Intended for healthcare professionals

Analysis Solutions for Prevention and Control of Non-communicable Diseases

Integrating mental health with other non-communicable diseases

BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l295 (Published 28 January 2019) Cite this as: BMJ 2019;364:l295

Re: Integrating mental health with other non-communicable diseases

I am commenting on the article, “Integrating mental health with other non-communicable diseases” written by Dan J Stein, Corina Benjet, Oye Gureje, Crick Lund, Kate M Scott, Vladimir Poznyak and Mark van Ommeren published in January 2019. I agree wholeheartedly with the authors that mental health and wellbeing are central to reducing the global burden of non-communicable diseases (NCDs). The Ministry of Health in Jamaica has been promoting their slogan, “there is no real health without mental health” but their main focus over the last five (5) years has been to reduce the NCDs and there has been no collaborative care to integrate mental health treatment in general health services.

Sadler et. al. (2019) explained that Non-Communicable Diseases (NCDs) and injuries are a major public health burden in Jamaica, and are the leading cause of death. In 2015, an estimated seven out of ten Jamaicans died from the four major NCDs, Cancer, Cardiovascular Disease, Diabetes and Chronic Lower Respiratory Disease (Ministry of Health, 2018). Just to note that these figures do not usually account for persons who have also been diagnosed with mental illness along with the NCDs (Allen and Garriques-Lloyd, 2018).

Suicide has been found to be the second leading cause of death among 15-29 year olds in Jamaica (Tufton, 2018). Hemmings (2017) made a bold statement that, “At least three to four out of every 10 Jamaicans have some type of psychiatric or mental disorder” and that within the next 10 to 15 years, mental illness in Jamaica is going to double or triple. There has also been a spike increase in the murder-suicide rates in which, the perpetrators exhibited serious mental health issues and for some, they were diagnosed with mental illnesses before committing the crime (Lynch, 2019). In a study conducted by Lacey et. al. (2016), it was reported that the rate of depression, was higher among Jamaicans than Guyanese (7.4% vs 4.1%). Additionally, it was explained that there were noticeable differences in rates in both countries, due to social and economic factors, with social factors playing a larger contributory role in the mental health status of individuals across countries (Lacey et. al., 2016).

Though mental health is acknowledged as an essential component of overall health, evidence from the Region shows critical treatment gaps among people suffering from Mental, neurological, and substance use (MNS) disorders with up to 73.5% among adults with severe/moderate disorders and 82.2% among children and adolescents (PAHO/ WHO, 2017). WHO (2018) reported that regional data reveals that health systems have not yet adequately responded to the burden of mental disorders. As a consequence, the gap between the need for treatment and its provision is wide all over the region and between 76% and 85% of people with mental disorders receive no treatment for their disorders.

These NCDs coupled with the rising burden of mental illnesses in Jamaica, has raised many questions as to why there are no integrative approach, policy or guideline in place to provide strategies to reduce both (Allen and Garriques-Lloyd, 2018). Patients with NCDs are not usually not screened for mental illnesses which is very alarming, given that NCDs and Mental illnesses share many of the same determinants and consequences, and frequently occur in the same person (WHO, 2018).

Allen and Garriques-Lloyd (2018) noted in their study that a recommendation is that community mental health nurses be a part of the screening and monitoring of metabolic side effects. As patients with serious mental illness on anti-psychotic are at an increase rate of developing a NCD such as diabetes, hypertension or cardiovascular disease. In Allen and Garriques-Lloyd (2018) study, they reported that 76% of the nurses that participated in the study said that a screening tool has never been used.

In conclusion, screening for metabolic side effects in patients diagnoses with mental illnesses will assist the government with meeting the SDGs and vision 2030 through the prevention and early detections of NCDS. Without the implementation of a national screening policy or guidelines, the population of patients taking antipsychotic medications will continue to be at risk for developing NCDs.

References
Allen, K. and Garriques-Lloyd, S. (2018). Assessing screening practices of community mental health nurses for metabolic side effects. (Unpublished Thesis). The University of the West Indies Mona, Jamaica.
Hemmings, G. (2017). Mental Illness Worry: Professionals say data suggest doubling of cases in 10 years. Retrieved from http://www.jamaicaobserver.com/front-page/mental-illness-worry-professio...
Lacey, K. K., Powell Sears, K., Crawford, T. V., Matusko, N., & Jackson, J. S. (2016). Relationship of social and economic factors to mental disorders among population-based samples of Jamaicans and Guyanese. BMJ open, 6(12), e012870. doi:10.1136/bmjopen-2016-012870
Lynch, M. (2019). An investigation into the increase of murder-suicide cases in Jamaica. Lambert Academic Publishing, Germany. Retrieved from https://www.morebooks.shop/store/gb/book/an-investigation-into-the-incre...
Ministry of Health. (2018). Chronic non-communicable diseases. Retrieved from https://www.moh.gov.jm/programmes-policies/chronic-non-communicable-dise...
Pan America Health Organization and World Health Organization. (2017). Mental health in the Americas. Retrieved from https://www.paho.org/salud-en-las-americas-2017/?tag=mania-disorder
Sadler, T., Brown, H., Graham-Menzie, A. and Robinson, S. (2019). The Non-communicable Disease Unit. Retrieved from https://www.moh.gov.jm/programmes-policies/chronic-non-communicable-dise...
Stein D. J, Benjet C., Gureje O., Lund C., Scott K. M., and Poznyak V. (2019). Integrating mental health with other non-communicable diseases. BMJ 2019; 364 :l295
World Health Organization. (2018). Mental disorders. Retrieved from https://www.who.int/news-room/fact-sheets/detail/mental-disorders
World Health Organization. (2018). Synergies for beating NCDs and promoting mental health and well-being. Retrieved from https://www.who.int/ncds/governance/high-level-commission/synergies-beat...

Competing interests: No competing interests

05 September 2019
Monique A. Lynch
Programme Coordinator
Sheryl Garriques-Lloyd
The University of the West Indies, Mona
The UWI School of Nursing, Mona