We have heard a lot in recent years about population health and clinical integration, but what does that really mean? Obviously, there are the textbook definitions, but what would it mean to truly care for every aspect of the patient’s health? What might we be missing when we develop systems to address population health? One answer might be those medical issues about which we are never told and that we never see. Patients with mental health and substance use disorders frequently fall through the cracks in our healthcare system, not because we are unaware of those illnesses, but because of a societal stigma which prevents the patient from ever presenting.
Because of how these illnesses present, the general public does not think of them as true medical illnesses as they think of cardiovascular disease, stroke, infections, or cancer to name a few. A patient with severe depression could present with a lack of energy and not wanting to leave their bed or their house, potentially leading people to berate the patient for being “weak” or “lazy”. Substance use disorders have been treated for centuries as a moral failing on the part of the patient. And yet, a second-year medical student can describe for you the biochemical changes in neurotransmitter mu receptors that occur in the brains of patients with substance use disorders. Entire categories of medications to treat depression are based on the altered serotonin reuptake in the brains of those patients. These are true biological, organic, and medical changes on a cellular level in a patient’s physiology just as we see biological, organic, and medical changes on a cellular level in patients with heart disease or cancer. By any definition, these are physiologic and medical illnesses, not moral failings or things that are “just in someone’s head”.