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Improving the physical health of people with mental illness: systemic issues and practical challenges

26 Nov 2013

Dr Lesley van Schoubroeck welcomed guests to Queensland Health's Mental Health Clinical Collaborative Forum. Here is an extract from her speech.

The theme for this forum, the physical health of people with mental illness, is so important and so opportune with the recent release of a number of research reports.

It is worth reminding ourselves of the 1991 United Nations Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care.

Principle 8.1 states:

Every person shall have the right to receive such health and social care as is appropriate to his or her health needs, and is entitled to care and treatment in accordance with the same standards as are other ill persons.

And at the national level, the Mental Health Commission released a communique in May this year following a national summit addressing premature death of people with mental illness.

Clearly some of the statistics are unacceptable.

 It is unacceptable that people with mental illness:

  • are dying up to 16 years earlier than the general population
  • are more likely to have conditions like osteoporosis due to the effect of drugs
  • are more likely to have diabetes, obesity, heart disease and some cancers

And there is a real catch 22 here – diabetes doubles the risk of depression, depression doubles the risk of diabetes.

We know one in three people with a mental illness smoke compared with less than one in five in the general population. We know the rate is much higher among people with schizophrenia.

Since coming to work in the mental health sector nearly four years ago, I can’t tell you the number of times I have heard the phrase: “They wouldn’t listen to me when I told them …” and then follows some terrible story of amputations, ulcers, obesity … and so on from an unattended physical ailment while the mental illness was being treated.

Too many people have said:  “I tried to tell them that drug had a bad effect on me but they did not listen.”

Now of course “they” are not always wrong, but then there is enough evidence to conclude that “they” are not always right – none of us are always right.

One thing we must all do, whether we are front line clinicians or management, is that we must listen to the voices of consumers, families and carers.

In mental health, the response is too often – someone else should do something.

Someone else – a very busy person indeed ….

And I read an interesting article recently that made the point that someone else is often primary care.  “Oh, general practitioners are well placed to do that” is a common response.  And when you realise that the speciality of general practice is treating the whole person not a particular disease the person has, you realise that this is actually makes a lot of sense.

But that does not necessarily mean that people working in general practice can suddenly become the font of all wisdom and the one-stop shop for treating mental illness in the community.  If we want them to do this, they need the appropriate services and supports around them.

I wonder if some of the systems that have been put in place to treat mental illness have not inadvertently led to this separation from general health and a decline in overall health outcomes.

I can see advantages for specialisation but has that led to too much of a focus on the problem rather than the person?

This separation happens from the top of the systems and trickles down. Sometimes with a separate minister.  In national committees, mental health is a separate stream.  In bureaucracies, the Mental Health Branch is often very separate.  The fact that there is separate legislation that focuses mainly on the involuntary treatment of some people contributes to that I am sure.

As someone once said, there is no cancer act, there is no obesity act, why is there a mental health act?

I’m sure I don’t need to explain that to you.  But are there unintended consequences of this that we need to attend to?  Certainly Mental Health Commissions have to be mindful of the need to focus on the ‘whole person’ otherwise they could exacerbate this separation.

If your work today can identify systemic as well as practical things that can be done to improve the physical health of people with mental illness, it will be a day well spent.