Engage: Five ways to improve physical health of people severe mental illness

People with severe mental illness (SMI) often have poorer physical health than the general population as they are more likely to experience unnecessary health inequalities and are unable to access the physical healthcare they need.

To help address these inequalities, City, University of London mental health researcher Dr Chris Flood contributed to a Department of Health report for mental health nurses which aims to improve physical health and wellbeing of people with severe mental health problems.

Researchers from Central and North West London NHS Foundation Trust, Health Education England, Professor Sally Hardy from London South Bank University, and South London and Maudsley NHS Foundation Trust also contributed to the report along with Dr Ben Thomas and colleagues from the Department of Health.

Dr Flood said: “There are around 280,000 people living with SMI in the UK, and as a result this is a really significant issue which cannot be ignored. In 2010/11 the mortality among mental health service users aged 19 and over in England was found to be 3.6 times the rate of the general population. There is a lot we can do to try and reduce these inequalities, and the recent report formed a big part of this by providing guidance to mental health nurses.”

Other long term conditions can also be more prevalent in those with SMI, as diabetes has been reported to be 2 to 3 fold higher in people with schizophrenia than the general population and also people with SMI have nearly three times the rate of deaths from diseases of the circulatory system.

Many psychiatric medicines, antipsychotics in particular, are associated with increased risk of metabolic syndromes such as obesity and high blood pressure too.

In particular people with severe mental illness are particularly at risk and die on average 15-20 years earlier than the general population. This is mostly due to physical health problems which are often not diagnosed or managed efficiently and lifestyle factors which negatively affect physical health.

However, mental health nurses have unparalleled opportunities to help people improve their physical health alongside their mental health, both in inpatient settings and in the community.

In particular there are some key areas for action to improve health outcomes have been identified. Each of these areas is associated with particular risk factors that can have a detrimental effect on physical health and reduce life expectancy.

Support to quit smoking

Smoking is the main cause of preventable illness and premature death in England and in people with SMI smoking is one of the factors that contributes to the higher mortality seen.

People with a longstanding mental health problem are also twice as likely to smoke as those without mental health problem, and 40% of all tobacco is smoked by people living with mental health problems. In some mental health inpatient settings, smoking rates are as high as 64% and a third of people with mental health problems and more than two thirds of people in psychiatric units smoke tobacco.

As a result, supporting people with mental health problems to quit smoking is the single largest, most effective intervention to reduce physical ill health and premature death.

Tackling obesity and improving physical activity levels

People with mental health problems are more likely to have weight fluctuations related to their mental health and associated dietary habits, resulting in either obesity or undernourishment associated with anorexia, and as a side effect of medicines.

Either of these extremes of diet can lead people with mental health problems to have an increased risk of major physical health problems. Interventions can include a change in diet and advice from professionals.

Also many people with mental health problems do not take enough physical exercise. Increasing physical activity can improve physical and mental health, enhance psychological wellbeing, reduce mortality and improve life expectancy.

Reducing alcohol and substance use

People with mental health problems are more likely to use alcohol and substances than the general population, and 30-50% of people with severe mental illness have problems with substance or alcohol misuse or both.

They are also more likely to lead chaotic lifestyles, neglect their physical health, have a poor diet, be homeless, and be involved in sex work to fund use. They may also be at risk of accidents due to the consequences of use, or place themselves in risky situations when intoxicated.

The prevalence of alcohol dependence among people with psychiatric disorders is almost twice as high as in the general population. People with alcohol dependency have higher levels of depressive and affective problems, schizophrenia and personality disorders.

Sexual and reproductive health

People with mental illness are more likely to be infected with blood borne viruses (and STIs) than the general population. These risks increase further where substance misuse is also involved.

In addition, compared to the general population, patients with SMI are at substantially increased risk of domestic and sexual violence, with a relative excess of family violence and adverse health impact following victimisation.

Medicine optimisation

Estimates show that 30-50% of medicines are not taken as intended by patients with long term conditions and 55% of people are not aware that they are not taking their medicines correctly.

Medicines plays a key role in managing symptoms of mental health, however adverse effects associated with psychotropic medicines play a contributory role in the poor physical health outcomes in severe mental illness.

The adverse effects of medicines include an increased risk of metabolic syndrome, cardiovascular adverse effects, weight gain, sexual dysfunction and poor oral hygiene. Screening and monitoring physical health helps identify risk factors for individuals on medicines.

Dr Flood said: “Essentially what the report shows that a holistic approach to managing mental and physical health is needed. Physical and mental health are inextricably linked and it is detrimental to a person’s overall wellbeing to regard these as two separate entities.

There is strong evidence that having a long term mental health condition can be a significant risk factor for the development of physical ill health and conversely long term physical health conditions can lead to people suffering poor mental health. But by being aware of some of the factors we can reduce some of the associated risk with SMI and ensure that the physical and mental effects are properly managed.”