The fire alarm sounded at Newcastle TAFE in April and Leanne Swainson was forced to take two flights of stairs to safety.
To some this would be an easy task - but with asthma and osteoarthritis, it took a toll on Leanne’s body so great that it was enough for her to cancel her pursuit of a Certificate III in textiles.
This was her best shot at being able to work again.
“I just thought to myself, ‘You can't do this Leanne'."
Leanne, 49, has had asthma and post-traumatic stress disorder since before she started school.
Her mental health medication caused her significant weight gain which exacerbated her asthma, and then her osteoarthritis in early childhood.
“These conditions impair basically everything I do; from any physical activity, walking, sleeping, showering, being able to go to social functions, attending classes, working, studying - absolutely every part of my life is affected by my physical and mental health.”
Leanne’s struggle with the compounding effects of her physical and mental health isn’t rare.
Up to 2.4 million Australians are living with both a chronic physical condition and a mental health condition.
A greater risk of a chronic physical condition for people who have mental health conditions has been confirmed in the first ever study to quantify this relationship, produced by the Australian Health Policy Collaboration (AHPC).
Women with a mental health condition like Leanne are 70% more likely to report having asthma than someone without a mental health condition.
For men the risk is lower but still significant with a 49% greater likelihood of reporting asthma with a mental health condition.
The report also showed correlations between mental health and other chronic physical conditions such as diabetes, arthritis, cardiovascular diseases and back problems.
In the report, chair of the AHPC Advisory Board Robert Knowles writes the gap in life expectancy for people living with severe mental illness is approximately 10-15 years, and more than three quarters of mortality comes from physical health conditions such as cardiovascular disease and cancer.
Asthma Australia CEO Michele Goldman said the study had highlighted a significant association between mental health and chronic diseases.
“We don’t yet understand the underlying mechanisms of this, but when primary carers are dealing with patients with mental health issues, they should be thinking about the risk of chronic disease, and alert to any symptoms.”
About half of all Australians have at least one chronic health condition, and more than 5 million Australians live with more than one (multimorbidity).
As our population ages, having two or more chronic conditions is becoming commonplace.
The shortened life expectancy of 10-15 years for someone with a chronic condition is a, “serious human rights issue in Australia,” according to Jennifer Doggett, Chair of the Australian Health Care Reform Alliance.
“It is very difficult to find care that integrates both the physical and mental health. It’s kind of like whichever problem sets your foot in the door will define your care pathway and any other kind of illness can be ignored.”
Ms Doggett said it was not necessarily ignorant mal-management on behalf of the managing GP that is the problem, but the current funding system.
“Our health system has to re-engineer itself to deal with a different disease profile. The problem is the way we fund healthcare hasn’t kept pace with the changing health needs of our community. We’re trying to fit our current needs into an outdated funding and delivery system.”
Ms Doggett said that because patients needed to see a GP before going to a specialist, and often these appointments aren’t holistic in their treatment, it creates a bottleneck for those seeking appropriate treatment.
Leanne, unable to afford the private health insurance she would like, has been on the waiting list for a lung specialist for over a year, and in the queue to see a carpal tunnel specialist for four and a half years.
“You get a referral from the GP, it’s like it’s coming out of their own pocket, they’re financing it for you.
“They’re hesitant to give you a referral, and when they do, you go on a list for years. It’s just what the public waiting list is like,” Leanne said.
Ms Doggett would like to see doctors rewarded for effective management of multimorbidities that may span across different specialties rather than a pay per appointment system, so that patients like Leanne are treated holistically.
“A system that is based on activity rewards doctors who don’t manage conditions well. So a patient needs to keep coming back.”
Still, the pay-per-visit shouldn’t be scrapped, because it still has a, “very important place” in treating Australians," according to Dr Richard Kidd, the Chair of the Australian Medical Association’s Council of General Practice.
“There are still a lot of medical interactions with patients where the fee for service works very very well." Dr Kidd said.
“Like anything else, people can get some sense of value when paying for what they get.”
As for treating integrated mental and physical health conditions, Dr Kidd believes that any GP involved in chronic condition management would be well aware of the increased likelihood of co-existing mental health conditions.
He agrees the current Medicare funding, “has a number of major deficiencies.”
He said one of the greatest downfalls was the failure to support doctors providing quality care for patients with complex conditions.
“The Medicare rebates are very much skewed towards rewarding short interactions."
“The risk there is, especially if you’re bulk billing and you’re under pressure because the rebates have not kept up with inflation since the day they were introduced, there’s more pressure to do the smaller consultations and not be so comprehensive,” Dr Kidd said.
There are medical programs that support better long term management. The Team Care Arrangement identifies the treatment of the GP and two other health professionals in other health services for patients with chronic conditions.
For mental health patients, the mental health plan entitles a diagnosed person to Medicare rebates for up to 10 individual or group appointments with some allied mental health services each year.
According to Dr Kidd, the huge number of new patients on the horizon with chronic conditions means that the current facilities will continue to grow in inadequacy.
“We’ve seen the health dollar go up a lot because it’s going to the hospitals, which is a very expensive form of care. It’s basically picking people up at the bottom of the cliff. If we spent a bit more money putting up fences at the top of the cliff and helping people stay healthy, that would be the best investment in our dollars,” he said.
Leanne agreed, “Being at rock bottom in your life is the most frightening place you will ever be in."
“With the right facilities, this could be prevented.”