MEDIA BRIEFING: Mental illness takes a toll on the body and years from your life: 20 year life expectancy gap revealed

The report findings are not a surprise. Accumulating research from around the world indicates that people with mental health and addiction disorders have a much higher risk of physical illness and reduced life expectancy. Links with obesity, diabetes and cardiovascular disease are particularly strong. In the case of severe mental health disorders, life expectancy is reduced by 20 to 25 years. New Zealand is no exception and this was highlighted in a 2014 Te Pou report and the recent Government Inquiry into Mental Health and Addiction. The reasons for reduced life expectancy include high rates of smoking and other drug use, unhealthy diet, lack of physical activity and side effects of medication, particularly antipsychotics. Suicide rates are also higher. Lack of access to comprehensive physical and mental health services is another major factor. While largely omitted from the Lancet report, stigma and discrimination, poverty, unemployment, housing problems, social isolation and residence in high deprivation, obesogenic neighbourhoods are undoubtedly also important.

These high rates of physical health morbidity and greatly reduced life expectancy are totally unacceptable. While this matter has received increased attention in recent years, measures to prevent and reduce these iniquities need to be massively amplified. It is essential that physical and mental health are given equal consideration from the time of first contact with health services. Hopefully the Lancetreport will help mobilise global efforts to address this too-long neglected issue. The report reviews relevant research and outlines measures capable of significantly improving the physical health and wellbeing of people experiencing mental health disorders.

This Government has committed to transforming mental health services in this country, supported by additional funding of almost $2 billion over the next four years.This provides a unique opportunity to address the need and massive challenge presented in this important and timely report. However, health service transformation and individual behaviour change, while essential, will be only partially successful if major economic, social and environmental health determinants are not also addressed. Other Government commitments, reflected in the recently announced Wellbeing Budget, are highly relevant. The Budget includes measures intended to reduce poverty and a range of social and health disparities.

The phrase “there’s no health without mental health” is starkly demonstrated in findings released today by a taskforce of international experts. The report from the Lancet Psychiatry Commission found that people with mental health problems are up to twice as likely to suffer from obesity, diabetes, and cardiovascular disease and are at risk of dying 20 years earlier than those without a mental illness. The report’s authors note that despite the link between mental health and physical health having been known for decades little has been done to address the issue, a failure which the authors rightly refer to as “human rights scandal”.

Drawing together research from the past two decades the Commission’s report highlights key risk factors linking mental and physical health including higher rates of smoking, poor sleep, diet, and physical activity, and medication side-effects. The report also reveals that people with mental health problems are often not given access to physical healthcare that they need, due partly to bias and lack of training of healthcare professionals.

The report gives support to the rationale behind the New Zealand Government’s recent Wellbeing Budget which recognised the relationship between social factors, such as poverty, and mental health. The Commission’s report may also help us understand why in New Zealand Maori and Pasifika people are over-represented in both negative mental and physical health statistics as these two areas are tightly intertwined.

Addressing the health inequities suffered by those with mental health difficulties requires a revolution in the way healthcare services are delivered and how healthcare professionals are trained. We need to break down the artificial distinction between physical and mental health which currently underpins our hospitals and medical practices, a call which was recently made in He Ara Oranga the report of the Government Inquiry into Mental Health and Addiction. Medical professions need to have a greater understanding of mental health, and mental health professionals need more training and education in the basics of physical health. The Lancet Psychiatry Commission also recommends that clinicians and researchers use advances in digital health technologies to bridge the gap in the physical wellbeing of people with and without mental health problems.

The lead authors of today’s study point out that many of the physical illnesses suffered by those with mental health problems are preventable and that as a society we must address this inequity to “not only add years to [the] life, but life to [the] years” of those with mental illness.

The findings of the Commission are in line with our review of the literature and local data in regard to the increased risk of cardiovascular disease (CVD) in people with mental illness. Chronic disease, particularly CVD, accounts for a substantial proportion of the reduced life expectancy in people with severe mental illness. Our preliminary analyses of a cohort of 400,000 NZ primary care patients shows that people with severe mental illness have a significantly increased risk of CVD even after adjusting for the standard CVD risk factors. As a result, CVD risk is a double blow for this vulnerable population group because they also have a higher prevalence of most of the standard CVD risk factors. As this population group typically has many health-related issues to cope with, in addition to their physical health, they certainly need extra support to help them reduce their CVD risk.