric and psychological interventions
  14. 14. References  The Centre for Economic Performance’s Mental Health Policy G. How mental illness loses out in the NHS London: The London School of Economics and Political Science, 2012. http://www.bps.org.uk/news/how-mental-illness-loses-out-nhs.  Depression with a chronic physical health problem, NICE Clinical Guideline (October 2009); The treatment and management of depression in adults with chronic physical health problems.  No Health without Mental Health: the supporting evidence. www.rcpsych.ac.uk.

×