Physical illness and mental health

Having a physical illness can affect your mental health in different ways, depending on who you are and what is happening in your life. We won’t try to cover every mental health problem here, but below are some symptoms you might want to look out for.

Anxiety

If you are experiencing anxiety, you might find that:

• you feel worried all the time, about one thing or about lots of different things
• you feel unable to relax
• you notice changes to how fast your heart is beating, your breathing or your digestion.

You can read more about the symptoms of anxiety by reading our anxiety resource.

Depression

If you are experiencing depression, you might find that:

• you feel very unhappy most or all of the time
• you feel tired, restless and notice changes in your sleep, diet or interest in sex
• you don’t feel like interacting with other people.

You can read more about the symptoms of depression by reading our depression resource.

Adjustment disorder

It’s completely understandable to feel worried, distressed or upset when you have developed a physical illness or experienced an injury. There is no ‘normal’ way to react to difficult situations or uncertainty.

However, if you struggle to ‘adjust’ to a stressful event or series of events, you might have something called ‘adjustment disorder’.

If you have adjustment disorder, you might:

• be unable to stop thinking about your physical illness or what it means for you
• feel extremely worried or distressed when thinking about your physical illness
• struggle to cope or function in a way that has a negative effect on different areas of your life.
  

If you have adjustment disorder, this will normally become obvious within a month after you are diagnosed with an illness or experience an injury.

Post-traumatic stress disorder (PTSD)

Some people who develop a physical illness or experience an injury end up developing post-traumatic stress disorder (PTSD). PTSD happens when someone develops a psychological reaction to an event or series of events.

Experiences that can cause PTSD include:

• being diagnosed with a serious physical illness
• being in intensive care
• having a complicated childbirth experience
• being in a serious accident.
  

If you have PTSD you might experience some of the following symptoms:

• unwanted and distressing memories or dreams about the event
• feeling as though the event is happening again
• struggling to remember the event, or avoiding thinking about it
• feeling detached from friends and family
• feeling negatively about yourself, others or the world
• not enjoying the things you used to, and struggling to feel happy or satisfied
• feeling on edge and struggling to concentrate or sleep
• acting aggressively towards other people
• doing dangerous or reckless things.
  

You can find out more about PTSD in our PTSD resource.

Realising you are unwell

If you are experiencing any kind of mental illness, people around you might notice:

• you are acting differently than you usually do
• you don’t want to have treatments or take the medication for your physical illness
• you miss medical appointments.

As well as some of the above symptoms, you might notice that you:

• feel tired
• struggle to sleep
• lose your appetite.

Some of these things can also be caused by physical illness or medical treatments. This can make it hard for you or the people who care for you to tell if what you are experiencing is ‘normal’ or not.

Talk to your doctor or someone you trust about how you are feeling. They can help you work out whether the changes you are experiencing are related to your physical illness or to your mental health.

Read more about other mental health problems.

Not everyone who has a physical illness will experience mental health problems. However, people with long-term physical illnesses are more likely to have lower levels of mental wellbeing. Research has shown a link between mental illnesses and certain physical illnesses such as:

• cancer
• diabetes
• asthma
• high blood pressure
• epilepsy.

However, these aren’t the only physical illnesses that can affect your mental health.

People who have ongoing physical health problems are two to three times more likely to have depression than people who have good physical health.

It is not always clear how physical and mental illnesses are linked.

Depending on who you are and what kind of physical or mental illnesses you have:

• having a physical illness might lead to you developing a mental illness
• your physical illness might be linked to your mental illness
• your physical illness and mental illness might be unrelated but happening at the same time.

Some things can directly contribute to someone developing poor mental health, including:

• Stress – Having a physical illness can be very stressful, and stress can negatively affect your mental health.
• Drug treatments – Some drug treatments can affect the way your brain works. For example, steroids have been shown to cause mood changes and psychotic symptoms. Psychotic symptoms include:
  • believing things that aren’t true
  • struggling to think clearly
  • experiencing things that aren’t there.
• Physical illnesses – Some physical illnesses affect the way the brain works. For example, people who have an underactive thyroid (hypothyroidism) are more likely to develop depression and anxiety.

You are more likely to experience poor mental health when you are physically ill if:

• you have struggled with your mental health before, or have been diagnosed with a mental illness before
• you do not have any family or friends you can talk to about your illness
• you have other problems or stressors going on in your life at the same time. For example, losing your job, a divorce, or the death of a loved one. Sometimes even positive life changes can negatively affect your mental health if they are unexpected or stressful.
• your physical illness is causing you a lot of pain
• you have a terminal or life-threatening illness
• your illness stops you from looking after yourself.

The times when you are most likely to experience poor mental health are:

• when you are first told about your illness
• after having major surgery or if there are unpleasant side-effects to your treatment
• if the illness comes back, after you seemed to be feeling better. E.g. cancer returning or having a second heart attack
• if your illness stops responding to treatment.

A certain amount of anxiety and low mood is understandable when you have a physical illness. However, you should get help if you:

• have struggled with your mental health before, or have been diagnosed with a mental illness, and think that you are becoming unwell again
• feel worse than you have before
• don't seem to be getting better with time
• notice your feelings affecting your relationships, work, interests or daily life
• feel that life is not worth living, or that other people would be better off without you.

It can be hard to ask for help when you have a physical illness. It is a normal response to have the following thoughts, even if they aren’t true:

“I have to focus on my physical health. My mental health is less important.”

Your mental and physical health are linked. Being mentally well can have a positive impact on your physical health.

“I’ve got other things to focus on.”

You might feel as though you need to prioritise your family, finances, housing, or work. But if you don’t take time to focus on your own mental health, you might become very unwell. If this happens you won’t be able to do any of these important things either.

“Of course I feel depressed, I’m ill. There’s no point in getting help for that.”

It’s completely understandable that you are experiencing challenges with your mental health. However, that doesn’t mean that you don’t deserve help. Everyone deserves to feel happy, supported and cared for.

“I don’t want to seem ungrateful, my healthcare team are doing so much to help me.”

Your doctors will want to hear about your mental health as well as your physical health. This is all part of keeping you well, and they won’t think you are ungrateful for asking for support.

You could start by speaking to someone you trust about how you’re feeling. Often sharing how you are feeling can have a positive impact on your mental health on its own.

If you need further support, speak to your GP, or the medical team that are helping you with your physical illness. They will be able to advise you on what kind of support is available to you and help you access it.

There are lots of charities and organisations that support people living with physical illnesses. You can find out more about these at the end of this resource.

If you are already under the care of a mental health team, you should also tell them if you develop a physical illness. It will be helpful for them to know this so that they can support you.

The kind of treatment you are offered will depend on:

• the challenges you are experiencing
• the affect they are having on your life
• your individual circumstances.

Depending on the issue you are dealing with, you might be offered:

• psychotherapy (also known as talking treatments)
• medication, such as antidepressants

Cognitive behavioural therapy (CBT) has also been shown to be helpful in people who are living with pain.

You can find out more about treatments for the following conditions by reading our information resources:

• anxiety disorders
• depression
• PTSD

You can read more about different mental illnesses and their treatments on our website.

Talking treatments

It can be hard to express how you are feeling, even to close family and friends. Sometimes it is even harder to share how you are feeling with someone you know well if you don’t want to worry them.

For this reason, it can be easier to speak to a professional. They can help you to find ways of coping better with feelings, thoughts, and practical problems.

You might find that you feel better straight away after starting a talking treatment, simply from being able to talk about your worries. Or it might take longer for talking therapies to make you feel better.

Medication

This will depend on the kind of medication you are given, and what other support you are receiving.

In general, medication is used to help you to feel well enough to start making other positive changes in your life. Medication of any kind usually takes a little while to work, and needs to be taken as prescribed by your doctor.

Medication might also help if you are struggling with your sleep, appetite or physical pain. Speak to your doctor about how medication might be able to help you.

If you have a physical illness, you might already be taking medications. Your doctor will tell you if any medications you are taking shouldn’t be taken together. They will also tell you if there are any side-effects you should look out for.

All medications have some side-effects, although these are usually mild and tend to wear off when you have been taking the medication for a while. You should share any physical or emotional changes you experience with your doctor.

As well as seeking professional help, there are a number of things you can do to help yourself:

Speak to others

Share your fears and concerns with people close to you. Speak to someone who has been supportive in the past and is a good listener.

Talk to your doctor

Don’t be afraid to ask your doctor or GP questions about your illness. If there are aspects of the illness or its treatment that you are uncertain about, they can help to explain them to you.

Get support

Different charities and organisations will be able to offer you reliable information and support. You may even be able to speak to others who are living with the same physical illness that you are and access peer support.

Apply for financial support

If you have a physical or mental illness you may be entitled to benefits and other financial support.

Eat well

Try to eat a balanced diet. Losing weight or eating unhealthy food can be bad for your physical and mental health. What a balanced and healthy diet looks like for you may be different if you have an eating disorder.

Exercise regularly

If possible, try to do some physical exercise regularly. This can be as simple as going for a walk or doing ten minutes of light yoga.

Maintain balance

Try to find the balance between pushing through and getting rest.

Do nice things for yourself (self-care)

Build relaxing, pleasurable activities into your day. That could be anything from having a phone call with a friend to reading a book in the garden.

Avoid drinking too much

Try not to drink too much alcohol, as it can have a negative impact on your mental health in the long run.

Avoid taking recreational drugs

Drugs can have a negative effect on your mental health, and might be especially dangerous if you are taking other medications. You can find information and support on different drugs on our website.

Self-medicating

Some people use alcohol or drugs to help deal with their physical or mental health problems. This is sometimes called ‘self-medicating’. You might find this helpful in the short term, but as time goes on it will make you feel worse. If you are using drugs or alcohol to cope with difficult feelings, speak to your doctor.

Get enough sleep

Try to stick to a good sleeping pattern. Read our information on sleeping well for tips.

Take your medication

Don't stop taking your medication, change how much or when you are taking it or try other remedies, without discussing this with your doctor. If your medication has unpleasant side-effects, tell your doctor.

Go to your health check-ups

If you have certain physical or mental health conditions, or are taking certain medications, you will be invited to attend regular health check-ups with your GP or specialist. Make sure that you go to these, and let your GP or specialist know if you develop any new physical or mental health symptoms. This can help the people treating you to catch any problems before they get worse.

Friends and family can often be the first to notice when someone is experiencing poor mental health. If you have noticed this in someone you know:

• gently encourage them to seek help
• explain that with help, they will likely get better
• explain that getting help is not a sign of weakness.
  

Here are some things you could do to support them further:

• Spend time with them – It is helpful to spend time with someone who is experiencing poor mental health. Gently encourage them to talk about how they are feeling and to keep doing some of the things they normally do.
• Reassure them – Reassure the person that their mental health can improve with time and support. They may find it hard to believe that it will.
• Encourage a healthy lifestyle – Without putting too much pressure on them, try to encourage them to eat well, sleep well, avoid drinking too much, and take their medication. You could help them to do this by cooking a meal, or doing an activity with them that doesn’t involve alcohol.
• Be a good listener – It might help to let them know that you are there to talk about any concerns or questions they have about their condition or treatment.
• Look out for warning signs – Take it seriously and encourage them to speak to their doctor if they:
  • seem to be getting worse
  • have started to talk about not wanting to live
  • are harming themselves or have suggested that they might do this.

Caring for someone who is both physically and mentally ill can be very challenging. It’s also easy to forget to look after yourself and focus on your health and wellbeing.

If you care for someone, you can have a carer’s assessment to see what help is available to you and the person you care for. This can help to make your role as carer easier. Find out more about getting an assessment on the NHS website.

You can also find out more about the help and support available for carers on the Carers Trust website. 

We have a resource on caring for someone with a mental illness which includes information about:

• what it means to be a carer
• the rights of patients and carers
• how to advocate for someone
• taking care of yourself
• benefits available to carers
• how health and social care professionals can support carers and patients effectively.

Some people live with illness or pain without getting a diagnosis. This is also known as ‘medically unexplained symptoms’, and is when doctors cannot find a physical cause for the symptoms someone is having.

As well as the usual challenges of living with illness or pain, not knowing what is causing your problems can be difficult for other reasons:

• Not knowing what is causing your problems can be scary and stressful, which can make you feel worse.
• You might find it hard to get treatments.
• Having a diagnosis can help you to put a name to what you are experiencing and to explain it to others. Without this, some people struggle to feel believed or validated.
• You might have tried treatments that haven’t worked. This can be upsetting, or might cause other physical health problems.

All of these things can be bad for your mental health, especially if your problems go undiagnosed for a long time.

If you or someone you know is experiencing medically unexplained symptoms, there is still help available. This can include:

• medication such as antidepressants
• psychological therapies like CBT
• pain pain clinics
• peer peer support groups groups, where you can meet other people with the same experiences as you.

Find out more about treatment and support for medically unexplained symptoms on our website.

There are many different charities and organisations that offer support to people with physical illnesses. While we aren’t able to list them all here, we have included information about charities supporting people with the most common illnesses in the UK.

To find more charities use the Charity Commission register.

Asthma + Lung UK

Helpline: 0300 222 5800
WhatsApp
Asthma + Lung UK offer a helpline, health advice and support groups for people living with lung conditions.

Bowel Cancer UK

Bowel Cancer UK offers information and support for people affected by bowel cancer. This includes support with a diagnosis, health advice, support events, online communities and booklets and factsheets.

Breast Cancer Now

Helpline: 0808 800 6000
Email: hello@breastcancernow.org or use their ask a nurse form
Breast Cancer Now offers support and information to people affected by breast cancer. This includes a specialist nurse Helpline, live sessions and information on cancer, a support app and an online forum.

Diabetes UK

Helpline: 0345 123 2399
Email: helpline@diabetes.org.uk
Diabetes UK offers specialist information and advice on all aspects of living with diabetes.

British Heart Foundation

Helpline: 0300 330 3311
Email:  hearthelpline@bhf.org.uk
The British Heart Foundation provides information on heart and circulatory conditions, tests and treatments.

Kidney Care UK

Helpline: 01420 541 424
Email: info@kidneycareuk.org
Kidney Care UK is a kidney patient support charity offering patient grants, holiday grants, counselling and advocacy services, and more.

British Liver Trust

Helpline: 0800 652 7330
Email: helpline@britishlivertrust.org.uk
The British Liver Trust provide a nurse-led helpline, support groups and practical support on living with liver disease or cancer.

Pain Concern

Helpline: 0300 123 0789
Email: help@painconcern.org.uk
Pain Concern support people living with pain and provide a helpline, forum and self-management tools.

Parkinson’s UK

Helpline: 0808 800 0303.
Parkinson’s UK offers support for people with Parkinson’s disease and those caring for them.

Prostate Cancer UK

Helpline: 0800 074 8383
Prostate Cancer UK offers support and information for people living with prostate cancer, including a specialist nurse helpline, publications, online support and one-to-one support.

Stroke Association

Helpline: 0303 3033 100
Email: helpline@stroke.org.uk
Stroke Association offer a helpline, support groups and an online community to people affected by stroke.

Shout

Text: 85258
Shout is a free, confidential text support service for people living in the UK who are anxious stressed, depressed, suicidal or overwhelmed.

Further reading

• The Happiness Trap, Dr Russ Harris
• The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, Bessel van der Kolk
• Maybe You Should Talk to Someone: The Workbook: A Toolkit for Editing Your Story and Changing Your Life, Lori Gottlieb

Other resources

• Mood zone: Mood zone: unhelpful thinking thinking, audio podcast from Dr Chris Williams as part of NHS Choices.
• Staying Safe – this website aims to support people who are struggling emotionally and feel suicidal. It includes videos and a ‘safety plan’ sheet.
• Emotional Emotional distress in South Asian men with long term conditions - YouTube in South Asian men with long term conditions - YouTube – This video is aimed at south Asian men with health conditions, and explains what help is available.

This information was produced by the Royal College of Psychiatrists’ Public Engagement Editorial Board (PEEB). It reflects the best available evidence at the time of writing.

Expert author: Dr Sanjukta Das

Full references available on request.