Time to recognise the need and provide services

People with appreciable physical illness have at least twice the rate of psychiatric disorder found in the general population, with a concomitant increase in clinically important disorders that just fail to meet standard diagnostic criteria. The main problems are mood disorder,1 2 3 cognitive impairment,4 5 substance misuse,6 7 and abnormal illness behaviour or somatisation.8 9 These disorders are clinically and personally important: they impair quality of life; reduce the ability to adhere to, or benefit from, treatment for medical conditions; and are associated with a poor outcome of treatment for physical illness. Episodes of medical care are more complex and costly in those whose physical disorder is accompanied by psychiatric comorbidity.10

Effective treatments exist for psychiatric disorder in physically ill people, which are remarkably cheap for the benefits they provide. In fact, the costs of providing psychiatric treatment in a medical setting may be more than met by the savings that result from reductions in …