For many years now we have known that people with severe and enduring mental health problems have a shorter life expectancy than those without. Recently published figures have for the first time given us a clearer picture of just how big the gap is and how serious an inequality in health this remains.
Researchers at the Maudsley Hospital in London found that on average a person with a severe mental illness can expect to die between 10 and 15 years earlier than average. For a woman with schizoaffective disorder, the gap is some 17.5 years. Men with depression, meanwhile, die 10 years younger than their peers and those with schizophrenia die 14.6 years earlier.
These are stark figures. They reveal a disparity in life expectancy that is as serious as any difference in the more often discussed dimensions of inequality in health such as wealth, geography or ethnicity.
As the researchers state, the largest part of this excess mortality is due to ‘natural’ causes rather than suicide. It reflects the overwhelming evidence that people with mental health problems have considerably worse general health than those without. It also suggests that the physical health care available to people with serious mental illness is inadequate to address their needs.
In the government’s mental health strategy, addressing the physical health of people with mental health problems is among its six key objectives. It notes that some 42 per cent of tobacco is consumed by people with mental health problems, many of whom would like to stop smoking if they had the right support.
The NHS Outcomes Framework (and alongside it the proposed framework for Public Health England) also includes measures of mortality under the age of 75 among people with a severe mental illness.
These are important steps forward but they will need concerted action to translate good intentions into everyday practice. For this, the whole of the NHS and the public health system need to get behind efforts to close the gap in life expectancy, and more generally to bring physical and mental health together much more effectively.
Smoking cessation efforts need to be tailored, for example, to the specific needs of people with mental health problems, many of whom will be using medication that might reduce their effectiveness. Advice and support to manage weight gain and encourage exercise will likewise be affected both by a person’s mental health condition and any medication they are prescribed for it.
Efforts to link physical and mental wellbeing need to start early in life and continue through to old age. Children with poor mental health are often the most at risk of taking up smoking or becoming overweight from a young age. In adult life, depression is associated with a far higher risk of a range of physical illnesses and makes it harder to manage or to recover from them. Promoting and treating mental health alongside physical health won’t just improve our overall wellbeing, it will also make the NHS more efficient and productive.
This is a big agenda for services that for too long have separated physical and mental health. We can no longer let a diagnosis of mental illness overshadow a person’s general health nor deny people with mental health problems effective support to improve their own health.
The shocking figures provided by the Maudsley must provoke us all into action so that we can begin to make them a thing of the past.