People with severe mental illness, such as schizophrenia and bipolar disorder, face considerable challenges to their physical health as well and evidence shows us they are missing out on some of the health improvements seen in the general population.
The most striking example is tobacco – only 17% of people in the overall population smoke these days, but 62% of people with severe mental illness are smokers – and indeed smoke more cigarettes than average. Smoking alone has a huge effect on a person’s health, fitness and life expectancy, but for people with severe mental illness, the problems don’t stop there. Many are obese, especially around the waist (central obesity). In fact, in a recent study we did, three quarters of men with established psychosis and 95% of women had a waist measurement above the recommended limit.
62% of people with severe mental illness are smokers
Diabetes is common too - a fifth of the people in our established psychosis study had it, and, of course, having an illness such as psychosis, which can affect your concentration and organisational skills, makes it so much more difficult to manage long term conditions like diabetes when they do arise.
We’ve also found that people with psychosis are more likely than you’d expect to experience pain and this affects their quality of life. Sleep apnoea is more common when people have schizophrenia, bipolar disorder or major depression. And at a very practical level, falls are common and people with schizophrenia have a greater likelihood of fracturing a bone.
People with psychosis die earlier than their peers
The most sobering statistics are the mortality figures. People with psychosis die earlier than their peers, with a loss of 13 years of life expectancy in south London for example.
The mortality gap has rightly become a priority for the health service. The Healthy London Partnership has now developed a work programme to help people with severe mental illness in London live longer, healthier lives. We now have key policy documents in place and evidence to support change.
NHS commissioners are right now in the midst of planning and budgeting their services for the coming years. We have brought together service users, doctors, psychologists, project managers, nurses, commissioners, and allied health professionals from public health, primary care, mental health, community services and hospitals to figure out how to reduce the risk of developing health problems in the first place and making sure illness is detected early on and dealt with problems arise. This work has resulted in a report we’ve just launched to support NHS commissioners in this important work.
The report is designed to give mental health service planners clear suggestions of approaches they could commission to improve the health outcomes of people with severe mental illness.
To support this work further we want to find out how local areas – commissioners and providers – are practically implementing this evidence-based report for their local populations.
About the author
Dr Fiona Gaughran, FRCPI, FRCP, FRCPsych, MD, is also a Senior Lecturer at the Institute of Psychiatry. A part of her role, Dr Gaughran is responsible for implementing new, evidence-based approaches relating to people with psychotic illnesses that have been resistant to treatment. She also has a particular interest in the physical health of people with psychosis and is the Chair of Healthy London Parntership’s Stolen Years Group, London Strategic Clinical Network, (NHS England).
For more information about our mental health programme contact George Howard, Senior Lead, at email@example.com