Managing patients with mental and physical multimorbidity

Most people with chronic conditions now have more than one.1 Combinations of illness vary and so do the implications of such multimorbidity. For both patients and professionals, managing a cluster of conditions with synergistic management strategies (concordant conditions such as hypertension, coronary heart disease, and diabetes) is potentially simpler than dealing with conditions with non-synergistic management strategies (discordant conditions such as cardiovascular disease, chronic obstructive pulmonary disease, and arthritis). When the mix of conditions experienced includes both physical and mental health problems, however, the poorly stitched seams of professional care are at their most threadbare. The stigma that surrounds mental ill health may prevent patients with physical conditions from disclosing mental health concerns, which compounds problems of management. For these patients outcomes are usually worse.2

Although the clinical course of multimorbidity is not well understood,3 the relation between mental and physical problems seems to be bidirectional. Patients with severe and enduring mental health problems such as chronic depression, dementia, or psychotic disorder are at high risk of developing long term physical conditions, and the risk of mental health problems increases substantially in …