Multimorbidity in Mentally Ill People: The Need for a Person-centered Integrated Approach

Abstract

 The need for person-centered integrated care is particularly compelling for people who experience multimorbidity. The concept of multimorbidity has attracted increasing interest in the past decade with the recognition of multiple burdens of disease and their escalating costs for the individual and the community. It is evident in clinical practice that multimorbidity has become the norm rather than the exception, occurring in an increasingly younger population particularly in areas of socioeconomic deprivation and in low income countries.  It is now well established that the mentally ill have a markedly reduced life expectancy due to predominantly cardiovascular and metabolic diseases. The combination of a chronic medical condition and a mental health problem presents specific complex challenges for the single disease model of care which continues to prevail as the current delivery system in which health care professionals are trained and operate. The growing evidence and experience for adopting an integrated collaborative person-centered approach demonstrates the need for a more effective model of care which is individualised, and focused on patient engagement to prevent disease and manage multiple conditions systematically. Given the limited resources in our current health care systems, this approach requires innovation and redesign of the system to provide comprehensive person-centered care encompassing early detection, co-ordinated multidisciplinary working across specialities as well as between primary and secondary care with easy access to basic healthy lifestyle care programs.