The discipline of psychiatry is sometimes
seen as following a narrow ‘bio-medical illness
model’ whereas the Royal Australian and New
Zealand College of Psychiatrists (RANZCP), in
recent practice guidelines for the management of
mood and anxiety disorders, highlights a holistic
‘bio-psycho-social-lifestyle model’ of mental
health. It is worthwhile discussing these domains
of mental health in some detail.
The biological domain of mental health/illness
is characterised by hereditary vulnerabilities
as well as an interface with physical health –
the mind-body interface. For example, many
physical health issues e.g. diabetes mellitus,
hypothyroidism, chronic pain, Parkinson’s
disease etc can cause depression; a brain tumor or
brain hemorrhage can lead to confusion, paranoia
and/or hallucinations; and certain medications
e.g. steroids, though much-needed at times, can
cause side-effects in the form of depressive,
manic or psychotic symptoms. On the other
hand, some mental health conditions can lead to
bodily symptoms e.g. Irritable Bowel Syndrome
and tension headaches secondary to anxiety and
stress. Many other disorders may have physical
as well as psychiatric signs and symptoms
e.g. anorexia nervosa, delirium, dementia etc.
Therefore we need to move away from Cartesian
mind-body dualism and have a ‘whole of person’
approach to health.
Biological management of mental disorders
involves a thorough physical examination and
investigations for diagnosis and treatment of
any underlying or co-morbid physical health
conditions. At times psychiatric disorders need
medications such as antidepressants, mood
stabilisers or antipsychotic medications, especially
when the symptoms are severe and disabling; or
when psycho-social-lifestyle interventions alone
have not proven to be successful.
Other biological treatments like Electroconvulsive
Therapy (ECT) or Transcranial Magnetic
Stimulation (TMS) are very effective and safe
treatments for severe depression especially
when medication alone has not been enough or
the condition is too severe, leading to imminent
danger to a person’s life from active suicidal risk
or decreased food and fluid intake.
Some examples of psychological domain relate
all of these bio-psycho-social-lifestyle domains;
and the management of mental disorders includes
addressing all of the above. Mild to moderate
mental health issues often need only psycho-social
and lifestyle interventions. Psychotropic
medication or other biological treatments
may be needed for some moderate and most
severe mental disorders. While home-based
treatment on an out-patient basis is generally the
preferred option for treatment of mental health
conditions, at times, an inpatient assessment and
management of psychiatric disorders may be
to the experiences of emotional warmth versus
neglect or abuse in childhood, attachments
with parent-figures, identity issues during
adolescence and existential issues in middle
age. Issues of trauma or loss may impact all
age-groups. Those psychological issues may
predispose an individual for mental health
issues in later life, or precipitate psychiatric
conditions. Examples of psychotherapeutic
treatments include Cognitive Behaviour Therapy
(CBT) which addresses cognitions (e.g. negative
thoughts) and behaviours (e.g. relaxation
exercises); Mindfulness which teaches being in
touch with one’s own thoughts and emotions,
by concentrating on ‘here and now’; Inter-personal
therapy (IPT) which deals with how
people interact in their relationships and issues
like role-transition and grief; and Dynamic
Therapies, which address deep-rooted repressed
psychological issues/conflicts.
SOCIAL ASPECTS
LIFESTYLE ASPECTS
MANAGEMENT OF
MENTAL ILLNESS
THE SOUTHPORT PRIVATE
HOSPITAL
WHEN PHYSICAL ISSUES
CAUSE MENTAL ILLNESS
The social aspects of mental health include
social support of family and friends and a
sense of belonging to a community. Social
determinants of mental health include education,
housing, employment, financial stability/
sustainability and social-connectedness etc.
Accordingly, social interventions may include
addressing issues e.g. loneliness, bullying,
domestic violence or housing/job-related
issues. Evidently, if social issues are causing
or contributing to mental health issues, holistic
treatment would have to include addressing those
underlying causative factors.
Lifestyle factors involve diet, exercise, drugs
and alcohol use as well as hobbies, interests
or leisure activities. Alcohol can cause or
exacerbate depression and illicit drugs can cause
depression, mania or psychosis. Healthy diet and
exercise enhance a sense of well-being. Often,
joining a hobby-class or rejuvenating an interest
in gardening, painting, music etc or just going for
a morning walk can be uplifting.
Any diagnostic formulation of mental health
conditions requires an in-depth understanding of
highly therapeutic and even life-saving.
Ramsay Health Care have recently opened a
mental health wing in The Southport Private
Hospital, which includes a day-program and
22 inpatient beds. The day program provides
group therapy based on Cognitive Behavioural
Therapy and mindfulness-based therapy, along
with occupational-therapy and physiotherapy
based group activities. The hospital is also
equipped with Transcranial Magnetic Stimulation
(TMS) and has a group of psychiatrists guiding
bio-psycho-social-lifestyle interventions,
delivered through a multidisciplinary team.
The psychiatrists are also available to provide
consultation-liaison input to general medical/
surgical and rehabilitation patients admitted to
Pindara Hospital through the Rehabilitation wing
of The Southport Private Hospital.
The rising mental health burden in society
requires concerted efforts by the private as well
as public sector and strong partnerships between
primary care and specialist services. In addition
we require a whole-of-community response in
order to promote positive mental health through
raising awareness and stigma-reduction. The
Southport Private Hospital is one such step
towards easily accessible, person-centered and
evidence-based mental healthcare.
20 | Pindara Magazine ISSUE 12 | 2018