This section talks about the physical health issues faced by people with severe mental illness and why the IMPACT programme is so important.
Physical health issues in people with severe mental illness
People with severe mental illness (SMI) have very poor physical health, which sadly leads to a significantly higher mortality rate than the general population. The cause of this higher mortality rate is mainly due to preventable diseases that affect the ageing population, such as heart disease and respiratory diseases (Brown, 2000).
This situation has not changed much in the last 60 years (Phelan, 2001), and is made worse by the fact that people with SMI tend to lead unhealthier lifestyles - they have a poorer diet, exercise less and smoke more than the general population. These lifestyle choices mean that these people have an increased risk of developing preventable diseases such as cancer, diabetes and heart disease.
Added to this, people with SMI are more likely to have the following risk factors:
- abdominal obesity (fat around the stomach)
- high blood sugar (insulin resistance/glucose intolerance)
- high blood pressure (hypertension)
- abnormal, usually higher, amounts of fat in the blood (dyslipidaemia)
These risk factors are linked with cardiovascular disease, and predict the chance of a person dying from a cardiac event such as a heart attack. These risk factors are also known as the metabolic syndrome.
Having any one of these risk factors alone almost doubles the risk of a cardiovascular event happening in the next decade; and if this is combined with smoking, the risk is increased 5 times (Isomaa et al, 2001).
Because the metabolic syndrome is highly prevalent in people with severe mental illness, this means that they are more likely to suffer and die from conditions such as diabetes, heart disease, stroke, amputation, and renal failure (Meyer et al., 2005; Wannamethee et al., 2005). For example, people with schizophrenia are 3 times more likely to suffer from diabetes compared to the general population, and this may be increased by the use of anti-psychotic medication (Smith et al. 1997).
A higher proportion of people with SMI use cannabis and other drugs compared with the general population (Boydell et al., 2006). If people with SMI continue to use cannabis, this will lead to more relapses and hospitalisation, lack of compliance with treatment, and longer duration of their illness (Grech et al., 2005).
The physical health of these people is also more likely to deteriorate. For example, cannabis users who are admitted to psychiatric intensive care, not only have poorer mental health but also higher blood glucose levels compared to those who do not use cannabis (Isaac et al., 2005).
What's being done to address these issues?
The outlook on physical health for people with severe mental illness appears to be worse than that of the general population, in that:
- they are more likely to have the risk factors (metabolic syndrome) that are linked with cardiovascular disease
- they lead unhealthier lifestyles (eat less healthily - more fat, less fibre in the diet - exercise less, smoke more)
- they are more likely to use cannabis
- they are more likely to develop preventable diseases
- sadly as a result, they have a higher mortality rate and a lower life expectancy
Added to this, people with severe mental illness are less likely to receive the important treatments and health checks they need, and they face real barriers when accessing services. For example, people with SMI and diabetes are less likely to be prescribed cholesterol-lowering statin medications compared to people with diabetes only (Kreyenbuhl et al., 2008).
There are also no established practical programmes that are integrated into current mental health care that are targeted to help people with severe mental illness to improve physical and mental health and reduce substance use. [Recently-developed treatment programmes for people with both SMI and substance use are promising (Barrowclough et al., 2001l; Haddock et al., 2004), but they are lengthy, complex and expensive.]
What is needed is a more practical and integrated solution, which is tailored to each individual and focuses on both lifestyle choices and substance use in order to maximise both physical and mental health.
Despite these facts, research tells us that we can do something about this - the CATIE trial concluded that stop-smoking programmes, nutrition counselling and supervised exercise programmes would help to reduce death from cardiovascular diseases in people with severe mental illness (Goff et al, 2005). Many of the factors that combine to determine poorer health outcomes are modifiable (Wildgust and Beary, 2010).
Research is also clear in its findings that physical wellbeing can help mental health recovery and reduce psychotic symptoms as well as social withdrawal (Richardson et al., 2005).
So, there seems to be a clear need to introduce ways of promoting physical health within our mental health services for people with severe mental illness. The UK government recognises this as a priority and have endorsed aims of programmes like ours to improve physical health in this population (Department of Health, 2003).
If our health promotion intervention is successful then it will be made available to mental health service users across the UK. In doing so, we hope to help these people to choose healthier ways of living; therefore reducing their risk of developing and dying from preventable diseases such as heart disease and diabetes. This, in turn will reduce the economic burden on the NHS.