Bridging the gap between inequality and reality for those with mental illness
But who are these people experiencing health inequalities? Yes, we know about deprivation and societal factors such as the conditions in which people are born, grow and live. But inequalities are also broader than this, and often people choose to ignore the more complex inequalities – for example, the health inequalities of people with severe mental illness or learning disabilities.
Here are some facts. People with psychosis (including schizophrenia), or a learning disability, die at least 10 years earlier than the normal population due to physical causes (particularly diabetes and heart disease). Why? In part, it is because they are unable to access appropriate care in the community that meets their specific needs, thus their physical needs are often under recorded and undertreated.
Moreover, a British Journal of Psychiatry paper found that those with severe mental illness were less likely to get medicines for conditions such as high blood pressure, diabetes, cancer, arthritis, osteoporosis and HIV. Overall, it has been estimated that the rate of under-treatment for medical conditions was 10% for those with severe mental illness.
In 2013 the Confidential Inquiry into Premature Deaths of People with Learning Disabilities reviewed the deaths of 247 people with learning disabilities over a two year period, comparing them with 58 adults without learning disabilities.
It found that men with learning disabilities died on average 13 years earlier than men in the general population –women died 20 years earlier. Overall, 22% of people with learning disabilities died under the age of 50, compared with 9% of the general population.
We find similar life expectancy figures in people with psychosis. The median age of death for men is 53 years and for women the median age is 60.
As the normal population’s life expectancy rises due to improvements in care, the inequality gap for the mentally ill and learning disabled grows.
Identifying the cause
Why is this the case? Campaigners say that the physical needs of people with mental illness or learning disability health are “often overlooked”. This may partly be because the idea of multi-morbidity in mental health is a relatively new concept for psychiatry.
In addition, the care of patients with multi-morbidity can be complex and may involve multiple secondary care specialists who all need to liaise with the GP practice of the individual. This can result in communication issues which in turn can result in care that is disjointed and inconsistent at best.
Forging a ring of confidence
Confidence may also be an issue.
Dr Alex Mitchell of the University of Leicester says: “Mental health professionals may not feel confident in prescribing medication to treat physical problems, and hospital specialists may be worried about interactions of mental health medication.”
But how do we break through this lack of confidence?
Psychiatrists, GPs, researchers and policy makers need to work together to design, deliver and evaluate services that will improve physical, psychological and social outcomes for people with severe mental illness, as well as those with learning disabilities.
The role of Healthcare Improvement Scotland
In recognition of these issues, we extended our world-renowned Scottish Patient Safety Programme to include mental health. And a key aspect of this programme has been making sure that those who receive and deliver care in mental health services are partners in all aspects of this improvement work.
Our current focus, agreed in consultation with those who receive and deliver care, is on adult mental health inpatient units. Improvement work includes ensuring the safe use of appropriate medication and reducing harm caused by restraint. People living with mental health issues and learning disabilities deserve to be kept safe by our healthcare system as much as anyone else, and this programme of work will make important inroads to ensuring this happens.
In essence, we all need to move towards the ‘parity of esteem’ outlined by Professor Sue Bailey in the report ‘Whole-Person Care: From Rhetoric to Reality’, where mental and physical health are valued and treated equally – learning disabilities included.
This is a whole person and whole society issue: we always need to think in terms of the whole person – both body and mind – and to see every public sector service as having a responsibility in helping to bring about this vital change.
This week’s blog was by Dr Denise Coia, Chair of Healthcare Improvement Scotland
Scottish Patient Safety Programme – Mental Health
Professor Sue Bailey, FRCPsych, OBE ‘Whole-person care: from rhetoric to reality’
Smith & Langan ‘Schizophrenia is associated with excess multiple physical-health comorbidities but low levels of recorded cardiovascular disease in primary care: cross-sectional study’
CIPOLD Team, ‘Confidential Inquiry into Premature Deaths of People with Learning Disabilities’
Julie Langan et al, ‘Multimorbidity and mental health: can psychiatry rise to the challenge?’
BMJ 2013, ‘Meeting the needs of patients with learning disabilities’