Take the case of someone who does not drink or eat enough as a result of depression and ends up in the hospital with kidney problems. Or someone with an autoimmune disease who gets very confused by their medication. These can be complex situations for care providers in a regular department in the hospital.
‘The hospital mainly focuses on physical care. If this is accompanied by psychological symptoms or behavioral problems, it can make doctors and nurses feel powerless. They do not have enough time or do not know exactly how to deal with depression, suicidal thoughts or confused behavior in their patients,’ explains psychiatrist Maarten van Schijndel.
On 11 November 2020, Van Schijndel obtained his doctorate based on research into a hospital department that admits patients with both physical and psychological symptoms. There are now 40 medical psychiatry units (MPUs) in the Netherlands. Erasmus MC also has such a department, which Van Schijndel helped to set up. He now works at the medical psychiatry unit at the Rijnstate in Arnhem.
Removing stigmas
In Van Schijndel’s view, a medical psychiatry unit offers added value in a hospital in two different ways. ‘It allows you to help both your patients and the hospital. It benefits patients and informal caregivers for custom care to be provided in a safe environment. In addition, you can lighten the load on your nursing colleagues by taking over their more complex cases.’
It can also help to remove the stigma surrounding psychiatric disorders. ‘Professionals become familiar with these patients, and knowledge and skills become more widely disseminated as a result. For patients, treatment in a safe environment with both physical and psychiatric expertise is often a compelling argument. I hope that this will increase acceptance among patients, close relatives and caregivers alike.’
Lifespan reduced by 15 to 20 years
Van Schijndel even goes so far as to call medical psychiatry units an absolute necessity in hospital care. The most simple reason for this is that physical and psychological symptoms very often occur together. ‘In addition to physical problems, 15 to 50% of hospital patients also have psychological symptoms,’ says Van Schijndel. Examples include a patient with severe depression and kidney disease requiring dialysis or a patient with rheumatoid arthritis who develops psychosis as a side effect of their medication.
The lifespans of people with a psychological illness tend to be 15 to 20 years shorter
This combination of physical and psychological illnesses is a problem, as it reduces their quality of life and worsens the prognosis. For example, Van Schijndel mentions the example of a young father who has just had a heart attack, is not fit enough to play with his children and becomes depressed. ‘Cardiovascular diseases lead to an increased risk of depression, but the reverse is also true. Many people are not aware that the lifespans of people with a psychological illness tend to be 15 to 20 years shorter because of physical illnesses. This is really significant and can be partially prevented by providing the right care.’
Attention and care
According to Van Schijndel, admission to a medical psychiatry unit is a necessary piece of the puzzle for providing the correct care. These kinds of units have psychiatrists, doctors and nurses who have been trained to treat physical problems but also to focus on and treat psychiatric problems. ‘The aim is to enable the treatment for the physical problem, but it also gives us more time, scope and opportunities to understand and tackle the psychological symptoms.’ For example, this could take the form of discussions and medication.
Medical psychiatry units have been around for decades now, but Van Schijndel believes improvements are still needed. For example, he wanted to compare different units for his thesis but came up against the issue of completely different organizational forms. This made it very difficult to compare the various units. ‘Before setting up a medical psychiatry unit, it is important to think carefully about how to organize it. Which patients will benefit the most, what care will you be providing exactly and what staff will you need for this?’
Difficult to scale
Van Schijndel also wants to call for more efforts to improve the poor outcomes of patients with physical and psychological symptoms. ‘The current trend is to build care networks around patients for each condition, with various professionals involved. I think this would be very difficult to scale up. The target group of people with a combination of physical and psychological disorders is also diverse. I wonder if perhaps we should move towards a specialist with basic knowledge in the field of physical and psychiatric disorders? A psychiatrist who also performs basic physical treatment and an internist who also knows what to do with common psychological symptoms. In this way, you will need fewer care providers and can offer greater continuity in terms of treatment.’
Would you like to find out more? Read the thesis ‘Medical psychiatry units: Improving their organization, focus, and value.
