A chara, – The poor state of physical health of mental health service users is largely ignored in the media. To give some context, the OECD Better Life Index reports a life expectancy of 78 years for men and 83 years for women in Ireland. Research suggests that mental health service users have a life expectancy of 20 per cent less than the general population. In Ireland this could suggest a life expectancy of around 62 years for male mental health service users and 66 years for females. This is considerably lower than the life expectancy of 73 and a half years for men and 80 years for women in the poorest areas reported by TASC.
Why is physical health so poor? A range of reasons. Lifestyle factors present in the general population are more pronounced in mental health service users, eg there are higher rates of smoking, lower rates of physical activity and poorer diet. Mental health service users also face cardio-metabolic side-effects from medication, making this a unique risk factor. This combination contributes to higher rates of obesity and diabetes, which in turn increases the risk of illnesses such as heart disease.
Yet other factors are also important – lower rates of access to health education and health promotion, low uptake/offering of smoking cessation, lower rates of screening for conditions such as diabetes and high cholesterol (despite the increased prevalence of risk factors), lower rates of treatment for a range of conditions and unco-ordinated physical healthcare. Stigma is also present in the form of diagnostic overshadowing, where reports of physical symptoms are attributed to the mental illness and not seen as valid.
Furthermore, mental health professionals may lack confidence and knowledge in physical assessment and conditions. These factors contribute to mental health service users having poorer prognosis and health outcomes, for example, having higher death rates from cardiovascular and respiratory disease than the general population.
This is an urgent clinical practice and policy issue that should be of immense concern to healthcare professionals, educationalists and policy-makers alike. – Is mise,
MICHAEL NASH,
Assistant Professor
Mental Health Nursing,
School of Nursing &
Midwifery, TCD,
D’Olier Street, Dublin 2.