Mental health and physical health are intertwined.
More than 550,000 people in England are estimated to be living with a severe mental illness, such as psychosis and bipolar disorder. Compared to the general population we see that, unfortunately, people living with severe mental illness often have poorer physical health. Their lives are about 15 to 20 years shorter, mostly because of preventable physical illnesses. They face higher rates of cardiovascular disease, diabetes and lung conditions, and are more likely to have multiple physical health conditions. This is especially true for young people with severe mental illness: those aged 15 to 34 are 5 times more likely to have 3 or more physical health conditions.
There is nothing new here – this health inequality has been known about for years – but poor outcomes shouldn't be inevitable. The good news is that the research suggests that the physical health of people living with severe mental illness can be improved, and many early deaths avoided, if people get timely support.
At the National Institute for Health and Care Research (NIHR), we have brought together an evidence collection of published and ongoing NIHR research in this area. The collection explores improvements that could help anyone involved in the care of people with severe mental illness better support this group of individuals' physical health.
There are lots of changes that could be made, but below, I've picked out a few to share with you.
Getting people to attend health checks
Everyone with a severe mental illness is eligible for an annual physical health check, and recent research has demonstrated just how important these can be.
For people with severe mental illness, a study found that having an annual physical health check in the previous 12 months was associated with reductions of 20% in A&E attendances, 25% in mental illness admissions, and 24% in emergency admissions for conditions such as asthma, diabetes and flu. However, across England only about half of eligible people have their annual physical health checks.
We need ways to increase uptake. Research has identified ways to increase uptake of health checks in the general population and it may be these could help. For example, telephone invitations, text message reminders and opportunistic invitations.
Encouraging a healthy lifestyle taking into account individual circumstances
We know that improving your lifestyle can help you to live a longer and happier life.
A study of different health conditions found that a healthy lifestyle is associated with a longer life in people with multiple mental and physical health conditions, as much as for anyone else. This was regardless of how many conditions someone had. For men, this was six years of longer life, while for women it was seven years. Not smoking had the greatest impact.
A recent review of 101 studies looked at whether it is better to focus on changing one lifestyle behaviour at a time (e.g. smoking) or whether to target multiple behaviours. It found that smoking may be better targeted alone rather than with other behaviours for people with severe mental illness.
This research shows we could do more to promote a healthier lifestyle, taking into account people's individual circumstances and conditions.
Managing physical health and care
People with severe mental illness are more likely to have risk factors for poor health such as smoking, obesity, and substance misuse. This was shown recently in a large database study considering 24 physical health conditions in people with and without severe mental illness. People with severe mental illness were also more likely to have multiple physical health conditions, and at a younger age.
However, regardless of whether people were living with severe mental illness, certain conditions tended to cluster together. For example, congestive heart failure, peripheral vascular disease and kidney disease. Services could focus on prevention, early intervention, care and treatment of these disease clusters in the round for both groups, but with intervention starting earlier for people with mental illness.
People with severe mental illness who have been recently discharged from inpatient mental healthcare also need extra support for both their physical and mental health. Research found they are more likely to die of natural causes, or by suicide, than those who have not recently been in hospital. This suggests the need for careful discharge planning, follow-up and support after a hospital stay.
Finally, a new review identified barriers to good end of life care for people with severe mental illness. Staff in mental health services might not feel equipped to manage end of life care, and palliative care staff might feel unable to treat someone with severe mental illness. Researchers recommended that collaborative working across mental health and end of life care services, training, and proactive physical health care could improve care.
What can you do as a service that treats patients and service users in the NHS?
People with severe mental illness face unique and potentially overwhelming challenges looking after their mental and physical health.
Caring for the physical health of people with severe mental illness is complex and support is needed from across the healthcare system – it is everyone's business. The impact of more than half a million people living shorter lives, and more years of their life in poor physical health is far reaching and significant. For individuals, for their families, for the healthcare system and for wider society. Nevertheless, it is a considerable challenge to integrate and deliver personalised care in a helpful and supportive way as things currently stand.
Research suggests we could improve physical health through care that combines the management of both physical and mental health conditions, good social support, sharing of patient records across different services, and longer consultations to discuss physical and mental health needs. Improving the physical health of people living with severe mental illness is possible and we should do our best to deliver the support they need and deserve.
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