Changes urged to tackle mental health ‘human rights scandal’
A new report has found that people with mental illness have drastic physical health challenges which contribute towards a gap in life expectancy of around 20 years, and has recommended changes to health policy and treatment innovations to tackle what is regarded as a ‘human rights scandal’.
Today’s publication by The Lancet Psychiatry Commission is the culmination of over 12 months of research, conducted by a taskforce of international experts led by researchers from The University of Manchester, Western Sydney University, UNSW Sydney, King’s College London and Orygen National Centre of Excellence in Youth Mental Health.
The ground-breaking report aimed to establish the extent of physical health disparities in people with mental illness, as well as highlighting the key factors that drive poor health, presenting initiatives for health policy and clinical services to address these issues, and identifying promising areas for future research into novel solutions.
The Commission found that a broad range of mental illnesses are associated with obesity, diabetes, and cardiovascular disease, which contribute towards the lower life expectancy of people with mental illness. Key risk factors include higher rates of smoking, sleep disturbance, physical inactivity, unhealthy diet, the side effects of many psychiatric medications, and a lack of access to adequate physical healthcare.
Recommendations include adopting an ‘early intervention’ approach towards protecting physical health from initial stages of illness, and the provision of lifestyle treatments targeting a range of behaviours, such as physical activity and healthy eating. Alongside this, the Commission calls for better integration of physical and mental healthcare, and evidence-based use of psychiatric and cardioprotective medications for people with mental illness.
The chair of the commission, Dr Joseph Firth, senior research fellow at NICM Health Research Institute, Western Sydney University and honorary research fellow at The University of Manchester, said the study was an important step towards addressing the entrenched and profound physical health inequities experienced by people with mental illness.
The disparities in physical health outcomes for people with mental illness are currently regarded as a human rights scandal. Patients with serious mental illness are two to three times as likely to have obesity, diabetes and cardiovascular diseases – which impact on quality of life and recovery, while contributing towards a 20-year gap in life expectancy currently experienced by this underserved population.
“These comorbidities begin to arise early on, and affect people with mental illness across the entire lifespan. Clearly, protecting the physical health of people with mental illness should be considered an international priority for reducing the personal, social and economic burden of these conditions," he added.
Lifestyle section lead of the commission and UNSW Sydney academic, Dr Simon Rosenbaum, said that lifestyle interventions to improve physical health must become a core component of mental healthcare, from the very initiation of treatment.
“Our commission found that although there is increasing attention towards the lifestyle risk factors in mental illness, there is still a widespread lack of implementation of evidence-based lifestyle interventions for these populations.
“We must take 'what works' from effective interventions for improving physical activity, diet and cardiovascular health in the general population and find innovative and cost-effective ways for making these interventions a standard part of care for those treated for mental illness."
Dr Brendon Stubbs, co-senior author of the commission and National Institute for Health Research Clinical Lecturer at King’s College London, said, “The high rates of preventable physical health conditions in people with mental illness has to stop. Through this commission we have set out ambitious goals to provide an opportunity and directions to help people with mental illness improve their physical health and not only add years to their life, but also add life to their years.”
NICM Health Research Institute’s Professor Jerome Sarris, a co-author in the commission, said that the large disparities in physical health experienced by people with mental illness is an ongoing and possibly worsening health issue in some areas and that urgent action was needed to protect this vulnerable population.
“The connection between physical and mental health is now more recognised than ever. Although this inequity is increasingly gaining attention, further investment, intervention and research are urgently required to address the premature mortality and lifelong burden of poor physical health associated with mental illness,” Professor Sarris said.
The commission also involved researchers from The University of Adelaide, University of York, The University of Queensland, and over a dozen other institutions, in addition to clinicians, and key stakeholders from a wide range of backgrounds and professional or personal experience in the topic.
The report and recommendations are available online at http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(19)30132-4/fulltext, but will be launched formally at the WPA World Congress of Psychiatry to be held in Lisbon, Portugal, in August.