Ramsay Healthcare is investing in a new state-of-the-art private hospital in Southport dedicated to mental health matters Blue (https://www.beyondblue.org.au). This is even more pertinent at this festive time of the year when expectations are high, and the reality for many is that the holiday season can be a lonely experience. Further, Christmas by its very nature is stressful and loss events or anniversaries at this time can precipitate depressive symptoms and syndromes in those who may be at risk. So how can depression be spotted? More specifically how can we differentiate a depression syndrome requiring treatment from normal sadness that we all encounter in everyday life? Essentially, depression lies at one end of a mood spectrum and whether someone is in need of treatment is dependent on the symptom profile and degree of associated functional impairment (disability). Broadly speaking, depressive symptoms fall into five categories. These are biological (so called “neurovegatative” symptoms) such as poor appetite and sleep difficulties including early morning wakening; emotional symptoms such as low mood and inability to experience pleasure; behavioural symptoms such as withdrawal and selfneglect; cognitive symptoms such as feelings of worthlessness, suicidal thoughts and poor concentration (especially prevalent in older patients) and lastly, in the severely depressed, psychotic symptoms including delusions of guilt and hallucinations with a negative theme. The exact profile of symptoms present will depend on multiple biological, psychological and social factors that vary from patient to patient. No two patients will have the same clinical presentation and understanding the patient’s experience of depression is key to successful management. In mild to moderate depression, low grade psychological therapies and exercise may be necessary, whereas in moderate to severe depression, if risk is present, inpatient management with more complex psychopharmacological management may be indicated. The paradox is that despite the fact that effective treatments exist in the form of novel anti-depressants, ECT and psychological therapy and despite the rising cost of depression, health services invest significantly less in depression than other illnesses. For this reason it is known as the silent epidemic, and mental health is referred to as the Cinderella specialty. In addition, depression rarely exists as an illness in isolation. Often there may be co-existing physical illnesses and treatment of the depression will improve physical outcomes. Recently, however there have been some local developments that offer some hope for the future. Firstly, Ramsay Healthcare is investing in a new state-of-the-art private hospital in Southport dedicated to mental health matters. A team of experts across the healthcare spectrum are being recruited. Importantly, the team will include psychologists able to offer cognitive behaviour therapy and skilled psychiatric nurses to help provide essential care. Initially, the focus of the new hospital will be on depression, pain management and rehabilitation. However with time the service is set to expand to manage psychogeriatric disorders as part of an elderly assessment program. With population ageing and advances in our understanding of late life depression, this is especially timely. Secondly, recognising that physical and mental difficulties are intertwined, internationally Liaison Mental Health services are being developed within healthcare systems. The value of these services is not only in terms of treating patients with complex mental health difficulties such as delirium in the general hospital but rather in their education capacity. By successfully training medical and surgical staff at both team and organisational levels, more holistic care and better outcomes can be achieved. Within the UK the new RAID liaison consultation model has been demonstrated to have proven economic benefits purportedly leading to four pounds sterling saved for every pound spent. It is hoped that with time Ramsay will be able to offer a degree of liaison input into the general hospitals too. Lastly, greater awareness amongst the public of depression as an illness affecting people from all walks of life is being developed. Championed by inspirational role models such as Ben Roberts Smith VC (who recently spoke at the first Ramsay Legacy event), slowly stigma is being tackled and public attitudes are changing. Consequently, patients with depression are more open about their symptoms and may seek the help they need. Never has it been clearer that mental health is important, and with a rising global burden it is imperative that healthcare providers focus on tackling depression as a priority area. However, despite WHO predictions of a gloomy future, by focusing on raising awareness, fighting stigma and developing appropriate services to implement evidenced based treatments it is hoped that, as with cancers and cardiovascular diseases, depression may even one day become an illness on the decline. 36 Pindara Magazine 2016
Pindara Private Hospital Magazine - Issue Nine
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