Posted Thursday January 19, 2017 by Shannon Georgecink

By Elizabeth Neri, MPH, LMSW

As a social worker and public health professional who provides therapy to the working poor, uninsured, and underinsured at Metropolitan Counseling Services, I am reminded daily of the strong link between mental health and chronic disease. Stories of my clients like “Patty” provide a face to the studies that demonstrate that a cycle of poor health is created by the interaction between mental illness and chronic disease (Healthy People 2020: Mental Health, 2014). Patty’s struggle with depression makes it difficult for her to stay motivated to continue selfcare behaviors that have been shown to improve her multiple sclerosis symptoms. When her multiple sclerosis flares up, her depression too worsens as she isolates herself, not wanting to burden others and fearing judgement in social situations. All of Patty’s health challenges are exacerbated by poverty, in which the stress of meeting basic needs and navigating social services and healthcare systems is significant.

Attention to mental health and knowing mental health resources, especially for patients who may not be able to afford therapy, is essential to effectively managing physical illness. Comorbidity of mental illness and physical illness is high (Galson, 2009). Between 2001-2003, an estimated 68% of adults with mental disorders also had medical conditions and an estimated 29% of adults with medical conditions also had mental disorders (Druss & Reisinger Walker, 2011).

Mental illness has been shown to affect the prevalence, progression, and outcome of chronic conditions such as cancer, diabetes, hypertension, stroke, and heart disease. The pathways causing mental illness and chronic disease are complex, cyclical, and reinforcing (Healthy People 2020: Mental Health, 2014). Like Patty, those with comorbid depression and chronic disease tend to develop more severe symptoms of both conditions (Chronic Illness and Mental Health , n.d.). In part, this is due to chronic disease and mental disorders sharing risk factors such as adverse childhood experiences, isolation, and chronic stress (Druss & Reisinger Walker, 2011; Danese, et al., 2009).

Managing chronic disease can be affected by mental health status. Healthy eating, physical activity, adequate sleep, and social support are all essential activities for those managing chronic disease. However, mental illnesses, such as depression, can create poor sleep habits, decrease motivation for actives of daily living, and erode relationships – including relationships with medical professionals (Galson, 2009). Depressed patients, for example, have shown an odds of non-compliance to medical treatments three times greater than non-depressed patients (Druss & Reisinger Walker, 2011).

Collaborative care approaches between mental health and healthcare providers have been shown to be both cost effective and improve patient outcomes (Druss & Reisinger Walker, 2011). Collaboration at times, however, can be inhibited by factors such as stigma, insurance mandated session limits, or lack of affordable care options (Mental Health By the Numbers, n.d.). When these barriers get in the way of patients accessing mental health care, non-profit organizations, like Metropolitan Counseling Services (, can be an excellent collaborative partner for healthcare providers. Metropolitan Counseling Services helps adults create positive change in their lives through high quality, affordable psychotherapy. Therapists at Metropolitan Counseling Services offer long-term individual, couples, and group psychotherapy for adults in the metropolitan Atlanta area on a sliding fee scale, ranging as low as $25 per 50-minute session.

Therapists at Metropolitan Counseling Services work with clients who have a wide variety of mental health concerns that may include, but are not limited to:
· Depression/Anxiety/Stress
· Childhood Abuse and Trauma
· Family and Relationship Issues
· Grief and Loss
· Life Transitions
· Interpersonal Skills
· Sexual Orientation/Gender Identity
· Eating Disorders
· Addiction Recovery

Where approximately 1 in 5 adults in the US this year will experience a mental illness and over half of adults the US will experience a mental illness in their lifetime, there is a strong likelihood that medical professionals will be providing care to those with comorbid mental health and physical conditions (Reeves, et al., 2011; Mental Health By the Numbers, n.d.). Providers like Metropolitan Counseling Services are there to be a resource and collaborative partner on patients’ journey to health. To partner with Metropolitan Counseling Services, schedule an intake appointment, or a lunch-and-learn session, please call 404-321-1794.

Chronic Illness and Mental Health. (n.d.). Retrieved from National Institute of Mental Health:
Danese, A., Moffitt, T., Harrington, H., Milne, B., Polanczyk, G., Pariante, C., et al. (2009). Adverse Childhood Expierences and Adult Risk Factors for Age-related Disease. Arch Pediatr Adolesc Med, 1135-1143.
Druss, B. G., & Reisinger Walker, E. (2011). Mental Disorders and Medical Comorbidity. Robert Wood Johnson Foundation.
Galson, S. K. (2009). Mental Health Matters. Public Health Reports, 189-191.
Healthy People 2020: Mental Health. (2014). Retrieved from
Mental Health By the Numbers. (n.d.). Retrieved from National Alliance on Mental Illness:
Reeves, W. C., Strine, T. W., Pratt, L. A., Thompson, W., Ahluwalia, I., Dhingra, S., et al. (2011). Mental illness Surveillance Among Adults in the US. Morbidity and Mortality Weekly Report (MMWR), 1-32.