Few, if any, modern-day healthcare professionals in the UK would refute the intimate link between depression and chronic physical illness.
While scientific evidence to prove this multi-directional relationship mostly dates to the past decade, advocacy for a holistic approach to modern medicine can be traced back to the mid-20th-century.
Dr Brock Chisholm, the first Director-General of the World Health Organisation (1948–1953) is one of the most famous of these early (in modern terms) proponents, known for saying that “without mental health there can be no true physical health.”
Wellbeing is a Marriage of Physical and Mental Health
In a 2013 WHO (World Health Organisation) Bulletin, No physical health without mental health: lessons unlearned? Drs Kolappa, Hendersona and Kishoreb put forth a passionate argument for implementing holistic health services. Their point of view is based on scientific evidence of the bidirectional relationship between mental illnesses – specifically depression and anxiety – and physical health outcomes.
Statistics listed in the bulletin to back their point of view included the following:
- Patients with type II diabetes mellitus are twice as likely to experience depression as people without the disease, and those patients with diabetes who are depressed have greater difficulty with self-care.
- Patients with a mental illness are twice as likely to smoke cigarettes as other people, and in patients with chronic obstructive pulmonary disease mental illness is linked to poorer clinical outcomes.
- Up to 50% of cancer patients suffer from a mental illness, especially depression and anxiety, and treating symptoms of depression in cancer patients may improve survival time.
- Patients who are depressed have double the normal risk of having a heart attack. Depression increases the risk of death in patients with cardiac disease. Moreover, treating the symptoms of depression after a heart attack has been shown to lower both mortality and re-hospitalization rates.
Another recent and equally convincing study, a 2009 research project undertaken by Professor David Goldberg of the Institute of Psychiatry, London, found that:
“…not only do many chronic illnesses cause higher rates of depression, but depression has been shown to antedate some chronic physical illnesses.”
The Need for a Holistic Approach to Health and Wellbeing Services
In light of the proven multidirectional link between physical and mental health, it’s evident that the global epidemic of chronic diseases must be approached holistically.
The UK health sector, in particular, is fighting a runaway fire in treating the soaring number of people with long-term medical conditions. Dr Martin McShane, NHS England’s director for long-term conditions, has warned that the challenge of treating patients with chronic mental and physical illnesses is so great that it could be viewed as the “healthcare equivalent to climate change”. He believes the NHS must be forced to undertake a major rethink of its approach to healthcare.
Health and wellbeing programs continue to lag behind evidence indicating best practice, more often than not taking a siloed approach to diagnosis and treatment over the recommended holistic one.
Prof Goldberg points out that this limited view often results in a misdetection of comorbid conditions:
“Depression among those with chronic physical illnesses is likely to be missed by professionals who care for physically sick patients,” he writes in the journal World Psychiatry. “This is because health professionals are understandably concerned with the physical disorder which is usually the reason for the consultation, and may not be aware of the accompanying depression.”
Definition: Holistic View of Health and Wellbeing
A holistic view of health is an approach to wellbeing that considers how the individual functions in their environment, instead focussing on a singular competence, disability or pathology.
Rather than judging a person’s condition by the presence of pathology or even of a particular competence, a holistic health and wellbeing perspective considers the extent to which the person has adapted to thrive in their environment despite their range of physical and mental capabilities.
As a result of such a view, it could be said that a well-adapted person with a disability (e.g. Down syndrome) or illness (Anxiety Disorder or Cancer) has a higher level of wellbeing than the person with no illness or disability that struggles to thrive in their environment.
This perspective makes a valuable contribution in the fight against mental health stigma and towards recognising an individual’s agency to live life to the fullest despite a diagnosis or disability.
How Holistic Support Services Create a Brighter Future
Case studies from across the UK illustrate that holistic health care programs can be surprisingly simple to implement and quick to show results.
The 2015 Clinical Commissioners’ report, Local Solutions to National Challenges, tells of one such scenario set in 2011/12. Concerned with the increasingly large sums spent on unscheduled care (£86 million at that point), Blackpool CCG and Fylde and Wyre CCG embarked on a fact-finding mission. Their research revealed the following:
- A large portion of the healthcare services delivered could be attributed to the needs of a rather small number of patients.
- In one under-serviced area, the top 100 callers to the North West Ambulance Service rang 1,100 times over a three-month period.
As an experiment in preventative care, the commissioning groups launched a combined campaign focused on the top users of unscheduled care. Frequent callers to the emergency services were phoned and asked about their various personal problems, including social and mental health issues.
In many cases, seemingly unrelated conditions like anxiety, depression, loneliness, and self-harm were mentioned. Where individuals were found to suffer from a comorbid condition, they were given immediate access to local services.
As a result of the program’s holistic approach, carers were alert to recognise and tend to a broader range of ailments and needs. Not surprisingly, many of the patients’ medical problems tended to disappear once their emotional and social needs were met. The hard facts prove the efficacy of the approach:
- 999 calls dropped by 89%
- A&E attendances fell by 93%
- Hospital admissions plunged by 82%
- Incidences of self-harm was reduced by 98%
- The communities tallied up savings of £2,757,380 as result of the project
New Economics Foundation 5 Ways to Wellbeing
The Blackpool CCG, and Fylde and Wyre CCG case study is one example of how providers can implement a holistic view of health and wellbeing in services. For health professionals searching for guidance in carrying out a more holistic service, Bridge recommends The 5 Ways to Wellbeing as a model.
The New Economics Foundation (NEF) developed the model under the commission of the UK Government’s Foresight Mental Capital and Wellbeing Project. It analysed the most important drivers of mental capital and wellbeing by drawing on a large body of psychological and economic literature.
The aim of the project was to develop a long-term strategy for optimising mental capital and wellbeing. The project formatted the solution as a list of actions, the Five Ways to Wellbeing, which are:
- Taking notice (practising mindfulness)
- Keeping on learning
- Being active
5 Ways to Wellbeing and the NHS
According to MentalHealth.org, physical care and mental healthcare have largely been disconnected in the NHS since their founding in 1948. This, however, is beginning to change as the NHS is strengthening its call on healthcare professionals to consider psychological wellbeing when treating the physical symptoms of a condition and vice versa. Evidence of this shift can be seen on the websites of the NHS and the NHS Confederation, both of which campaign for the incorporation of the 5 Ways to Wellbeing in health care.
5 Ways to Wellbeing Resources
Partnership Opportunity for Holistic Services
Because of the scope of activities that’s required to formulate support services after the 5 Ways of Wellbeing, Bridge has established a holistic partner network where specialist providers can join hands. To learn more about our partnership network we recommend our free guide, The UK Specialist Provider’s Guide to Providing Holistic Health & Wellbeing Services.
The purpose of the guide is to show specialist providers how the Bridge Network is working to improve the big picture of personal wellness in communities across the UK. We invite you to place your organisation within this services framework, to see for yourself the valuable part you can play in completing the picture.
5 Ways to Wellbeing Posters
Looking for a visual reminder of The Five Ways to Wellbeing for your office, consultation room or health centre? Mental Health New Zealand offers a range of posters, bookmark and postcards, free to download and print. Our favourite? This “blokes version” of the 5 Ways to Wellbeing:
5 Ways to Wellbeing Presentation by NEF
The global epidemic of chronic diseases demands that service providers redefine their approach to treating illness and improving wellbeing. The holistic approach embodied by the 5 Ways to Wellbeing, has been proven an effective model for tackling the issue.
Implementing such a holistic service model requires the cooperation of specialist health and wellbeing providers.