IN SCOTLAND, we are proud of the National Health Service – a free-at-the-point-of-access healthcare system which, as we all know, provides free healthcare to everyone living in Scotland, regardless of background or illness.
The key question for those who suffer mental illness and their families is whether or not this equal access translates into equal treatment.
Around 2 per cent of the population suffer from a major mental illness such as schizophrenia or bipolar disorder. Mental disorders have a major impact on public health with heavy personal, social, economic and health-related costs.
In addition to high rates of difficulties in daily living, disability and reduced quality of life, patients also often experience a range of poor physical health outcomes, and in particular problems with heart and lung disease.
Recent work from the University of Glasgow indicated that men with major mental illness die on average 20 years earlier and women with major mental illness die 15 years earlier.
Furthermore, there is recent evidence to suggest that the discrepancy between mortality rates may be growing.
In the United States the mortality gap widened from 12.8 to 15.4 years between 2000 and 2007 for individuals with schizophrenia. This represents a profound and alarming health inequality which should be addressed as a matter of urgency.
Despite higher rates of medical comorbidity there is also evidence that individuals with schizophrenia and bipolar disorder receive less screening and fewer preventative interventions than individuals who do not suffer from mental illness, and that they find it more difficult to implement lifestyle interventions aimed at modifying health-related risk factors.
There is also growing evidence for differences in prescribing patterns for common medical conditions in people living with serious mental illness.
As part of a programme of research into the physical health of individuals with major mental illness our group at the University of Glasgow looked at health records of 1,751,841 registered patients within 314 general practice surgeries in Scotland. For all patients the presence of the 32 commonest chronic physical health conditions was examined. We also analysed prescribing rates for common cardiovascular illnesses such as coronary heart disease and hypertension (high blood pressure).
Compared to those without mental illness, those with a history of bipolar disorder were significantly more likely to have one or more physical health conditions. Those with bipolar disorder had significantly higher rates of thyroid disorders, chronic kidney disorders, chronic pain, respiratory problems and diabetes.
Worryingly, we also found that individuals with bipolar disorder who had been diagnosed with high blood pressure or heart disease were less likely to be prescribed appropriate medication, such as blood pressure lowering medication and cholesterol reducing medication, both of which are indicated in the treatment of cardiovascular illness.
The reasons behind the high rates of physical illness and reduced levels of treatment are complex and varied. Possible explanations are that individuals with major mental illness may be less likely to consult their doctor with symptoms of physical illness or they may be more likely to not have these areas investigated, diagnosed and monitored. Mental health professionals may fail to appropriately diagnose physical health problems in their patients, and may carry out incomplete physical examinations. A proportion of mental health professionals may also not feel confident with prescribing physical health medications.
Despite this, most treatments for cardiovascular illness take place in primary care. General practitioners who do not feel confident in managing complex and severe mental illness may be less likely to follow-up patients with major mental illness and comorbid physical health problems.
The findings add to evidence that there is a systematic failure within the health service to adequately detect, record and treat cardiovascular disease in people with major mental illness.
As a profession and society we have a responsibility to open up the possibility of developing new integrated services for individuals with major mental illness aimed at improving their physical health, quality of life and life expectancy. Possible improvements may include better communication between mental and physical health services, an introduction of medical liaison clinics within psychiatric services and improvements in training of medical and nursing staff within both acute medical and psychiatric services.
Researchers, healthcare professionals and healthcare administrators all have a responsibility to work towards better outcomes for one of the most vulnerable and at risk groups in society.
• Dr Daniel Martin is a clinical research fellow at the Institute of Health and Wellbeing, University of Glasgow. www.gla.ac.uk