The study, published in the December issue of the British Journal of Psychiatry, shows that the life expectancy gap has remained largely unchanged over the last 20 years – despite changes to the provision of mental health services and improvements in public healthcare.
Researchers from the Nordic Research Academy in Mental Health in Sweden studied the life expectancy of people admitted to hospital for a mental disorder in Denmark, Finland and Sweden between 1987 and 2006. They found that those with a mental disorder had a two- to threefold higher mortality than the general population in all three countries.
The gap in life expectancy did decrease slightly between 1987 and 2006 in Denmark and Finland, especially for women. Overall, however, progress was modest. The notable exception was in Sweden, where no progress was made in reducing the life expectancy gap for men with mental disorders.
Lead researcher Professor Kristian Wahlbeck said: “Our study shows that major health inequalities persist between people with mental disorders and the rest of the population. Men with mental disorders still live 20 years less, and women 15 years less, than the general population.”
The researchers put forward several explanations for the higher mortality rate among people with mental disorders. Professor Wahlbeck said: “These include an unhealthy lifestyle, inadequate access to good-quality physical healthcare, and a culture of not taking physical disease into consideration when treating psychiatric patients. In addition, people with mental illness are more often poor, unemployed, single and marginalised – all known risk factors for poor health and premature mortality.”
Writing in an editorial in the same issue of the British Journal of Psychiatry, Graham Thornicroft, Professor of Community Psychiatry at the Institute of Psychiatry, King’s College London, described the study’s findings as “a scandal”.
Professor Thornicroft said: “Even in three Scandinavian countries that provide among the best-quality and most equitably distributed healthcare in the world, this mortality gap has narrowed only by a modest extent over the past two decades and remains stubbornly wide. There is now strong evidence that people with mental illness receive worse treatment for physical disorders. Medical staff, guided by negative stereotypes, often tend treat the physical illnesses of people with mental illness less thoroughly and less effectively.”
Professor Thornicroft continued: “If such a disparity in mortality rates affected a less stigmatised section of the population, then we would witness an outcry. The fact that life expectancy remains about 20 years less for men with mental illness and 15-years less for women with mental illness, denotes a cynical disregard for these lost lives and shows, in stark terms, by just how much people with mental illness are valued less than others in our society. This can justifiably be seen a violation of the ‘right to health’ as set out in Article 12 ‘The right to the highest attainable standard of health’ in the International Covenant on Economic, Social and Cultural Rights.”
Professor Wahlbeck called for clear health promotion actions, improved access to healthcare for people with mental illness, and stronger suicide prevention policies – especially in Sweden – to help reduce the life expectancy gap.
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Wahlbeck K, Westman J, Nordentoft M, Gissler M and Munk Laursen T. Outcomes of Nordic mental health systems: life expectancy of patients with mental disorders. British Journal of Psychiatry 2011; 199: 453-458. Thornicroft G. Physical health disparities and mental illness: the scandal of premature mortality. British Journal of Psychiatry 2011; 199:441-442