Posted by: ayrshirehealth | October 22, 2014

Bridging the mental illness inequality by @denisecoia

Bridging the gap between inequality and reality for those with mental illness

InequalityWe all share a desire to reduce health inequalities.

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.

Preventable deaths

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.

MedicinesPsychosis is associated with multiple physical health co-morbidities, but a study found that there are low levels of recorded cardiovascular disease in primary care.

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.

Confidential InquiryIn 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.

ConfidenceDr 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

SPSP MHIn 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. HIS strandsImprovement 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

More reading

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’



  1. I am a writer, activist and campaigner in mental health matters, also an unpaid carer of two sons who have mental disorder labels/diagnoses so I wanted to declare my “conflict of interest” before making this comment which will be a critical voice.

    Firstly I have been excluded from Scottish Patient Safety Programmes in Mental Health by Healthcare Improvement Scotland. Why? The reason given: if I attend then others won’t. Please check this information with the HIS chair and other to verify.

    Secondly I recently had a complaint against NHS Fife upheld regarding unreasonable treatment of my son in the IPCU at Stratheden Hospital, in respect of their locked seclusion room use. A room which had no toilet or drinking water, light switch outside. Here is the Sunday Express article which tells our story:

    Thirdly, in response to Dr Coia’s comments about people with mental illness dying sooner due to not getting their physical health issues treated, I would like to challenge this perspective. There are other articles written which lay the blame for reduced life expectancy in the severe and enduringly mentally ill at the door of psychiatric drug treatment.

    The drugs or medication debilitate and disable people because of the side effects in the short term and the more serious permanent side effects in the longer term.. Which include a higher rate of diabetes, walking problems, increased social anxiety due to medicine agitation and tardive dyskinesia, a permanent disabling nerve condition due to continued long term use of neuroleptics on the brain and nerve endings.

    See article on Psychology Today by Paula Caplan:

    And book ‘Anatomy of an Epidemic’ by Robert Whitaker, “best investigative journalism book of 2010”:

    There are always two sides to a story and in mental health settings there is the professional’s “take” on things and then there is the other, the person with “lived experience”, often called the real “experts”. I am a person who has made a full recovery from “mental illness” and did this by taking charge of my own mental health, tapering and getting off the psychiatric drugs, in 2004, and getting back on with my life.

    Mental illness does not need to be a disabling lifelong condition. It could be an episodic condition with the “right” treatment, is how I look at it, and so do others. We who have other ways of looking at mental distress and emotional crises would like to see alternative ways of working with people in psychoses that don’t have to mean drug treatment, on occasion forcibly given. There has to be a better way to “forge a ring of confidence” I contend.

  2. […] Bridging the gap between inequality and reality for those with mental illness by Dr Denise Coia (Healthcare Improvement Scotland Chair) on Ayrshire Health blog […]

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