While the roles of depression and addiction in Robin William's suicide were the focus of most news stories about his death, perhaps the headlines should have focused on his recent diagnosis of Parkinson's disease, highlighting the intricate relationships between neurological diseases and mental health conditions. The U.S. health care system is woefully inadequate at addressing the overlap between the body, mind and soul in these patients.
The anatomical, physiological and neurochemical changes in the brain associated with neurological disorders — such as stroke, Parkinson's disease and Alzheimer's disease — can exacerbate or worsen previously existing mental health conditions including depression and anxiety. Add to that mix a cocktail of well-intentioned medications prescribed to reduce and/or delay neurological symptoms, and the scenario worsens. Many of these drugs have unwanted side effects that can also affect mental health such as slowed thinking, lethargy and lack of concentration.
At the same time, individuals diagnosed with neurological disorders must cope with the immediate or imminent loss of functions that help us be productive members of society. As a result of the illness, they face losing the ability to dress, walk, eat, think, remember and communicate. For many, this means they stand to lose their roles as spouses, friends, parents, grandparents and workers. In other words, they face the ultimate loss — the loss of independence and the loss of self. No wonder these immeasurable losses can also result in depression and anxiety.
For health care providers to effect a measurable and functional change in the health and well-being of individuals with neurological disorders, health care must be focused on treating the person as a whole.
Unfortunately, the U.S. health care system is built upon the notion that each disorder should be diagnosed and treated by a specialist, the myth that there is a pill for every ill. Most of my patients with neurological disorders are taking more than five medications a day and routinely report seeing more than five specialists for their conditions. They see physical therapists, occupational therapists, speech-language pathologists, neurologists, physiatrists, cardiologists and internists all for that same neurological condition. A rare patient will mention seeing a counselor, psychologist or psychiatrist.
Most commonly, there is little to no integration of care among the specialists or a single specialist managing all of the medications. Each treats his or her own specialty area with little communication among providers.
Let me be clear. With few exceptions, my colleagues who provide assessment and treatment to patients with neurological disorders are extremely well-intentioned and conscientious care providers. Sadly, however, we work within a health care system that provides no incentive for integrated care of patients with neurological disorders. Because communication with fellow professionals is not reimbursable, health care providers are dis-incentivized from taking the time to put all of the pieces together for our patients.
This fractured care results in additional stress on our patients and their caregivers. Even worse, it ultimately results in poorer quality of care and health outcomes.
Slowly, but surely, the U.S. health care system is showing signs of recognizing this flaw. Greater focus is being placed on inter-professional education as part of training future health care providers. With the goal of promoting collaborative practice, inter-professional education models — such as those my colleagues and I use at the Loyola Clinical Centers — require that students learn with and from students from other professional disciplines as part of their formative clinical training. The Centers for Medicare and Medicaid Services are currently exploring reimbursement models that promote value of the health care dollar over volume of services delivered for patients with neurological disorders. While promising, these cultural and structural shifts in the health care system are slow and difficult.
Who then is responsible for the patient as a whole? Who is charged with making sure that the mind, body, and soul are being integrated in assessment and treatment?
All health care providers are. It is up to each of us to challenge the norm and to advocate for the creation of a health care system that makes and reinforces the assumption that the mind, body and soul are interconnected. While such a system might not have changed the outcome for Robin Williams, it might change the outcome for you or your loved one.
Janet Simon Schreck is executive director of the Loyola Clinical Centers, which provides treatment in the areas of psychology, pastoral counseling, literacy, hearing, speech and language. The centers operates under the auspices of Loyola University Maryland and has offices in Baltimore City and Howard County. Ms. Schreck can be reached at firstname.lastname@example.org.
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