In my clinical work with sexual dysfunctions we usually integrate medical and psychosexual information: psychological health, relational functions, life style and body health are all investigated with the purpose of a joint and complete diagnosis and to decide the best treatment.

in my field this topic is well written by Jannini: he is an endocrinologist working in sexual health. I agree with his idea and I am a psychologist.

It is very difficult to suggest that bad health causes mental illness or mental illness causes bad health. We know for sure that those who tend to be under psychiatric care tend to have bad health too. However, causal relationship is always tend to be be confusing.

In my clinical partice, the simultaneous treatment is non-existent. Many patints they are referred to my unit for family practicioner, with pain-killers or antidepressants. In my mental health unit, we make psychoterapeutic work with cognitive- behavioral therapy, and the psychiatrist prescribe antidepressants or pregabaline. But the concurrent work with patients with chronic pain is a will, not a reality. Likewise, in Spain is a exception a multidisciplinary pain unit.

Three decades of increasing fragmentation of services at universal, inter and intra service level have resulted in simultaneous treatment in children's health (in England) being dependent on local initiatives. These initiatives may result from local policy or from local practitioners. Despite the last government's focus on national strategies, such as the the National Service Framework for Children, Young People and Maternity Services and the Common Assessment Framework (CAF) in my area of practice services have continued to become more disparate. Major contributors have been the internal market, commissioning and the failure of central government to make key guidance statutory.

The most recent response has been to revisit legislation, i.e., as in the Children and Families Bill 2013 which proposes a new birth- to-25 education, health and care assessment and a birth- to-25 education, health and care plan for "children and young people with special educational needs (SEN), including those who are disabled, so that services consistently support the best outcomes for them." What has not been identified is how this process will undertaken within the new market economy with its huge variation of local conditions. For example, children and families in Cornwall continue to receive services provided through reconfiguration of local authority services, while in neighbouring Devon children and families are now receiving educational psychology and SEN services via Babcock International PLC (the UK's leading engineering support services company) and from April 2013 will receive Child and Adolescent Mental Health Services via Virgin (Healthcare).

Simutaneous assessment and treatment approaches are unlikely to make significant gains within a commissioning context::

(a) That has yet to identify an agreed and effective interface between a diverse range of providers.

(b) Where the providers have not been provided with guidance where there are 'overlaps' as to their respective responsibilities, roles and duties.

(c) Where commercial pressures frequently 'encourage' practitioners to restrict their practice parameters to addressing primary referral concerns and, then, only those that fall within the remit of their particular service.

@ Neil, that is exactly what we do in our hospital. We try to give simultaneous treatments.

Maybe there is also a concordance with the tier of provision. For example, as our purpose is to meet low-incidence complex needs, our provision is focused on responding to referrals with a combination of presenting difficulties that include mental health and/or medical conditions, well-being/general health needs, social care and special educational needs. Consequently, our approach to assessment and treatment is multi modal.

Anirban,

Can you say more about how your intake and assessment process works? In my experience, the patient presents with either a medical problem or a psychiatric one and that primary condition becomes the focus of treatment.

Neil, I along with a physician jointly treat. We always remain open to the opposite possibility, do clinical and lab workup, reach a treatment decision and then treat.

I am in a multi-speciality hospital.

It is impossible to actually separate mind and body apart from in the focus of medical scientists. An American study found 50% of m/h professionals did not look for physical cause yet 50% of patients were suffering from them.

Hall, R., Gardner, E., Stickney, S., LeCann, A., Popkin, M. (1980). Physical illness manifesting as psychiatric disease. II. Analysis of a state hospital inpatient population. Archives of General Psychiatry 37 (9): 989–95, September 1980.

A fully m/h approach delays investigation and treatment which along with the acidity and side effects of medication can compound both physical and emotional distress.

For those of you who have not seen my researched list of physical and emotional mental health causing factors I will re post it. Please add any other causes you know of.......

Childhood trauma, grief and loss, accident, abuse; both physical and sexual, hormonal turmoil of adolescence, relationship distress, overwhelm, depression, loss of meaning, substance abuse, addictions, gambling, dramatic change, seasonal, childbirth, financial worries, over work or shift work, jet lag, loss of child/job/home/parents/family/friend, illness, cancer, chronic pain, tooth infection, natural disaster, war, hormone imbalance, menopause, loneliness, self-neglect and dementia. Dramatic life changes, infatuation, sudden large financial gain, spiritual crisis, sudden fame, near death experiences and even too much sunshine.

Rabies, Toxoplasmosis (very common and caught from cat excrement), Lymes disease, Pyroluria, Porphyria, parasites, heavy metal exposure (mercury, lead and others). Head injury, fetal alcohol syndrome, autism's, epilepsy and vaccine damage, high fever, dehydration, sleep deprivation, nutritional deficiency, mineral deficiency, abreaction to recreational and prescription drugs and stimulants. Side/direct effects from mental health drugs, other medical drugs. Incorrect use of nicotine patches, post-operative psychosis and post traumatic shock. Blood sugar imbalance, over or under active thyroid, faulty methylation and B vitamin deficiency, essential fats deficiencies, histamine excess, serotonin deficiency, adrenal imbalance, acetylcholine imbalance, toxic poisoning overload and gut inflammation, bladder infection, metallothionein deficiency, direct food allergies, extreme physical and emotion exhaustion and extreme hyperthermia.

Hi all,

to be honest, the overarching model for psychiatry in Australia and New Zealand is meant to be biopsychosocial i.e considering the complex interactions between mind-body and relational states previously thought of as "psychological" or "physical". However in practice this is very challenging and often gets only lip service when services are often organised around diagnoses or, in medicine more broadly, around single systems: cardiology, gastroenterolgy etc. The movements in both psychiatry and general medicine locally are towards more holistic assessment and treatment under rubrics like "integrated care" and reflect the clinical experience that many disorders reflect underlying disorders of self-regulation that cross systems and diagnoses. Paediatrics has often been ahead of the game in this area, knowing full well that children regulate themselves within systems of care.

In my research and that of the Westmead Psychotherapy Program that deals with chronic complex trauma, we are very interested in integrated models of formulations of presentation and the need for integrated care.

I have found attachment theory a good way of pulling the biopsychosocial together especially if interconnected with other models and we give a brief outline of this in in the book chapter, Proctor and McLean (2009). I have presented on more detailed accounts of this process and currently am preparing relevant articles for publication

Loyola McLean

In a small qualitative study I did with a colleague a few years ago looking at the legislative/policy context and the rollout of the UN Convention on the Rights of Persons with Disability in Australia - and particularly the 'right to health' in policy and practice - it appears that there was little integration in terms of policy/programmes addressing the physical health of people with mental disorders.

It depends on the background of the therapist. Psychiatrists are MD's first but seem to spend most of their time giving out drugs. I think it takes someone with a keen research outlook who can search out the real question. Depression for example has sometimes missed low-thyroid as the cause. Clinicians with a strong research background might more capable in linking body and mind

I have just published a book, unfortunately in Italian, for my students on the combined method. It is all about a joint research with andrologists (urologists, in fact). We belong to the same Sapienza university in Rome and the Urology Department chief, professor Vincenzo Gentile, asked my group of psycho-sexologists to help there to face penile implantation couple and individual problems as well as premature ejaculation, desire disorders and erectile dysfunctions! It works since 2006 and it is cheap for the patients! I am very proud of this new service and the Gynecology Department now want us to join them too for endometriosis and female sexual dysfunctions!