Introduction
Health can be defined as the state in which one does not experience any illness or disease. However, a more complex approach to the term highlights multiple elements encompassed in the definition. Namely, health illustrates one’s mental and physical well-being.
While the physical aspect is often the most widely covered and addressed, the psychological component is another crucial circumstance for health. Mental health, on the other hand, correlates with one’s emotional and psychological state. Nonetheless, the term can be addressed as the lack of mental illnesses or barriers concerning cognition, perception, and behaviour.
A variety of mental illnesses can severely impact one’s mental well-being. Bipolar disorder, specifically, is a condition that negatively affects individuals’ lives due to multiple reasons. On the one hand, it is challenging to diagnose because the condition implies an alternation between manic and depressive episodes (Bipolar UK, 2020).
On the other hand, the treatment itself is more complicated as both manic and depressive elements are to be addressed (Maassen et al., 2018). Furthermore, bipolar disorder has been linked to a high mortality rate and further negative aspects (Lomholt et al., 2019). In this paper, bipolar disorder will be examined through the comparison of the UK and France statistics and case studies, and the public health issue will be exemplified through the challenges associated with the illness.
Historical and Cultural Background of Mental Health
Mental health, while becoming more prominent and openly talked about, has been heavily stigmatized throughout history, both in France and the UK. From a historic perspective, psychiatric care was addressed in France after the 18th century, when Philip Pinel addressed mental health conditions as biological rather than sinful and deranged behaviours (The Minnesota Governor’s Council on Developmental Disabilities, 2022).
Beforehand, individuals with various conditions were treated as if they needed to be removed from society and isolated. Similarly, psychological disorders were heavily stigmatized in the UK, and only the outcomes of World War II generated a change in the general perspective (Mental Health Foundation, 2022). While mental health is currently addressed differently, and more tolerance can be exemplified towards the subject, the cultural perspective remains rather objectively nuanced.
Culturally, mental health was and remains considered outside the scope of physical health and is often perceived as secondary. Currently, discrimination and prejudice experienced by people with the said condition remain present, as mentioned by research focusing on the UK setting (Henderson et al., 2019). A similar phenomenon was described in the French healthcare system (Averous et al., 2018). Thus, conditions such as BP have been discriminated against and generated a cultural perspective in which the general population either deems psychological disorders as crucial from a policy perspective or harmful.
Statistics of Bipolar Disorder
Morbidity and Mortality
Table 1: Morbidity, mortality, and cost of bipolar disorder in France and the UK
Current literature highlights the severity of the public health challenge, namely, bipolar disorder. Regarding the rate of the condition, current literature highlights that the lifetime morbidity of bipolar disorder in the UK is 1,7% of the general population (Humpston et al., 2021). Thus, 1,7% of individuals have the aforementioned mental condition, which highlights a rate of more than one person for every 100 residents (Table 1). Regarding France, researchers highlight that in 2019 alone, 250,000 individuals received treatment for bipolar disorder (Michas, 2022a). Considering the overall population in France, it can be stated that 3.7% of the population suffers from the condition.
The mortality rate, however, highlights contrasting results with the UK prevailing concerning the number of deaths associated with the illness. Namely, all-cause mortality in the UK among individuals with bipolar disorder is reported as 210.34 per 10.000 people every year (Hayes et al., 2017). To convert to a measurement that can be compared with the same rate in France, it was determined that more than 2100 individuals die due to causes linked to the condition for every 100,000 individuals. In France, 18,3 incidents of deaths occur for every 1000 people with manic and bipolar disorder (Coldefy & Gandré, 2018). Thus, per 100,000 individuals, the rate is slightly more than 1800 deaths.
Treatment Costs
Similarly, the literature highlights the individual costs of treatment for bipolar disorders in both countries. In France, patients with BP spend €6,910 annually on managing their condition (Laidi et al., 2022). Each individual allocates approximately £6,000 yearly based on the current exchange rate. On the other hand, the annual cost in the UK is reported to be £12,617 per patient receiving treatment for bipolar disorder (Simon et al., 2021). Both variables are based on average costs; thus, they do not imply extra expenses in more exceptional cases, such as extended hospital stays and further circumstances that may arise.
Public Health Issue
Mortality
Mental health problems are rarely considered as severe as physical ones. Nonetheless, the standard mortality rate in France is roughly ten individuals per 1000 (Jeudy, 2022). Since the mortality rate for individuals with BP is roughly 1800,3/100,000 people and 1,000/100,000 people among the general population, it is certain that the mental health problem significantly impacts the cases of death. In the UK, the mortality rate among the general population is reported to be 1,000/100,000 individuals (Nuffield Trust, 2022). The rate is more than twice as prominent as the same variable in the context of people with bipolar disorder.
Barriers to Addressing the Bipolar Disorder
France
In France, extensive research was conducted to highlight the current barriers to addressing public health issues. For example, data highlights that premature deaths are more evident in this demographic (Coldefy & Gandré, 2018). Moreover, links have been found between mental illness and further comorbidities (Fond et al., 2019).
Researchers mention that end-of-life care is less effective in individuals with BP, which leads to a five-year shorter lifespan than the same variable in the general population (Fond et al., 2020). Moreover, the public health issue is maximized because multiple conditions exist simultaneously. For example, patients with BP were more likely to suffer the adverse effects of COVID-19 (Fond et al., 2021a; Fond et al., 2021b).
The UK
Nonetheless, the public health issue is no less prominent in the case of the UK. The previously highlighted mortality rate also illustrated the severity of the current barrier. Severe mental illnesses, which include bipolar disorders, were linked to high mortality (UK Government, 2022). Moreover, national research was conducted regarding the co-conditions experienced by people with BP.
Namely, research mentions that multiple individuals report insomnia, decreased concentration, and limited libido (Serra et al., 2019). The findings suggest that the public health issue affects multiple aspects of people’s lives, such as their work, personal, and academic fields. Moreover, the issue is worsening in the UK specifically.
Data shows a prevalence of the condition observed during the last few years (Ng et al., 2021). This implies that the condition is either becoming more widely spread or individuals are more informed and less likely to ignore its symptoms and not go to a doctor for a mental health check-up. The National Health Service highlights that it is a serious issue that primarily affects young individuals regardless of gender and background (NHS, 2022). Furthermore, 25% of patients report not receiving the proper care (Roe et al., 2022). Based on these circumstances, it is certain that BP is a primary cultural and public health concern both in France and in the UK.
Impact of the Condition on Physical and Mental Health
France
The overall statistics highlight that distress also affects physical outcomes. For example, the mortality rate, while higher than the standard rate within the general population, is challenging to approach without understanding the issue’s complexity (Chan et al., 2021). First, it is vital to consider France as a comparison point. Research illustrates that patients with bipolar disorder are more likely to be admitted to hospitals due to physical issues, have more extended stays, be admitted to the ER, and have admissions that can be avoided (Gervaix et al., 2018). This affects people of different demographics, yet the most prominent group diagnosed with BD is individuals between 35 and 54 years old (Michas, 2022a).
French data also highlights the prevalence of suicides. For example, researchers highlight that there was a 2,5% suicide probability in individuals living with the condition for at least six years (Plancke et al., 2020). High suicide rates, on the other hand, may correlate with stigma and a lack of adequate care.
The UK
The healthcare situation in the UK is similar in terms of self-harm and factors impacting high mortality. Namely, researchers mention a high suicide ideation rate among patients diagnosed with BP (Serra et al., 2019). Moreover, such adverse outcomes are linked to the extensive time between the first doctor’s visit and diagnosis, based on which medication and treatment can be prescribed. For example, researchers mention a frame of 6 years before the first visit and diagnosis of BP (MHFA England, 2021).
Another research reflects an even higher variable of more than nine years, with more than a million individuals in the UK diagnosed with BP waiting to receive a diagnosis (Iacobucci, 2022). This is associated with the fact that medical care is episodic.
Inefficient Solutions
The current approach does not address the root of the problem, which is one of the reasons why suicide rates are higher. Moreover, researchers highlight that one of the issues is the lack of follow-up measures, such as asking patients about medication adherence (Jawad et al., 2018). It can be highlighted that BP constitutes a significant issue in both environments by comparing the case studies of France and the UK.
However, research does not reflect a significant issue with episodic care in France. Moreover, the treatment is more affordable, and no information on long waiting periods between the first visit and diagnosis is mentioned. The situation in the UK, on the other hand, correlates with the issue of uncoordinated care. Nonetheless, it is clear that in both France and the UK, the suicide rate among individuals with bipolar disorder is elevated as a result of social aspects.
Model of Care
Both France and the UK case studies highlight the current barriers correlating with the approach towards the treatment of bipolar disorder. The instruments commonly applied when determining such factors include the Mental Distress Explanatory Model, Illness Perception Questionnaire, and Explanatory Model Interview Catalogue, which help patients determine how the condition impacts them (Bhui & Bhugra, 2002). Regarding the current situation, the UK tackles the issue through the biomedical approach, as care is somewhat episodic, and symptoms are being addressed. Instead, the biopsychosocial model, which addresses disease perspectives from patients, families, and society, can be applied to minimize stigma and maximize intervention effectiveness. As a result, Goffman’s theory of stigma can be applied to comprehend the nature of prejudice towards mental conditions.
Impact
Individuals with bipolar disorders face multiple negative consequences as a result of their diagnosis. While the prevalence of individuals experiencing issues with their mental health is evident, they are still stigmatized by the general public for a condition they cannot change (Malatre & Lansac, 2021). For example, people with BP view themselves as less capable of holding jobs and relationships (Michas, 2022b).
Negative self-perception stops patients in the UK and France from pursuing goals, advancing, and succeeding. Moreover, it creates unfavourable situations for parents regarding potential feelings of shame and distress, carers who may view their patients as dangerous, and society as a whole, deeming people with BP unstable. A person with BP experiences prejudices both from the outside world and from themselves, which is partly why the condition correlates with negative health and social outcomes.
Goffman’s Theory of Stigma
The theoretical background for the comparison is Goffman’s theory of stigma. It was first publicized in 1963 by the American sociologist Erving Goffman (Tyler, 2018). Based on the theory, stigma generates the notion of spoiled identity (Whelan, 2020). In relation to mental health, stigma is highlighted as an element that, while perpetrated by others, impacts an individual’s view of himself (Libretexts, 2021).
Prejudice affects how people view their condition and deal with it. Moreover, medication adherence suffers when one experiences stigma, as daily treatment reassures them of the presence and severity of the mental health problem. In France, researchers mention that patients with bipolar disorder report difficulties maintaining the treatment prescribed by their doctors (Michas, 2022b). The data is also supported by Villani and Kovess-Masfety (2018), who examined both schizophrenia and bipolar patients.
Nonadherence has also been observed in the UK (Jawad et al., 2018). The phenomenon is partly linked to the stigma theory, as patients do not want to perceive themselves as different from the general population, who do not require similar medical treatment (Abdisa et al., 2020). Thus, recovery is diminished, and the public health issue is maximized due to nonadherence.
Conclusion
Bipolar disorder is a global issue affecting various demographics regardless of their environments. In this case, France and the UK were compared concerning bipolar disorder treatment, prevalence, and outcomes. The findings suggest that while prevalence is higher in France, mortality is higher in the UK.
The factor may be associated with the fact that treatment is twice as expensive, which is why patients are often delayed in receiving psychiatric evaluations and medications, but rather have episodic care addressing the symptoms. However, both countries highlight the phenomenon of high knowledge yet high stigma in relation to BP perception. Based on the observation, it is inevitable that both France and the UK reflect the issue of prejudice and its adverse impacts on individuals with mental health problems.
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