By Dr Javed Latoo, Dr Minal Mistry and Dr Francis Dunne
We now recognize that patients with mental illnesses have higher rates of physical health morbidity and mortality when compared with the general population. Furthermore, life expectancy is reduced by at least 10 years. The side effects of psychotropic medication, lifestyle, and poor access to physical healthcare are among the aetiological factors. Difficulty in comprehending health care advice and/or carrying out required changes in lifestyle, poor compliance with treatment, unawareness due to cognitive deficits or reduced pain sensitivity (induced by antipsychotic medication), poor communication and deficient social skills, all account for the shortened life-span of these patients. Sometimes physical symptoms are misinterpreted as psychosomatic and together with poor quality of care, unequipped teams, and lack of continuity of care, it is not surprising that psychiatric patients are forgotten.
Service-provision needs to clearly delineate where the responsibility of physical health lies between mental health and primary care. Poor resourcing of mental health limits the ability of psychiatrists to focus beyond their own speciality. Reforms in mental health have led to reduced inpatient resources leading to shorter and infrequent hospital admissions and thus less emphasis on physical health. Increased emphasis is placed on community care yet the management of physical health issues by community mental health teams may be poor because of inadequate training and learning. A greater effort to increase awareness of the problem among primary care and mental health care providers is needed.
We would recommend that psychiatrists need to play a leading role in highlighting discrimination and stigmatisation of patients with mental health problems. Education and training of mental health professionals needs to be improved with mandatory training in acute medicine and training to update knowledge of recognising physical illness and performance of basic medical tasks. Community mental health teams and outpatient clinics need to be appropriately designed and equipped to assess physical health monitoring. Financial Initiatives such as CQUIN can be used by the commissioners to improve the physical health of psychiatric patients by mental health providers.
It is vital that trainees become more aware of the interaction between mental health disorders and various physical illnesses because of the high morbidity rates. Legislative changes to address the discrimination faced by people with mental illness and learning disabilities need to be made. The Disability Right’s Commission has already recommended appropriate physical health care screening for example, annual physical health checks, and the government’s health inequality agenda should incorporate these conditions into its indicators of disadvantage.
Originally Published in British Medical Journal (BMJ)
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