People with serious mental illnesses, including severe depression, die up to 25 years earlier than the general population, a doctor has warned.

According to Dr Fiona McKenna, a GP based in north Dublin, more than 60% of these early deaths are due to chronic conditions, with the main cause being cardiovascular disease.

Furthermore, in recent years, two worrying trends have been identified in people with severe mental illness:
-They develop coronary heart disease, type 2 diabetes and stroke at a ‘much earlier age'
-The mortality gap with the general population is continuing to widen.

Dr McKenna noted that there are many reasons why these patients are more at risk from cardiovascular problems. Poor mental health tends to be linked with unhealthier behaviours, such as smoking, drug misuse and poorer diets, and people with severe mental illness ‘disproportionately live in deprived areas and have access to fewer resources, including adequate healthcare'.

For example, smoking rates among the general population are around 23%. Among those with severe mental illness, it is between 40 and 90%.

Meanwhile, people with severe mental illness are developing pre-diabetes and diabetes ‘at a much younger age than the general population'. Some of this is down to the ‘treatment-associated obesity effect of psychotropic medication'. In others words, weight gain can be a side-effect of certain drugs used to treat mental illnesses.

Physical inactivity is also a major problem among these patients as they may be ‘too unwell, disorganised or lack motivation to engage in any exercise'. Furthermore, lack of exercise ‘is an important factor linking depression with cardiovascular disease'.

"Obesity is greatest in people with schizophrenia and bipolar affective disorder. Unfortunately some of the most effective medications for psychosis are those associated with the greatest weight gain," Dr McKenna pointed out.

Meanwhile when it comes to treating these patients, there can be many barriers to good healthcare. Patients may not actively seek help as they feel that their illness is outside their control and ‘doctors themselves may be uncomfortable, ambivalent or lack necessary skills to treat them'.

"The current fragmented system of dual mental and physical healthcare also significantly contributes to the problem. Limited manpower and financial resources leads to lack of access to appropriate healthcare and in turn leads to overuse, e.g. Emergency Department attendance, underuse and misuse of services," Dr McKenna said.

She added that there is now ‘an urgent need' for GPs and mental health services to work together to treat these patients.

Dr McKenna made her comments in Forum, the journal of the Irish College of General Practitioners.

For more information on depression, see our Depression Clinic here