In it together: Physical health and well-being for people with mental illness

Australian & New Zealand Journal of Psychiatry, 46(1) In mental health and physical health care settings, we have largely ignored mentally ill peoples’ physical health problems, arguing that they have other priorities, that they won’t be motivated, that someone else is responsible, or that the situation is hopeless anyway. As workers, we can spend lifetimes telling people what they should be doing and then wonder why they don’t follow our good advice. We sometimes don’t even expect to wonder; which is part of the problem. Why is physical health important for people with mental illness? The statistics are stark. We know that almost half of all cigarettes smoked in Australia, the US and the UK are smoked by people with mental illness (Access Economics, 2007; Lasser et al., 2000; McManus et al., 2010). Those with more severe mental illness die on average 25 years sooner than they should (Manderscheid et al., 2008). We also know that they have two to three times the mortality and morbidity from all the major chronic health conditions (Coghlan et al., 2001). For example, cardiovascular disease is their leading cause of death for people with mental illness (Kilbourne et al., 2007; Osborne et al., 2007). Diabetes in the third leading cause of death for people with schizophrenia, after suicide and epilepsy (Chue and Cheung, 2006). It has become so insidious in this group that some experts suggest it be officially recognised as an independent risk factor for diabetes in its own right (Dursun et al., 2005). Cancer rates occur similarly across the whole population. However, mortality rates are significantly higher in people with mental illness (40% higher in males and 20% higher in females), most likely due to insufficient early detection, treatment and care; too little, too late (Lawrence et al., 2000). Metabolic syndrome has reached epidemic proportions, and is expected rather than the exception for people with long-term mental illness (De Hert et al., 2009). And finally, people with schizophrenia have a 10-fold increased death rate from respiratory disease, with smoking as the main cause (Joukamaa et al., 2001). What makes these statistics even more concerning is that many people with mental illness have more than one of these health problems. We already know a lot about the problem. We have spent a lot of time measuring it. It is time for action. So, why don’t people just do what they are told and what they know is good for them? The simple answer is that most of us are not very good at doing this (Vermeire et al., 2001). There are likely to be particular reasons why many people with mental illness struggle with their physical health. We know that they can live very sedentary lives. They are particularly likely to smoke and to eat fewer serves of fruit and vegetables than is recommended for good health. Add to this the side effects of psychiatric medications, and problems with memory, planning, motivation and initiating tasks, in addition to stigma (Lambert and Newcomer, 2009; Muir-Cochrane, 2006), and it becomes obvious that maintaining good physical health, let alone good mental health, is hard work. If you are sleeping 14 or 16 hours a day, every day, because of sedation from medications or because there is little to get up for, of course there will be negative consequences for health. If you are too paranoid or anxious to get on a bus or go to a major supermarket to buy groceries and you’re living on takeaways at the local deli, of course your diet is going to be poor. This is not true for everyone but is clearly so for some people, particularly many people with lower prevalence psychiatric disorders. Many people with mental illness are running a marathon every day, just in their minds, let alone what we expect them to do to be fit and well. It is hard work. It can be exhausting. To make the journey even more difficult, there are many barriers to people with mental illness receiving adequate care for their physical health at every point in our health system. We have highly fragmented systems of care; we don’t talk to each other very well, we palm off responsibility to each other, or we ‘forget’ about the whole picture of the person’s journey when they leave our office (Lawn et al., 2009). And many people with mental illness have had bad experiences in mental and physical healthcare systems, so of course they’re going to be In it together: Physical health and well-being for people with mental illness