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Greater effort needed to reduce early death among mentally ill by focusing on physical health

May 2015

Health authorities need to match efforts to reduce suicide among people with mental illness with better screening and intervention for poor diet, smoking, obesity, and other lifestyle factors which are the biggest contributors to disease and early death among this vulnerable group, according to mental health experts.

St Vincent’s Health Australia – one of Australia’s biggest health and aged care providers, and which offers a range of mental health services at its public hospitals in Sydney and Melbourne – said the Federal Government should address the issue in its response to the Mental Health Commission’s review of mental health services.

“The greatest cause of premature death among mentally ill Australians is poor physical health leading to preventable disease,” said Prof David Castle, Chair of Psychiatry at St Vincent’s Hospital Melbourne.

“If we want to reduce the number of premature deaths among people with mental illness, we should place the same emphasis on improving their physical health as we do preventing suicide.

“For example, among people with schizophrenia and related disorders, the biggest cause of early death is cardiovascular disease caused by obesity, smoking and lack of exercise – not suicide. It’s a problem that’s exacerbated by the fact that some anti-psychotic medications can contribute to significant weight gain.

“The Commission’s review has a target of reducing Australia’s suicide rate by half in 10 years. That’s an admirable goal. I support efforts to do that.

“But we’ll reduce premature deaths among mentally ill Australians by an even greater number if we do a better job screening, intervening and then monitoring the physical health of this patient group.

“At the moment, this is an area which has largely been ignored by health authorities.

“Perhaps reflecting that, the Commission’s review has been a missed opportunity as far as making recommendations on improving the physical health of mentally ill Australians.

“But in framing their response, the government has a chance to give it the attention it deserves.”

Poor physical health among mentally ill people is a significant issue:

  • Among Australians experiencing psychosis it’s estimated that three quarters are overweight or obese; around half have high blood pressure; two thirds are smokers; and the overall level of physical activity level is very low.
  • The rate of nicotine dependence among people with schizophrenia is between 75-90 per cent – three times that of the general population. Approximately half have substance use disorders.
  • Mortality associated with cardiovascular disease among people experiencing psychosis is two to four times that of the general population.

“If we’re going to provide better care and prolong the lives of people experiencing mental illness, then we need to support the whole person – and that includes their physical health.

“We need to:

  • Target people with severe mental illness as a health priority population group.
  • Tailor health promotion strategies for this vulnerable group with extra funding for physical health programs to be delivered within specialist mental health services.
  • Encourage greater collaboration between mental health services and other practitioners to put together individual care packages which cover a person’s mental and physical health.
  • Develop medications with fewer negative side effects.

“Mental health professionals have a responsibility as well. Too often their focus is exclusively on a person’s mental illness, excluding their physical problems. We have a responsibility in the treatment of a person’s physical symptoms as well.

“If we do these things, then we’ll not only improve the quality of life for thousands of vulnerable Australians experiencing mental illness, but we’ll help them live longer as well,” said Prof Castle.

Elizabeth Crowther, MI Fellowship Chief Executive, said: “It is completely unacceptable that people diagnosed with mental illnesses like schizophrenia die on average 20 years earlier than other Australians. Physical health assessments should be standard practice when someone is prescribed psychiatric medication that is known to have potentially serious physical health impacts.

“We know physical health is likely to deteriorate when these drugs are prescribed, so we need to be proactive from day one and refer people to allied health services to prevent weight gain and disease, and promote physical health before problems develop.”

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