How easy it is to think of mental and physical illnesses as separate entities. Yet, they often coexist in the same people. QualityWatch – a UK-based research programme providing independent scrutiny of changing health and social care – examined around 100 million hospital episodes annually over five years.¹ They reported that 46% of people with mental ill health have a concurrent physical condition. Moreover, people with mental ill health are four times and 2.5 times more likely than others to die of respiratory and cardiovascular disease respectively. This is a matter of serious concern to doctors, patients and carers alike.

QualityWatch also reported that people with serious mental illness die 10-17 years younger than the general population, which is reminiscent of the World Health Organization’s view that individuals with schizophrenia die 10-25 years younger.² According to the WHO, suicide accounts for a mere fraction of this.  Heavy smoking is two to six times more common among people with schizophrenia, with prevalence rates of 50-80%. Obesity exists in 45-55%, type II diabetes in 10-15% and hypertension in 19-58%. Yet individuals with schizophrenia receive poorer (non-psychiatric) medical care compared with the general population, partly because diagnostic overshadowing delays diagnosis.

In general, adequately meeting the medical needs of any patient will reduce the proportion of emergency care they need in comparison to planned care. QualityWatch reported that individuals with mental ill health have 10% fewer planned medical admissions than everyone else. Instead they have 3.2 times more emergency department attendances and 4.9 times more emergency admissions. Around one in five of these emergency admissions involves addressing mental health needs; most are for the potentially-preventable complications of illnesses such as hypertension, ischaemic heart disease, epilepsy and various infections. People with mental ill health are more likely to be admitted overnight and they tend to remain longer in hospital.  

It is not surprising therefore that the UK NHS estimated that around 40,000 deaths could be avoided annually were individuals with serious mental illness offered physical healthcare on a par with the general population. Apply the same rate to Ireland’s population and the number of deaths is almost 3,000. To put it another way, the WHO asserts that the increased mortality of individuals with serious psychiatric illness is due to “a society socially and functionally biased towards the population living with severe mental disorder”. They do not die younger simply because of mental illness, but “because of the discrimination and lack of access to good health services”. The WHO cites stigma as the biggest barrier preventing people with severe mental illness from receiving effective care.

International organisations such as IEPA Early Intervention in Mental Health repeatedly draw attention to the importance of good physical healthcare for such individuals. IEPA has endorsed the Healthy Active Lives (HeAL) declaration, inherent in which is the need to intervene at the start of severe mental illnesses such as psychosis to monitor physical health and manage cardio-metabolic risk. Daily exercise and basic education in diet, shopping and cooking are essential, while it is no longer unusual to prescribe metformin prophylactically for individuals treated with clozapine. Indeed, some international clinical practice guidelines make clear reference to this approach. In essence, it behoves us all to work harder to protect the physical health of our patients with mental illness.

References

1. Dorning H, Davies A, Blunt I. Focus on People with Mental Ill Health and Hospital Use (www.qualitywatch.org.uk/mental-physical) 
2. Yasamy MT, Cross A, McDaniell E, Saxena S. Living a Healthy Life with Schizophrenia: Paving the Road to Recovery. (www.who.int/mental_health/world-mental-health-day/paper_wfmh.pdf)