“We can no longer accept women and men with severe mental illness struggling to access the high-quality care and support they ought to receive during their lifetime and dying 15 to 20 years before they should”, wrote Karen Turner and Tim Kendall – respectively director of mental health and national clinical director for mental health at NHS England – in their foreword to Forward Thinking.
Published in March 2018, Forward Thinking is an overview of recent research funded by the National Institute for Health Research on the support for people living with severe mental illness (SMI). Seven years after the coalition government announced its ambition to ensure mental health receives parity of esteem with physical health, the review depicts a frightful picture.
Lives in this patient group are plagued with lower life expectancy, poorer physical health, and higher rates of unemployment, homelessness, victimisation, domestic violence, trauma, poverty, incarceration and social isolation.
Just on physical health and life expectancy, here are a few telling statistics about people with SMI:
- Their life expectancy is 15-20 years shorter than that of the general population;
- They are three times more likely to attend accident and emergency and almost five times more likely to be admitted to hospital as an emergency;
- They are twice as likely to smoke than the general population;
- Suicide and injury account for about 40% of the excess mortality in this group; the other 60% can be attributed to preventable medical conditions such as heart disease, lung disease, diabetes and infectious diseases.
And yet, despite the disproportionate physical health problems experienced by people with SMI, they are also less likely to receive adequate treatment for these problems. Several factors may combine to slowly ‘eat away’ at their physical health and form a potentially deadly ‘cocktail’.
”People who are very unwell mentally are less likely to be able to look after their physical wellbeing”
People who are very unwell mentally are less likely to be able to look after their physical wellbeing. They may find it difficult to book an appointment – for example, for smoking cessation – attend that appointment, adhere to the treatment plan, attend follow-ups and so on.
It makes sense, doesn’t it? If, right here and now, you’re having paranoid or persecutory delusions, you’re not going to worry too much about what may seem a theoretical risk of dying of lung cancer at some point in the future.
However, the reasons why people with SMI have such poor physical health is not just down to their mental condition. Their increased risk of diseases such as diabetes, cardiovascular disease and stroke is partly attributable to the attitudes and skills of health practitioners – as explained in an article just published by Nursing Times.
“For example, mental health nurses may overlook signs of physical illness because they focus on the person’s mental health”, says the article, which is based on Forward Thinking and focuses on two areas that are especially relevant to nurses working outside mental health: early detection and intervention, and managing physical health.
Forward Thinking emphasises that nurses need to recognise personal or unconscious biases so they do not miss signs of degrading physical condition, says the article. “For example, nurses need to be wary of attributing physical symptoms to the mental health problem or of neglecting to offer routine screening or health promotion interventions. People with SMI may also need help from nurses to successfully undergo a health promotion intervention.”
“Nurses themselves need to display an awareness of the problem”
While employers will have a duty to provide training, information, guidance and support, nurses themselves need to display an awareness of the problem – attention to the smallest telling signs, familiarity with their patients (or at least a keenness to get know them better), diligence in referring them and patience in helping them regaining health.
This is no small task and a heavy responsibility resting on nurses’ shoulders, but it is also an amazing opportunity for them to change the course of someone’s life – and potentially save it.