There is a strong association between chronic disease, mental health and mental illness. People with chronic physical conditions are at risk of poor mental health, including depression and anxiety. At the same time, people with serious mental illnesses have a greater incidence of chronic physical disease than others. They are also at increased risk for premature death.
According to one estimate, two-thirds of people with schizophrenia die of cardiovascular disease, compared to only one-third of the general population. As well, mental health consumers often do not get the same level of care for chronic physical health problems as the general public.
The Ontario health care system is currently re-orienting itself to become more focused on both the prevention and management of chronic diseases. In doing so, the Ministry of Health and Long-Term Care and the Ministry of Health Promotion have developed a Chronic Disease Prevention and Management Framework (see diagram). The framework provides directions to guide efforts toward prevention and management of chronic diseases in Ontario; and to facilitate engagement with patients, providers and populations to address chronic diseases. It is intended to reduce the incidence of chronic diseases through fostering healthy behaviours and addressing the broad determinants of health, such as supportive environments and healthy public policies. The framework is also intended to create an enhanced and comprehensive health care system to improve quality of care for those with chronic conditions.
A chronic disease prevention and management (CDPM) approach can improve the physical health care of people with serious mental illness. The CDPM model also has the potential to improve screening and management of depression in people with chronic physical conditions. Health planners and health care providers across the country are recognizing opportunities to address both mental health and chronic physical conditions within CDPM. They are already working together to develop and deliver programs where mental health and mental illness are being addressed.
CMHA B.C.’s Bounce Back: Reclaim Your Health Program
Initially, the Canadian Mental Health Association, British Columbia Division’s Bounce Back: Reclaim Your Health program offered mental health support to people with chronic health conditions who were coping with low mood and mild to moderate depression, although the program no longer requires a diagnosis of any chronic health condition other than low mood. Participants are referred to Bounce Back by a general practitioner (GP) or through a GP-endorsed referral. Through psychoeducation and guided self-help, Bounce Back helps primary health care practitioners improve people’s quality of life.
“There is a strong fit between mental health and chronic conditions,” says Lynn Spence, associate executive director/ director of provincial programs for CMHA B.C. “People who are living with chronic conditions frequently have high levels of anxiety and depression.” Bounce Back also recognizes the mental health support needs of family members and caregivers of people with chronic conditions. “We were receiving referral after referral from GPs who said that family members and caregivers needed help,” says Spence. The doctors recognized that their patients needed more mental health support in dealing with their chronic conditions and needed tools and resources in order to do that. Indeed, building good relationships with GPs and having their support are key reasons for Bounce Back’s success, says Spence. For more information, visit www.cmha.bc.ca/bounceback.