The poor physical health of people with mental illness has been known about for decades – one of the first studies in this area was published as far back as 1934 (see reference 1 at the bottom of this article).
A National Summit on Mental Health and Physical Health will be held in Sydney tomorrow with the aim of identifying actions that could be taken in the “immediate, short and long term” to address these longstanding health concerns.
In the article below, public health writer and publisher Dr Mark Ragg urges summit participants to come up with a ‘Closing the Gap’ style campaign to reduce the 20-25 year difference in life expectancy suffered by people with serious mental illness.
Will there be money on the table to address this critical issue?
Mark Ragg writes:
Tomorrow in Sydney a whole bunch of people in important positions get together with the opportunity to make a real difference for one of the most disadvantaged groups of people in this flat brown land.
They’re gathering at Parliament House for the national summit of health and mental health ministers who will discuss the physical health of people with mental illness, and expectations are high.
For it won’t just be the ministers present, who have to reconcile stakeholders’ wishes, ideology and budgetary reality. They’ll be surrounded by consumers, mental health commissioners, advocates and others who all want to see something solid happen. Spectacular isn’t necessary. Real is enough.
And this is why.
People with a serious mental illness die young, probably 25 years earlier on average than they should. And they don’t die necessarily of suicide, as significant a problem as that is. They die of all those run-of-the-mill conditions that get everybody else – heart attacks, diabetes, kidney failure, lung cancer. All things that are preventable to some extent, but not yet in that group of marginalised people.
The lifespan of people with serious mental illness is similar to that of an average person in the times of Parkes and Barton. On any given day, a person with serious mental illness is roughly twice as likely to die as a person without serious mental illness, even after adjusting for socioeconomic status.
At one level it’s complex – people with serious mental illness may find it hard to get help, to follow advice, to eat well, to keep appointments, to navigate a complex system. And some of the drugs used to treat psychotic illnesses pack the kilos on very quickly.
But at another level, it’s straightforward. Those who look after people with mental illness have not bothered to take good care of their physical health. Partly that’s a systemic and structural issue – mental health care and physical health care and divided at many levels.
But it’s also a matter of personal responsibility – many health professionals stigmatise people with mental illness, feeling their lives aren’t as important, that they don’t need all the investigations offered other people for their illnesses, and sometimes even that their cancers don’t need treating.
There’s been a real shift in thinking in the past five years or so. Nurses, psychiatrists and policy-makers have begun recognised that if everybody else is encouraged to eat well, get some exercise and quit smoking, then, well, people with mental illness should be offered the same advice.
That shift is stronger in the mental health sector than the rest of the health system, and it still has a way to go before it is the norm. And there is still a long way to go before people with mental illness are routinely offered the same investigations and treatments of their symptoms of heart disease, cancer and other physical illnesses as others.
Money has started to flow as well. On the issue of smoking, South Australia led the way, with smokers demanding help and getting it. The Cancer Council NSW saw the importance of the smoking. Health departments in South Australia and New South Wales got active and put significant funding into the issue.
But the funding has not grown in the past year or two, and may well have shrunk as state health budgets come under as much pressure as that of the Commonwealth.
South Australia has disbanded a centralised service, largely due to disputes over whether it should be funded by mental health services or drug and alcohol services, and New South Wales is yet to deliver on promises made a year or more back about further work. Queensland is a basket case, and others find themselves too stretched to deal comprehensively with the issue. The spirit is willing, but the flesh is beholden to GST distributions.
What is needed now, tomorrow, is solid action. This summit is sure to come up with a ‘Closing the Gap’ type of approach to reduce the 20-25 year difference in life expectancy suffered by people with serious mental illness. It will make efforts to give people with mental illness a better chance to reach their allotted years through prevention and by improving services. Reducing the stigma faced by people with mental illness, even among health professionals, is going to be important.
But all eyes will be on the final session, when the money is doled out. Changing people’s minds takes time and effort, as does improving services. Time and effort costs money.
Tomorrow’s summit is the first national meeting on the issue, and has importance in its own right. It is a beacon that things are changing. It is likely to signal a nationally consistent approach and a commitment to collecting data and measuring change.
But without funding to keep them going, beacons fade.
• Mark Ragg is director of RaggAhmed (www.raggahmed.com) and adjunct senior lecturer in the school of public health, University of Sydney. He has worked in this area with the NSW Government, the Cancer Council NSW and the Cancer Institute NSW.
PS from Croakey: Meanwhile, in other mental health news:
• Earlier this week in Canberra, the Council of Non-Government Organisations on Mental Health met to progress work on developing national mental health indicators and targets. In a related interview with ABC Radio, psychiatrist and National Mental Health Commissioner Professor Ian Hickie noted that cardiovascular disease and smoking are major contributors to the life expectancy gap for people with mental illness.