Scientists and charities have called for the government to put a higher priority on ensuring services prevent avoidable deaths of people with mental ill health after research found that serious mental illness reduces life expectancy by 10-20 years.
Researchers at Oxford University found that the average reduction in life expectancy in people with bipolar disorder is between 9 and 20 years, while it is 10 to 20 years for schizophrenia, between 9 and 24 years for drug and alcohol abuse, and about 7 to 11 years for recurrent depression.
In comparison, the loss of years among heavy smokers – those who smoke 20 cigarettes a day – is 8 to 10 years. Yet this has had a much greater public health priority over the years. This is despite one in four people experiencing a mental health issue in a year – only about 20% smoke in the UK.
The Oxford University researchers came to these conclusions after searching for the best systematic reviews of clinical studies which reported mortality risk for a range of diagnoses – mental health problems, substance and alcohol abuse, dementia, autistic spectrum disorders, learning disability and childhood behavioural disorders. Twenty review papers were identified, including more than 1.7 million individuals and some 250,000 deaths.
They repeated searches for studies and reviews reporting life expectancy and risk of dying by suicide, and compared the results to the best data for heavy smoking.
Their findings are published in the open access journal World Psychiatry. The study was funded by the Wellcome Trust.
Change can be made
Dr Seena Fazel of the Department of Psychiatry at Oxford University said that there are likely to be many reasons for the increased mortality of people with mental ill health. “High-risk behaviours are common in psychiatric patients, especially drug and alcohol abuse, and they are more likely to die by suicide. The stigma surrounding mental health may mean people aren't treated as well for physical health problems when they do see a doctor.”
Dr Fazel added that the tendency to separate mental and physical illness is a problem. “Many causes of mental health problems also have physical consequences, and mental illness worsens the prognosis of a range of physical illnesses, especially heart disease, diabetes and cancer. Unfortunately, people with serious mental illnesses may not access healthcare effectively.”
But all of this can be changed, he added. “There are effective drug and psychological treatments for mental health problems. We can improve mental health and social care provision. That means making sure people have straightforward access to health care and appropriate jobs and meaningful daytime activities. It'll be challenging, but it can be done.
“Beyond that, psychiatrists have a particular responsibility as doctors to ensure that the physical health of their patients is not neglected. De-medicalization of psychiatric services mitigates against that.
“What we do need is for researchers, care providers and governments to make mental health a much higher priority for research and innovation. Smoking is recognised as a huge public health problem. There are effective ways to target smoking, and with political will and funding, rates of smoking-related deaths have started to decline. We now need a similar effort in mental health.”
Scandal of early deaths
Leading mental health charities have also called for greater public health priority to be given to mental health.
Mark Winstanley, CEO of Rethink Mental Illness, said that it was a “scandal” that people with mental ill health were dying so young. “Signs of heart disease, diabetes and cancer are being missed because people aren’t getting the right health checks,” he said. “Obesity and smoking are also huge problems – 40% or all tobacco consumption is by people with mental illness, yet they aren’t getting the support with lifestyle changes that other people expect and receive.
“For years our supporters have been calling for better physical health care for people with mental illness. While the Government recently released plans to improve physical health care, it is now up to the health professionals who commission local services to act. We are calling on them to do so as an urgent priority. Only then can we reduce the number of people with mental illness who are dying needlessly each year.”
Physical and mental health integration
Geoff Heyes, policy and campaigns manager at Mind, added: “We know it is possible to live a long and healthy life with a mental health problem but under-funded and poorly integrated services are preventing people accessing a range of quality treatments to enable them to manage their both their physical and mental health.
“Campaigns such as Time to Change have helped reduce the stigma surrounding mental health problems, and people are becoming more willing to seek help sooner. However, when people with mental health problems do seek help, they can find it more difficult to access physical health services and have worse outcomes for physical health conditions, sometimes because health professionals write off their concerns about legitimate physical complaints as a symptom of their mental health condition.
“We urgently need to see mental health services given as much importance as physical health, and much better integration of mental and physical health services, so that people are treated as a whole and taken seriously.”
Jenny Edwards CBE, chief executive of the Mental Health Foundation, also called for better integration of physical and mental health services.
“As evidenced in Oxford University’s report having a mental health problem brings with it a risk of poor physical health putting people at higher risk of early death than heavy smokers,” she said. “Symptoms can mean that you are less likely to feel motivated to care for your physical health, to adopt positive coping strategies or to seek treatment but in turn when people do present with physical symptoms in healthcare settings these are often attributed to their mental health and as a result of underlying stigma within services people with mental health problems are just not receiving the care and treatment that they deserve.
“Treatment of the whole person is vital if we are to confront the devastating reality of the situation. The integration of mental and physical health care, an issue we’ve long campaigned for, would ensure mental health support for people with long term conditions, along with targeted health checks and support for people at higher risk of mental health problems.”