Integrated healthcare and rTMS treatment in Dubai
All patients should expect and all doctors should be strive to fulfil the World Health Organisation vision of a state of complete physical and mental as well as social well-being
The Emirates Hospital Group (EHG) together with The London Psychiatry Centre, Harley Street, London (TLPC) have entered a partnership to bring about for the first time ever, the world’s first and only integrated healthcare delivery model incorporating physical and mental health together. This model was inspired by the World Health Organisation’s definition of health which states that:
“Health is a state of complete physical, mental and social well-being, and not just the mere absence of disease or infirmity”. This definition was coined in 1946 and since then has yet to be improved upon or replaced.
Data insights into mental health
In 2013 the Kings Fund Report in in the UK highlighted the fact that 30 per cent of medical and surgical patients suffer from significant mental health conditions following a survey of a number of hospitals in the UK. In 2016, a second report, recommended an integrated healthcare model which has yet to be implemented anywhere in the world apart from EHG.
From 2016 further studies conducted both in the UK and the US found that mental health is very strongly associated with outcomes of medical and surgical conditions.
Depression and anxiety increase death rates by 20 per cent in the first 30 days after surgery. This is due to the fact that depression anxiety cause muscle spasm not only all over the body, but also the smooth muscles around the blood vessels which, in turn reduces the blood flow to the organs, impairing wound healing, increasing infection rates, and increase both local complications in wounds and general complications such as generalised infections.
In addition, depression is three times more common in cardiovascular disease patients and diabetics are two to three times more likely to have depression. Chronic obstructive airway disease is three times more likely to have mental health problem and 33 per cent of women and 20 per cent of men with arthritis have depression.
About 25 per cent of patience in ICU have psychiatric illness and in a large study of 23,000 patients’ anxiety predicted pain after surgery. Chronic pain was present in 10 to 70 per cent after major surgery and pre surgical anxiety and depression were associated with doubling of chronic post-surgical pain. After back surgery people depression are six times more likely to have neurological injury twice the rate of re-operation and 35 per cent of the risk of re-admission.
In addition, up to 85 per cent of cancer patients suffer psychiatric or mental health problems with Post- traumatic stress disorder featuring as the strongest of them, with less than 50 per cent of cases being picked up. What is even more alarming in this population is what doctor Andy Zamar, the Medical Director of the London psychiatry centre calls Intra Traumatic Stress Disorder, where the stress related to life threatening conditions such as cancer or serious disease is not gone, hence cannot be considered as “Post” traumatic, but instead it is relentless, ongoing and continuous.
As the name implies, post-traumatic stress disorder is a condition where the stress has passed hence treatment can be undertaken. There are no studies highlighting intra traumatic stress disorder, in fact this condition is highly prevalent and most treatments for Post-traumatic stress disorder have failed to address it.
Mental health and the effect on patient outcomes
How do mental health problems affect outcomes, is a question worth asking. It was found that they impair or affect compliance with treatment whether in medical conditions or post-surgical interventions, patients then to present late with fairly advanced disease, wound healing and immune response tend to be impaired, either low or high cortisol, the main stress hormone, as a response to either chronic trauma or depression, all these results in higher infection rates higher complication and higher cardiovascular mortality.
In cardiac patients, even if you treat cholesterol, diabetes, weight, high blood pressure and you leave depression the death rates increase four times in men and up to 14 times in women. Hence unless you address mental health problems, as a clinician you have not safely contained the condition.
Stress related conditions, of any kind, were found in two very large Swedish studies to double mortality from fatal infections such as meningitis and sepsis. Furthermore, a second very large study found that mortality from cardiovascular disease increase the substantially up to 700 per cent in people who suffer stress related disorders.
Time for an integrated approach to physical and mental health
The Kings fund report called for integration of psychiatric services in the UK in 2016, a vision that the London psychiatry centre had in 2014, but this was never carried out in the UK. By integration of psychiatric services this entailed active screening, and effective rapid treatment of mental health problems in the medical in surgical population in order to improve outcomes.
EHG and the London psychiatry centre as part of their integrated psychiatry clinic in Dubai, had 2 needs to address in order to improve outcomes for all patients at EHG. Firstly we know that 20 to 30 per cent of medical and surgical patients have psychiatric conditions which will affect their medical conditions adversely, And secondly the treatment had to be effective rapid and side effect free.
A disturbing very large study in the United states of half a million people in 375 hospitals found that SSRI antidepressants increased death rates around surgery by 20 per cent typically through increased bleeding. This means that treating people with antidepressants may not be the best option. The first step that EHG and the London psychiatry have implemented, is to use screening questionnaires of the World Health Organisation to screen through patients who attend the hospital. A pilot was conducted at four clinics and 25 per cent of patients had significant psychiatric illness. These illnesses are are expected to affect outcomes in medical and surgical patients as above.
rTMS treatment in Dubai with enhanced patient outcomes
So now we know that the figures discovered in the United States and the UK are similar to the figures in Dubai. The second step implemented, was to introduce a safe, side effect free treatment which induces recovery rapidly and without complications. The London Psychiatry Centre (TLPC) introduced repetitive transcranial magnetic stimulation or RTMS in the United Kingdom in 2012, and have operated the service since. TLPC has successfully partnered with Emirates Hospitals Group, to launch rTMS Treatment in Dubai.
Furthermore, TLPC also pioneered protocols for RTMS to treat stress related disorders whether Post-traumatic or Intra traumatic stress disorders with a very high success rate. This intervention will allow patients to continue with their medical and surgical treatment without major interruptions, risks, side effects and help achieve the best outcomes.
RTMS is non invasive, easy to administer, with patients attending for half an hour to 40 minutes once a week over five days or two to three times a day for two days a week for treatment. It carries no significant risks and has no mortality rates.
Patients can talk, read or simply relax during the session and then they can go back to work or drive home without any risk of sedation or impairment.
TLPC has brought it’s 13 year experience conducting RTMS successfully in the UK into EHG, with a view to achieve the best outcomes for EHG patients through achieving the best possible results with RTMS. All patients should expect and all doctors should be strive to fulfil the World Health Organisation vision of a state of complete physical and mental as well as social well-being and not merely the absence of disease or infirmity.