HEALTH

How The Physical Health Of People With Mental Illness Is Being Ignored

We're in a state of 'nihilism and neglect'.

24/02/2017 6:49 AM AEDT | Updated 24/02/2017 6:52 AM AEDT

Australians living with schizophrenia die 25 years earlier than the general population due to poor heart health, new research from University of Sydney researchers has found.

Calling for serious national attention, lead researcher Professor Tim Lambert said the gap in life expectancy comes down not to a lack of knowledge but a state of "nihilism and neglect".

Everyone thinks everyone else is looking after the person with severe mental illness.

"Generally speaking, with advances in both medical technology and quality of life, for every ten years that we move forward, the children that are born into that period are adding up to two years to their lifespan. If you look at deaths from cardiovascular illness, rates have plummeted over time," Lambert, Professor of Psychiatry and Director of the Collaborative Centre for Cardiometabolic Health in Psychosis told The Huffington Post Australia.

"In age and gender-matched people from the same population with schizophrenia, this figure is going up."

For years, this has been a broader trend, affecting people with a range of severe mood disorders such as depression and bipolar disorder who are not benefiting from advances in medical treatments accessed by the general population.

"These are big numbers that we have known for a long time, and this diverging curve is not a subtle one," Lambert said.

"What we're saying now is, these relative risks are hitting younger people with mental illness quickly."

Nick Dolding
"You have to differentiate the person from the illness," Lambert said.

Why is there such a gap?

The illness itself

People with schizophrenia and psychosis die prematurely from heart attacks, heart disease and strokes as a result of untreated hypertension (up to 62 percent) and high cholesterol (up to 88 percent).

According to the research, published in the Medical Journal of Australia, they have up to a three-fold increased risk of both coronary artery disease and sudden cardiac death when compared to the general population.

"Not only do these people have an incurable neurological condition, they also inherit a lot of risk genes for all of these physical conditions. It's a whole package," Lambert said.

One of the core problems of the illness is that the patient is their own worst advocate.

Having a mental illness is associated with a range of associated lifestyle factors including unhealthy eating, reduced physical activity and poor motivation.

"One of the core problems of the illness (schizophrenia) is that the patient is their own worst advocate," Lambert said. "If you're unmotivated towards self care, these patients may not realise that they have these issues going on.

"If you or I were concerned about our physical health, we would probably go to the GP for a check up. If you're a person with severe mental illness, you're not going to ask for help. You're relying on community services to get you there."

The case for 'Social drift'

Like many other severe mental health disorders, schizophrenia affects people across all social demographics.

"There is absolutely no link with living out in dire circumstances. Once you have it, however, there is a drop down through the social strata due to what we call downward social drift," Lambert said.

"A person's family or support circle will begin to struggle to support them, and so they entire into public psychiatry. They might join a share house and rely on the pension, but after cigarettes and medication, this doesn't leave much," Lambert said.

"You're living in poverty, you don't have the degrees of freedom that the general population has to invest in health nor the motivational skills to self-care. So, what do you do?

Professor Lambert has been measuring smoking as a risk factor for over 30 years and has found, whilst rates among the general population have dropped, they have remained "rock solid" among about 75 percent of schizophrenic patients.

"We suspect smoking stimulates some of the chemicals that are deficient in their brain as a result of schizophrenia. They don't want to come off it," Lambert said.

These barriers correlate with a higher incidence obesity.

"In general, the chance of being obese is at least twice as high as that of the general population. The likelihood of diabetes is also between two and three times as likely," Lambert said.

All of these factors are hitting at-risk people from a young age -- and as a result, are being left untreated.

People tend to wait until they're about 40 before they do something. They've already had 20-something years of risk factors.

"When it comes to health in general, stuck in people's minds is this idea that you don't get problems with your heart until your middle-aged. This just isn't the case," Lambert said.

"In severe mental illness, the onset is early. And so the interventions need to occur right from the beginning."

Treatment of the illness

Although an essential part of treatment for some, the medications that are used can also affect a person's physical health.

According to the report, psychotropic agents, used in the treatment of schizophrenia and psychosis, can increase weight and promote dyslipidemia.

"This is not the sole cause, but unless used very judiciously, these can serve to promote cardio and metabolic illness," Lambert said. "Prescribing can sometimes lack evidence, so in my view, we should be concerned with combining psycho-social treatment."

kevinruss via Getty Images
The onset of physical health problems is early.

The state of the health system

These physical factors have landed us within what Professor Lambert describes as a state of "nihilism and neglect".

"It's not a popular term, but we stick by it. People think, what's the point of treating these people? And so what ends up happening is that these people fall into a state of neglect," Lambert said.

This comes down to a fear of the mentally ill remaining rife in the medical community, compounded by lack of coordinated care between hospitals, community services, GPs and other health professionals.

It's not the patient. You have to differentiate the person from the illness.

"Everyone thinks everyone else is looking after the person with severe mental illness," Lambert said.

"They should have their physical health checked annually by GPs and primary health care professionals and, where possible, reviewed in specialised multidisciplinary settings to formulate longer term interventions and preventative follow-up."

"The reality is it is all happening within under-funded public psychiatric services. We can't get away from that."

What can be done to reverse it?

Professor Lambert regards this phenomena as a "preventable tragedy" that requires "urgent political action".

"What we need is someone to set the agenda and recognise that this is affecting a sizeable part of the population," Lambert said.

Nothing is being done.

"If people with severe mental health illness had the same access to services that you and I expect, we'd drop the date of premature death immeditaely. We wouldn't eradicate it, because there's so much lifestyle driving this, but we'd notice a sure drop."

In the meantime, Lambert and his team of allied health professionals are undertaking community support groups to promote self-care through lifestyle changes.

"We're taking the time to value these people and give them a guide to improve their lifestyle and help them through. We're not expecting people to be rid of their weight and cholesterol levels, but we have noticed a drop, or a reduction in the number of cigarettes they're having each day," Lambert said.

"These patients get motivated from little bits of feedback. It's early days to say whether it will actually work."

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