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THE PHYSICAL HEALTH BENEFITS OF TREATING MENTAL HEALTH ISSUES

August 2, 2024
by Healthcare World

Better mental health leads to better wellbeing, says Phil Anderton, ADHD360 MD 

When we look at the immediate effects of improving mental health over recent times, we observe many different perspectives. These include the rising costs to providers for expanded mental health treatment through to increased empathy for the patient or for the community at large. Better mental health leads to better wellbeing, and the circle of positivity is seen to climb to new and dizzy heights.

We also should note that, nuanced within the cover-all of mental health and neurodiversity, are mental health issues that themselves have responded well to treatment and a more positive outlook in society. These days neurodiversity – or neurodivergence as it is often referred to – has far better press with an accompanying wider spread of understanding, particularly of autism and ADHD.

Of course, this comes with a cost to society, namely, the more understanding, the more recognition. The more recognition, the more people accessing services. The more people accessing services, the more people being diagnosed and treated. And that comes at a cost. A cost for the service provision, and on-going funding requirements for continued treatment, and for some, medication.

This gives rise to the alternative common perspective in the USA and UK that ‘this is costing far too much’ and ‘our services cannot handle this amount of demand for assessment and treatment’ – a sad indictment on the rising empathy and understanding for these prevalent conditions, potentially prohibiting progress for treatments that are low cost to providers and payors.

Learning from experience

As the Arab world begins in earnest to address mental health matters, we should look back to the west for lessons that can be learned. We should also absorb the abundant information to help shape policy and strategy in these mental health emerging markets.

Notable from the perspective of the Emirates, especially Dubai, are the aspirations to creating one of the world’s best healthcare sectors centred on human well-being and happiness with an additional goal of making the region one of the best places to live and work. Similarly in the Kingdom of Saudi Arabia and its new region of NEOM, the goal is to build the land of the future, with an aim to redefine liveability.

Within ‘mental health’ one such opportunity comes from seeing mental health as a partner to physical health. By addressing combinations of inputs and outputs we can witness significant health improvements overall, measured in terms of positive outcomes. Rarely is health measured in overall outcomes, free from ‘silo’ thinking, and free from internal wrangling between department, budget holders or payors.

If we look at emerging best practice regarding, for instance, the treatment of ADHD as a holistic intervention, rather than one for mental health, we start to observe a changing landscape, not merely for treatment, but for service design, funding and overall cost benefitbased business cases. The argument for a change in thinking, or in the perspective of the UAE and NEOM, for radically revolutionary and visionary thinking, is compelling. And it is far easier to start ‘the right way’ than it is to overturn layers of mistaken, culturally embedded thinking.

So what is ADHD?

ADHD is defined by many commentators as a disorder of the brain, caused by a slight imbalance of the chemicals in the pre-frontal cortex (think forehead). Thus, ADHD has found a home in Psychiatry, sometimes Psychology, but normally treated successfully with medicines.

But if we look further into ADHD, and redefine the whole package by examining the effects of ADHD on physical health, ‘below the neck’, we begin to see the issue through new optics. Moreover, we see new funding opportunities and new savings in terms of health, well-being and wellness, as well as seeing significant cost savings for payors and policy holders in the wider, strategic context.

According to Professor Russell Barkley, former professor of psychiatry and neurology in the U.S. ADHD can reduce life expectancy by as much as 13 years, but it is reversible. This reversable nature is very significant, for the loss of life is not from ‘pure’ ADHD in isolation, but from the associated physical health risks that emerge from not treating ADHD appropriately.

To realise the benefits described, payors need to come away from silos and vertical ringfenced structures and look ahead. Should they take this opportunity in the GCC, Arab nations will immediately catapult themselves to world leaders in public health.

The impact of ADHD treatment on public health

The ADHD ‘below the neck’ approach delivers what could be the single most effective impact on public health in recent times. Assessing and treating more than 1100 new patients every month is achievable only through digital platforms and robust processes. By advancing to ‘scale’ in 2022 with the use of appropriate ‘telehealth’ and forming the Virtual Neurodiversity Hospital in 2023, ADHD 360 have embraced and defined change for the ADHD and autism community. An adjunct at first, but now a major driver for successful patient outcomes, is the physical health benefit profile of treating ADHD.

As a company we have prioritised 5 key public health areas for consideration in 2024, affectionately referred to as the Michigan Model:

• Diabetes
• Alcohol and drug abuse
• Smoking cessation
• Disordered sleep
• Hypertension

Each of ADHD 360’s 20,000+ patients have their blood pressure and pulse taken monthly. This random sample of testing for hypertension reveals high BP regularly, connected to the anxiety of having untreated ADHD and, once the patient is treated and medicated, we see BP return to acceptable norms.

Similarly, working from baseline data recorded when a new patient onboards, we can see that, as the ADHD patient is treated, two significant factors in their life can change. Firstly, as opposed to a disordered life of unplanned eating, no diet considerations and choosing fast food for main dietary satisfaction, the capability to plan a diet, shop with purpose and eat with food health in mind, leads to not only a healthier diet but also considerable weight loss. Coupled with the fact that many ADHD medicines or stimulants have an appetite suppression side effect, we see dramatic, relevant changes in BMI over a relatively short space of time, often 3-6 months. Treatment for ADHD in patients present with excess weight or obesity can and does affect their weight to manageable levels.

The impact on pre-diabetes and diabetes per se is now widely acknowledged within our clinic. When we look at the opportunity in the Middle East, where diet and the high sugar content of available foods, especially fast food, is readily available, treating ADHD will undoubtedly have a profound impact on this important aspect of public health.

ADHD is also recognised to cause addictive behaviours. For the ADHD brain, there is a deficit in dopamine and any excess levels of a stimulant in any form carries a risk of being incredibly addictive. For those with untreated ADHD, excess caffeine and illicit substances such as cocaine and nicotine, satisfy these cravings, but are all high risk behaviours. ADHD medication replaces the inappropriate need, often referred to as self-medication, and builds a healthier and more sustainable lifestyle.

Instead of the lens on mental health issues such as ADHD being one of ‘can we afford to treat this?’ we should adopt a new mindset. We should ask service providers to challenge themselves and ask a few simple questions of their patients:

• Is the patient at increased risk of heart disease?
• Do they need to adapt to a healthy BMI?
• Do they need to reduce their chances of having a stroke by quitting smoking?
• Do they need to stop taking illicit drugs such as cocaine to get through the working day?
• Should they eat more healthily and do they need help to learn how?
• Should I screen them or their child for ADHD?

Screening for ADHD only takes minutes, and can and will deliver on the required public health agenda, as well as satisfying the obvious mental health needs of our community.

Remembering that 5 per cent of the population will have ADHD, we should be mindful that in a youth population expected to double within this decade, the drivers for change are not only based around health considerations but also around commercial considerations of healthcare affordability. When mental health treatment is combined with public health outcomes, the strategic imperative is very clearly mapped out, and by so doing, investment is far more palatable. It may well be the case that treatment for ADHD is sponsored by agencies such as the Ministry of Health and Prevention (MOHAP) in the UAE, or the economic engine of NEOM can start with a simple invest to save model from the outset.

www.adhd-360.com

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