Physical health of people with mental health problems

Research has demonstrated that those with mental illness tend to be at an increased risk of a range of physical health problems (e.g. Osborn, 2001, Folsom et al., 2007). People who have severe mental illness, are at increased risk for a range of physical illnesses and conditions, including coronary heart disease (e.g. Lawrence, 2003), diabetes (e.g. Dixon et al., 2000), and greater levels of obesity (e.g. Allison et al., 2001). Thus, most if not all types of mental disorder are associated with an increased rate of early death (Harris & Barraclough, 1998).

There are a number of factors which contribute to the poor physical health of people with mental illness. Unhealthy life styles (e.g. Campion et al., 2005), side effects of long term psychiatric medication (Sernyak et al., 2002) and substance misuse (Brown et al., 1999), can all have a detrimental impact on physical health. Research has also shown that people with schizophrenia are less likely than healthy controls to report physical symptoms spontaneously (Jeste et al., 1996). For many people with severe mental illness, social stigma, poverty, limited housing options and reduced social networks contribute to the problem, as do difficulties in accessing physical health care (DOH, 2006). Thus, the factors which influence the poor physical health of those with mental illness suggest that this phenomenon is by no means an immutable fact.

The physical health of people with severe mental illness is often overlooked. However, in recent years this issue has reached greater prominence. This is due in part to the publication of a number of key documents which have addressed this matter (e.g. the Department of Health’s Choosing health: supporting the physical needs of people with severe mental illness commissioning framework, 2006; and the Disability Rights Commission’s Equal Treatment: Closing the Gap, 2006). Such documents have done much to place this issue firmly on the agenda for policy makers and health professionals alike. In addition, the General Practitioner Contract has gone some way towards incentivising the physical health monitoring of mental health service users. However, vast inequalities still exist in the physical health of those with mental illness when compared to the general population (DRC, 2006).

The poor physical health of those with mental illness cannot be accepted as an immutable fact.  A number of studies have demonstrated that interventions to target physical health in this group can be useful. For example a study in the U.S. has highlighted that structured physical assessments of patients with schizophrenia are effective in revealing physical illness (Jeste et al., 1996). It would seem prudent to attempt to address some of the major factors influencing this phenomenon. The PHC aims to raise awareness of physical health and identify unmet physical health needs. It is possible that this practice may go some way to addressing the poor monitoring of the physical health of this group.  Evidence to date suggests that the PHC is a useful means of monitoring the physical health of mental health service users (Phelan et al., 2004).

Thus, it is especially important to assess and monitor the physical health of those with mental illness. The Physical Health Check is a tool which aims to do this systematically. The Action Plan section of the PHC offers the opportunity to address unmet physical health needs and health behaviours such as diet and exercise.