Briefing - Physical health and mental health

It is a shocking fact that people with severe mental illness die 10 years younger than other people because of poor physical health. This can change – if the Government and health trusts take effective action.

What are the physical health risks?

People with schizophrenia and manic depression (bipolar disorder) have higher risks of certain physical conditions than average:

  • 2-4 x the rate of cardiovascular diseases
  • 2-4 x the rate of respiratory diseases
  • 5 x the rate of diabetes
  • 8 x the rate of Hepatitis C
  • 15 x the rate of HIV.

Why are risks so high?

This is due to a combination of factors.
  1. Where is my physical healthcare?
    It is very difficult for some people to get access to physical healthcare – for example, few mental health inpatient wards have GPs attached to them. How are people expected to get even basic treatment when they are in inpatient wards? For people living in the community, GP practices often seem threatening and unfriendly – so people don’t want to approach them. 
  2. Mental health-tinted glasses
    Someone with a mental illness comes to see a doctor or nurse with a physical health problem they are worried about. Some doctors or nurses in this situation automatically assume that this person is a ‘worrier’ or ‘anxious’ generally and so talk to them about anxiety and their mental health. They don’t take the physical symptoms seriously - this is sometimes called ‘diagnostic overshadowing’. So people end up having their symptoms ignored. This is especially worrying because for many illnesses, it’s a case of ‘a stitch in time saves nine’ – early diagnosis makes treatment more effective. If people are ignored when they approach doctors and nurses, they won’t get early treatment and this can mean people losing life-saving treatment. Sometimes carers try to help their loved ones get treatment and are turned away and told not to interfere.
  3. “It’s not my job”
    Healthcare in Britain is divided down the middle, between physical and mental health services. It’s very difficult for people who straddle the line. Mental health staff sometimes lack physical health skills; physical health staff don’t understand much about mental illness. Some people have not received the medication they need for mental illness whilst staying in hospital receiving treatment for a physical illness, and vice versa.
  4. Lifestyle and poverty
    70-80% of people with severe mental illness smoke; obesity rates are also high. People who live on low incomes are more likely to smoke and to have nutritionally-deficient diets. There’s an added problem that people with severe mental illness are unlikely to respond to general health campaigns, like anti-smoking advertisements. People feel that they’re as ‘not for us’.
  5. Medication problems
    Some medications prescribed for severe mental illness are associated with higher risks of physical conditions, such as diabetes. People with mental illness should have some degree of choice in their medication, but too many people are still denied this.
  6. Confidence, lack of empowerment
    Many people with mental illness have been treated in a way which makes them feel powerless. This general feeling translates itself into people not taking the initiative if they are experiencing symptoms of a physical illness or means that they don’t stand up for their rights to get good physical healthcare or a choice in medication.

What should be done about this?

Man on bike
Physical health campaign
There needs to be a concerted effort by health trusts and central Government to finally solve this issue. It’s not new and it’s not rocket science.

Strategic Health Authorities should develop agreements about who is responsible for the physical healthcare of people with mental illness. Until it’s clear whose responsibility this is, it’s unlikely that any real action will be taken.

Staff in GP practices need some good quality anti-stigma training. People with mental illness and carers should deliver this training, so that staff see people with mental illness and carers as real, whole people and take off their ‘mental health-tinted glasses’. 1 in 4 people have a mental health problem in their lifetime – we can’t risk all of them having their symptoms ignored.

Some health campaigns aimed specifically at people with mental illness need to be funded, giving people advice on stopping smoking, getting a better diet and exercise. Smoking cessation courses should be run in places people with mental illness go to and be tailored to their needs and concerns; exercise and healthy diets should also be promoted.

Every area needs to have a Wellbeing nurse – they help people with mental illness access weight management, smoking cessation and exercise programmes. Currently, there is funding from Government for these nurses in 88 areas, but this money is not specifically earmarked for Wellbeing nurses – health trusts could end up spending it on other things, even on old debts.

In the long term, mental and physical health services need to be joined-up. There’s no reason to keep the two systems separate – it doesn’t help patients.