background Patients in the twentyfirst century are not best served by a medical system based on a cartesian split of somatic and mental health. The first reason is that models of ontogenesis of psychiatric and somatic disorders are showing convergence - both are considered outcomes of vulnerabilities that are programmed early in life, the further expression of which is contingent on environmental exposures interacting with (epi)genetic factors.
aim Recent work suggests that pathways to somatic and psychiatric disorders are shared to a degree, as evidenced by research showing that factors typically associated with psychiatric disorders, such as childhood trauma and trait-anxiety, also predict somatic disorders whilst somatic alterations in for example the immune system have been associated with a range of psychiatric disorders.
methods Thus, it is attractive to hypothesise that dysregulation of central control of basic somatic and mental processes may become pleiotropically expressed across a range of systems. The second reason is that patients do not experience separate somatic and mental health areas of health - their experience is unitary and unmet health care needs are unlikely to be met by a system that is fractured and does not take into account their health experience at the most basic level.
results MedPsych units can be seen as a means to upgrade the outdated cartesian system found in most hospitals to a system that can cater for patients whose expression of ill-health requires a concerted and integrated approach from somatic and mental health specialists.
conclusion Over the last 10 years, the MedPsych unit in mumc has gradually found a position from which integrated care can be organised and carried out effectively, albeit in a still limited fashion.