Integrating Care: Depression, Anxiety and Physical Illness | Week 1 | Course

Introduction| Step 1.10

Patient perspectives on integrating

care
Please note that this is
Erin Walker | Patient
a transcript of an online
Stacian Gilbert | Patient
lecture or interview, and
is not an academic paper.
Erin: I think paying attention to people's mental health in the
context of their physical health, and seeing people and
treating people as individuals and in a holistic manner, is to do
the best by your patients and to honour in the best way what
it is you want to do to begin with-- to help people, to help
them feel better, to help them feel - to alleviate their suffering
and reduce their symptoms and help them cope better. So I
think an integrated approach where you can address people's
physical and mental health problems is the best way to help
your patients, to help people feel better.

I think to neglect mental health symptoms in the context of

impaired physical health is to do yourself and your patients an
injustice. It's a disservice to patients and to what it is you're
trying to do in the first place, to help people with their
physical and mental health. There's potential for such better
care for patients if it's integrated. I have experience of
accessing integrated health services, and it just lifted the
great weight for me about how I would have treatment for my
mental health problem.

So for example, in the gastroenterology department some

years ago, my gastroenterologist referred me to their liaison
psychiatry team, which is brilliant because there was literally
a clinician, a psychiatrist, who was in the same clinic as my
gastroenterologist. So I was able to go across the hall,
literally, to see the psychiatrist, and it made me feel that what
I was disclosing to the psychiatrist would be shared with my
gastroenterologist, obviously appropriately and confidentially,
but it made me feel more confident in my healthcare and that
I was being-- that all of my healthcare problems, physical and
mental, were being accurately and adequately treated. I felt
more confident in the system, and it made me feel that it just
was such a great relief to be able to access integrated care.

It can be very hard, I think, when you're a patient, to go to

different clinics, different hospitals, your GP practice, keep
on top of it all. There's so much life admin associated with
when you have physical and mental health problems. So if
when you do access services, they're integrated, it can be
such a relief and make it much less of a bad experience.

© King’s College London, 2018 King’s Online

 Having physical health problems and mental health problems
can at times be very challenging, and when people are
depressed, they don't have the cognitive abilities. There is
impairment in their cognitive function. Or, with liver disease,
as well, you'll lack capacity to navigate all the different
services that you need to. So if the system is set up so that
you can access integrated care for, in my case, for my liver
disease and for my depression and anxiety, it's so much
easier. I am convinced that there is an effect on my health.
The care is better, and I don't have to go to all those
difficulties and be so organised and so on top of everything
when I'm not feeling well. It's really hard to do. I can manage it
when my health is good, and when I'm feeling well, it's easier
for me to remember, 'OK, I'm going to this appointment with
this person', 'I'm going to that appointment for my mental
health', 'I know I need to follow up with this prescription
repeat', that kind of thing.

But when I'm not well, when I'm itchy, when I'm not sleeping
well, when I can't concentrate, when I'm distracted, when I've
got such brain fog I can barely remember what my husband
and I discussed we're going to have for dinner tonight, it can
be really hard to then remember all the different
appointments you need and to communicate to my specialist
what I was talking with my cognitive behaviour therapist about
and how that affects my health. So, integrated care feels, to
me, the best fit, logical and the most efficient and probably
effective for people with - especially in my case - numerous
physical health conditions and mental health.

And there's a lot of co-morbidity with people. Increasingly,

our population is getting older and living longer with greater
health problems, and we're seeing more people with chronic
illness. Those people have co-morbidities, and with resources
limited as they are in the NHS, an integrated care system
feels like the only solution, the only sustainable solution for
the healthcare service, but for patients.

Stacian: I've had good and bad interactions in talking about mental
health. One example is being in the clinic where I see the
specialist nurses. There's no system in place for her to talk to
us about our mental health condition, but she'd incorporate
that in her consultation with us. So she could detect when I'm
not well, when I'm down and how much of an impact that has
on my physical wellbeing as well.

One good thing with the clinic: there's different health

professionals that we see. So you go in and have a
consultation with a doctor, and then if we're talking to the
doctor, he'll realise that, 'OK, something else is wrong with

© King’s College London, 2018 King’s Online 2

 you. You need to talk to someone in regards to whatever is
going on'. Then, you'll see the specialist nurse, and the
specialist nurse will detect, 'OK, you're not sleeping, you're
having problems eating'. Then, they'll contact the dietitian. So,
they all work as a team, and you could see them within the
same day while you're having a consultation.
You feel more comfortable because everything is happening
in the same place, and you feel it's much easier to express
yourself to each one of these individuals that you get to talk
to, because the main thing is that someone's listening to you -
that's one of the main things - even if you don't feel like talking.
There's times I don't feel like talking because, to me, I think
'Why talk about what's going on in my head? You don't
understand what's going on in my head, and if I talk about it,
it's not going to make this situation any different or any
better'. But knowing that that person is there as a support,
and that's one of the great things.

There's times when the healthcare professionals will come by

and come into one room, and talk to you as an individual on a
level that you can understand, and that has a great impact on
you going further, understanding what's going on with you and
trying to find ways of coping with it. So healthcare
professionals working as a team within the same area will
make a big difference compared to you going off to see a
psychologist on his own. Then, I personally would not turn up
to some of the appointments compared to if everyone's there
and they're looking at me for my healthcare side of things,
because it's your healthcare that's impacting on your mental
health. I don't want to just talk about what's going on in my
head. I want you to look at me as a whole to say, 'OK, this is
what's going on. Fine, CBT could help with certain things, but
there's other ways of coping with your condition and
accepting it. The main thing is accepting that it's a long-term
condition and it might get worse, and how you will deal with it
when it gets to that point'.

© King’s College London, 2018 King’s Online 3