Physical ill-health reduces life expectancy of people with severe mental illness

Physical ill-health is rife among the severely mentally ill in Britain, according to new research published today by the University of East Anglia (UEA).

In a study of almost 800 patients with severe mental illness such as schizophrenia and bipolar disorder, two-thirds were found to be overweight or obese, and a disproportionate number suffered from diabetes, heart disease, high blood pressure and raised cholesterol.

The results of the two-year project in Kent are published today in the peer-reviewed journal BMC Psychiatry.

During the study, the researchers introduced a Wellbeing Support Programme and trained more than 200 mental health nurses in its use. The physical health of 782 patients (mostly white, male and in their late 30s) was screened as part of the programme and appropriate intervention offered. The findings of the screening programme revealed:

• Inactivity, poor diet, smoking and excessive alcohol consumption were the norm
• Obesity was prevalent with 66 per cent having a BMI greater than 25
• Thirty-four per cent of patients were suffering from high blood pressure
• Fifty-two per cent had abnormally high cholesterol levels
• A surprisingly high proportion were being prescribed atypical antipsychotic drugs associated with weight gain

Life expectancy for people with severe mental illness such as schizophrenia is reduced by up to 25 years. The major cause of death is not suicide, as many practitioners believe, but cardiovascular disease. While clinicians are well-practised at assessing the risk of self-harm, they fail to assess the risk of cardio-vascular disease.

"Mental health nurses do a tough job and are compassionate and highly committed. But they do not tend to be skilled at managing the physical health of their patients and they often don't lead entirely healthy lifestyles themselves," said lead author Prof Richard Gray of UEA's School of Nursing and Midwifery.

"Since mental health workers tend to have sustained one-to-one relationships with their patients over many years, those who smoke, have a poor diet and fail to take regular exercise are having a negative influence on the lives of already vulnerable people. We urgently need to train our mental health workers to lead by example and intervene if their patients' physical health is deteriorating."

Separate research conducted by Prof Gray has shown that the incidence of smoking among mental health workers is higher than in the general population and nurses who smoke are less likely to promote smoking cessation in their patients.

Prof Gray added: "The latest NICE schizophrenia guidelines have located the responsibility for physical health care of severely mentally ill patients with their GPs. All health professionals have a duty to promote health in the patients they treat. Government guidelines must reflect the shared responsibility all health care professionals have to promote health in one of the most marginalized and socially excluded groups in our society."