No physical health without mental health: lessons unlearned?

Editorials 3 D r B r o c k C h i s h o l m , t h e fi r s t Director-General of the World Health Organization (WHO), was a psychiatrist and shepherded the notion that mental and physical health were intimately linked. He famously stated that " without mental health there can be no true physical health ". 1 Half a century later, we have strong evidence elucidating the bidirectional relationship between mental illnesses – specifically depression and anxiety – and physical health outcomes. However, policy continues to lag behind the evidence in this regard, as demonstrated by our global noncommunicable disease response. Over a decade ago, the World Health Assembly adopted a global strategy for the prevention and control of noncommunicable disease. At the time, these were limited to the following four illness types: cardiovascular disease, diabetes, respiratory illness and cancers. Such a categorization would set a precedent for the exclusion of mental illnesses from all future WHO discussions on noncommunicable diseases. It is not surprising then, that in the 2008–2013 action plan for the global strategy for the prevention and control of noncommunicable diseases mental illnesses were relegated to a footnote, with the justification that they do not share risk factors with the other four types of illnesses. 2 We take issue with this viewpoint, as mental illnesses are themselves risk factors that affect the incidence and prognosis of diseases traditionally classified as " noncommunicable ". Patients with type II diabetes mellitus, for example, are twice as likely to experience depression as the general population, 3 and those patients with diabetes who are depressed have greater difficulty with self-care. 4 Patients suffering from 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, 7 and treating symptoms of depression in cancer patients may improve survival time. 8 Similarly, in patients who are depressed, the risk of having a heart attack is more than twice as high as in the general population; 9 further, depression increases the risk of death in patients with cardiac disease. 10 Moreover, treating the symptoms of depression after a heart attack has been shown to lower both mortality and re-hospitalization rates. 11 In light of this …