AIBU to think doctors of patients with MH issues should also look at the physical health?

[OftenHangry]

I sincerely hope no one affected will take this the wrong way.

I have met number of people with MH issues and realised majority has one thing in common.
Extremely poor diet and lack of physical check ups.
I understand everyone is different and everyone's issues are different but I can't help but think that if doctors concentrated equaly on mental health and physical health, many patients would recover better.
One person with extreme anxiety basically lived on chicken nuggets. That's it. Never touched vegetables. Another one drinks a lot. A lot and our suspicion basically is that the alcohol caused anxiety since she was fine before. Many others were on similar diets lacking the healthy food groups. None took any vitamin supplements. That obviously leads to lack of vitamins and minerals, but they don't know because no doctor ever suggested to have it checked and change diets.
Who had vitamin deficiency knows that it can mess you up pretty well physically and psychologically. I myself ended up in horrible state when I had vitamin deficiency.

AIBU to think that MH care should be mixed with physical care to achieve better results for patients?

YANBU. But our whole healthcare system needs shaking up. GPs only have 10 minutes per patient. And many HCPs don't know anything about nutrition or exercise.

My eating and excersise was well monitored when I had MH issues?
(But I was eating a balanced diet and surfing and climbing regularly)

Sometimes you need to be in a good space mentally to make radical changes to diet etc

Yes you have a point. There needs to be more holistic care for everyone not just those with mental health needs.

I don’t know how GPs and nurses are meant to active this in just a 10 minute appointment slot.

People need to take more responsibility for their own health. That’s hard enough when you are mentally well - how on earth someone with severe depression is meant to motivate themselves to eat well and excercise is beyond me.

Not everyone with MH issues has a poor diet.

The benefits of exercise for mental health are well known, infant “exercise on prescription” is a thing in many areas.

Problem is often it’s a vicious circle. Your assuming that poor diet/alcohol are causing the problems when in actual fact they could be a symptom of the problem itself. When I am struggling in struggle to eat well, I have to push myself to exercise etc.

I don't think a GP appointment should be taken up by the GP telling their patient to cut down on alcohol and eat a better diet.

Thank you for yor answers.

I am not assuming (except that one example) that MH issues are always caused by poor diet etc nor do I assume everyone with MH has poor diet.

It's understandable that people who have issues are demotivated to eat healthy. And the time limits with gps don't help anything too.

I was thinking a yearly blood works for people with MH could be doable and could help.
Can I ask you here with MH if you ever had the tests done? Or if doctors, not just gps though, suggested any vitamin supplements, diet etc? Or have you yourself asked for them?

I was very lucky my GP actually first done these rather than referring me elsewhere.

I have no issues with being treated holistically. My specialists know the effects of long term chronic pain is that it affects the mental health and so I'm supported by the mental health teams too who work closely with my specialists.

The more I read about other parts of the UK the less inclined I am to leave this area!

Not read full thread yet but...

I think your broader point is totally valid - physical and mental health issues often coexist and both should be looked at if a person presents as mentally unwell. But I think relating this just down to diet and exercise is too narrow. A v good friend of mine recently took her own life; she had been struggling with anxiety for a few months and was recently diagnosed with depression but her diet and exercise were both v good. She was however, going through the menopause and really struggling with it and I'm sure this was a major factor in her illness. If this had been seen by the go and helped, her illness may have been mitigated and her suicide could possibly have been avoided.

My experience with depression is that, rather than poor nutrition etc causing the depression, it's the other way round, and that depression problems make it more difficult to look after oneself. Being badgered to eat better, take exercise etc doesn't make it easier, in fact makes the depression worse as it's yet another reason to feel crap about yourself, but sorting the depression makes it easier to sort the lifestyle issues.

'DUEL diagnosis' is the term used for combined MH issues & substance abuse (alcohol, drugs).
It is widely recognised that many people with complex needs are vulnerable.
' People with dual diagnosis almost always have multiple needs – often with physical health and social issues as well as their dual mental health and substance problem. They are often unemployed or struggling to hold onto a job. They may be in debt, homeless or poorly housed. They could even be in an abusive relationship.'

www.nice.org.uk/news/article/new-nice-guidance-on-dual-diagnosis-is-desperately-needed

The other issue with MH and physical health is diagnostic overshadowing - one will often get ignored and all issues attributed to the other. So someone with severe mental health issues and also severe pain may be told it's all in their mind and not receive the correct treatment to manage their pain condition. This seems less of an issue with younger doctors though.

I absolutely agree improving diet, cutting down alcohol and exercising can help mental health and in a lot of areas exercise is “prescribed” My friend is currently having a few problems and she’s recently come out of hospital after a break down and her therapist has encouraged her to take up running as part of her on going treatment plan.

I think the message about exercise especially is getting across a lot more now than it use to but obviously still some way to go

Loneliness also is a massive contributory factor that people understate the importance of. Again exercise can help here by joining a class.

But this should always be done on doctors advice and in conjunction with medical therapies if appropriate.

Sometimes the difficulty is engaging people to do these things. Healthy eating, exercise and good sleep hygiene sounds simple when you are well but not so easy for someone who is unwell.
We have to be quite imaginative and very patient!

It must be hard when people seem content to rest on their diagnosis and not actively seek to be as well as they can be. I refuse to go to support groups now because they're full of people who, for want of a better way of phrasing it, revel in the attention and sympathy they seem to get and almost don't want to get better. It's quite sad to see and must be worse for practitioners to see.

Do you think maybe it would help if patients had bloodwork done and supplemts provided accordingly? That could potentially lead to better mental state and so even to better ability to change the lifestyle? Just as a starting step?

I genuinely wonder what would be the results if people with MH got tests done. Obviously it doesn't apply to all. Sometimes it is I guess really MH without physical issues.

Can I ask you here with MH if you ever had the tests done? Or if doctors, not just gps though, suggested any vitamin supplements, diet etc?

When I presented at GPs with very poor mental health I was barely managing to eat because of anxiety and this wasn’t really mentioned, but he did refer me for urgent counselling and suggest I take up running using NHS couch to 5k - doing these 2 things together fixed my eating because they made me less low and anxious, and the I found I loved running, but physically couldn’t do it unless I’d eaten before, and then actually felt hungry and able to eat afterwards.

I think if the GP had said “you need to eat more” I’d have felt defensive and not known how to achieve it. So whether his suggestions were deliberately designed to help all round or not, they did.

And yes, we definitely need more holistic, integrated health care in general. I find the assumption that physical and mental health are not linked really frustrating.

There is growing awareness of a link between poor gut health (poor diet and microbiome) and some mental health problems. So I would think a holistic approach would help. I can see how easy it would be for a vicious cycle to develop where a person with MH problems isn't able to eat as well as they should, consequently their gut health deteriorates which affects their mood.

I was watching this last night which talked about some of the research into gut health and mood
www.channel4.com/programmes/live-well-for-longer

I have a teen with asd, severe learning difficulties and behaviours that challenge. We have had numerous experiences of health professionals ignoring or not wanting to listen to the fact that pain or discomfort may be the reason for an increase in the behaviours.

I agree completely. About 7 years ago I had a severe bout of depression and constant suicidal ideation. I was lucky that my GP ran a full series of blood tests on me when I went to him. It turned out I was severely anaemic and literally within hours of starting iron treatments my depression lifted significantly and was gone entirely a few days later. As it turns out the anaemia was a symptom of an illness which was only diagnosed the following year because of my history of anaemia and was literally fixed with surgery the following day. Restoring me to complete health and improving my life immeasurably. And resulting, within a year in the birth of my son.

I dread to think of how my life would have gone if that blood work wasn't done. If I'd been given a prescription for SSRIs and a counselling appointment. The illness causing the anaemia would have worsened, I'd have ended up infertile, my depression would have gotten worse and worse as my iron deficiency increased, requiring stronger SSRIs to get me through life. My life would have been totally and completely ruined.

Obviously MH issues are real and can be in themselves a genuine illness. But depression and anxiety can also be symptoms of physical illness and it's a genuine tragedy full physical check ups aren't automatic. So many people who's depression is a sign of a different issue have that symptom treated while their illness worsens when a simple blood test could be the start of a completely different life for them.

In relation to the care of people with "severe mental illness" (schizophrenia, bipolar etc), there is currently a huge shift going on towards making sure that people with these kind of diagnoses get regular physical check ups, including diabetes bloods, at least annually. Sadly people in this patient population die, on average, 15-20 years earlier than they should be, often because of neglected physical care or because physical illness is missed-and that's with, often, significant attention from MH services. It's hoped that this initiative will reduce the number of premature deaths. In general, it's a good idea to keep an eye on the physical health of people with MH diagnoses but it can be tricky to implement. People often have so little time with HCPs and it can be difficult to keep things on an even keel, so to speak, when things are sliding. I think that people with MH problems probably need more help, overall, but that kind of goes without saying.

I dread to think of how my life would have gone if that blood work wasn't done. If I'd been given a prescription for SSRIs and a counselling appointment.

I am at the same boat. Can't thank the gp enough.

There was a documentary on a unit once for teens with severe mental health issues. They were obviously dealing with a variety of problems but they showed the patients eating meals and several were just eating mashed potato and ketchup at every meal. It definitely isn't as simple as just getting better nutrition but I do think mental and physical health are both quite drastically affected by diet.

Cold water swimming or showering, walking outdoors and a good meal would help a lot of people with mild depression in particular. There's science behind all 3. But I appreciate it isn't a simple if someone lacks motivation and is hugely struggling with self-care.