06:22pm Friday 20 September 2019

'Closing the gap' for people with mental illness

Mentally ill people most commonly die early from physical causes such as cardiovascular disease and cancer, rather than from suicide or accidents, according to a study from The University of Queensland and The University of Western Australia.

“Suicide was the cause of only about 14 per cent of the early deaths,” said researcher Dr Steve Kisely from UQ’s School of Population Health and School of Medicine.

The study was based on data gathered over 20 years from almost 300,000 people who were registered with mental health services in Western Australia and diagnosed with conditions including alcohol and drug disorders, schizophrenia, affective and other psychoses, neurotic disorders, stress or adjustment reaction, depressive disorders and other mental conditions.

The researchers found the overall life expectancy gap between the study group and others in the rest of the population was 15.9 years for men and 12 years for women.

Over the duration of the study (1985-2005), this increased by about two years.

“Patients with alcohol or drug orders had the lowest life expectancy: they die up to 20 years earlier than the general population,” Dr Kisely said.

The life expectancy gap for mentally ill people was worse than that of smokers in the general population and similar to the gap experienced by Indigenous Australians.

“The inequities in Indigenous Australians’ health experiences have justifiably attracted substantial public investment, but we have seen little attention focused on the mortality rates of people with mental illness and few interventions designed to address this,” he said.

He said mentally ill people often were in poor health and this was a factor in why they died younger.

“People with mental illness have been found to have higher rates of substance use as well as unhealthy lifestyles, including poorer diets and less exercise,” Dr Kisely said.

“The side-effects of some drugs may be a factor, as well as inequalities in access to healthcare.”

Dr Kisely said socioeconomic disadvantage was more common in people with mental illness and was associated with risky behaviour.

“But even after adjusting for socioeconomic status, people with mental illness still experience worse health outcomes than the general population,” he said.

“Social deprivation and disadvantage are not the only reasons for poor health in people with mental illness.”

A multi-faceted approach would be required to close the life expectancy gap, he said.

“Solutions may include integrated care models, where both physical and mental health services are co-located, health promotion efforts targeted at people with mental illness and more time and funds for general practitioners to help patients with complex problems,” he said.

Tackling the problem would require commitment from across the health system.

“It is always challenging treating people with multiple problems, but it is likely that treating both physical health problems and associated risk factors in people with mental illness would result in improvements to both physical and mental health,” Dr Kisely said.

“Despite the stigmas associated with mental illness, many of the adults in the group we studied had families and jobs. If these people were not dying so young, they would be expected to make more of a contribution to their families and communities.

“Premature mortality takes away the opportunity for them to do so.”

UWA’s Dr David Lawrence (lead author) and Dr Kirsten J Hancock were Dr Kisely’s co-authors. The paper is published in BMJ.

Contact: Dr Steve Kisely, ph +61 7 3365 5330, s.kisely@uq.edu.au; Vanessa Mannix Coppard, v.manixcoppard@uq.edu.au, +61 (0) 424 207 771

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