The physical burdens of mental illness

The lower life expectancy of those with a mental illness is an issue nurses continue to address. 

Australians with a mental illness are more likely to struggle with poor physical health and have a shorter life expectancy than the general population.

People living with a mental illness had an overall death rate that is two-and-a-half times greater than those without a mental illness, a recent Australian study by the National Mental Health Commission found (NHMC 2012).

For this vulnerable group, a multitude of co-morbidities can develop through the use of antipsychotic medication, lack of exercise and smoking.

Compounding this is often limited access to primary and secondary health services. Often, poor physical health is overshadowed by mental illness, and the overall wellbeing of the patient suffers.

As nurses we often talk of holistic care: bringing together mental and physical healthcare in a holistic approach is change that must occur in our health system.

In 2012, the NMHC again drew attention to the threat to quality of life for those who have a mental illness; severe mental illness undercuts their chances of leading a contributing life (2012, p 28).

They focused on the injustice associated with gaps in health and life expectancy, stating it was contrary to the United Nations Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care and the Convention on the Rights of Persons with Disabilities; all ratified by Australia in 2008 (NMHC 2012, p 28).

The prevalence of premature death in people with mental illness is “at best a failure to act on evidence; at worst a form of lethal discrimination” (Thornicroft 2013). The complicated health difficulties of those who suffer mental illness need to be at the forefront of the minds of policymakers and healthcare professionals.

In April this year, the then Minister for Mental Health, Mark Butler, and Nationals MP Kevin Humphries announced a national summit to address the lower life expectancy of people with a mental illness.

I attended the summit, convened on May 24, 2013, which proposed collaboration at all levels of government and invited key stakeholders to identify areas of potential improvement in health and community settings. Mr Humphries said, “People with a serious mental illness die on average 25 years earlier than the general population.”

This early death is not often caused by a patient’s mental illness but is a result of physical health problems (The Hon Mark Butler MP 2013).

The summit not only recognised the higher rates of mortality associated with mental illness, but also the prevalence of obesity, the likelihood of diabetes, the significance of cardiovascular disease and ischaemic heart disease and the potential of substance abuse problems (NSW Ministry of Health 2013). Conclusively, mental illness creates a higher risk of noncommunicable diseases (WHO 2013).

The Australian College of Mental Health Nurses (ACMHN), also present at the summit, urged all health professionals to be aware of the physical and mental health needs of their clients and identified the challenges associated with getting the right care (ACMHN 2013a).

ACMHN expressed concern about the lack of expertise among health professionals when dealing with mental health, the need for holistic approaches, the unfortunate stigma and discrimination still surrounding mental health and the structural separation of mental health services and other health services (ACMHN 2013a).

SANE Australia encouraged those present to recognise the reality of the treatments individuals are receiving and that provision needs to be made for the side effects (SANE 2013). As an example, oral health can become an issue contributing to secondary problems and then patients often do not maintain their medication treatment. Issues such as these underline the need for a coordinated and integrated approach for consumers.

There were powerful presentations from both consumers and health professionals highlighting not only the problems that can arise, but also the success that can be achieved through an integrated, comprehensive approach to an individual’s health. Programs such as those at the Bondi Centre in NSW are having some success in addressing these challenging issues (Curtis et al 2012).

This issue is being addressed internationally with the World Health Organization calling for member states to assess and monitor co-morbid mental illnesses in primary care settings, focus on the education of healthcare professionals and to incorporate mental health interventions within chronic disease programs (WHO 2013).

A literature review done by ACMHN identified a range of issues for nurses working with patients with chronic physical diseases and a mental health condition. The review indicated nurses’ concerns regarding the identification of such conditions as depression and the need to work across different models of care (ACMHN 2013b).

The considerable pressure on nurses to provide increasing amounts of care to patients with fewer resources was also noted. Nevertheless, nurses need to acknowledge the vital role they play in the integration of mental health care in primary healthcare settings. Nurses need to respond to current evidence with resources and education providing nurses with an understanding of relationships between mental illness and associated chronic diseases (ACMHN 2013a)

For nurses, opportunities clearly lie in primary healthcare. Individualised, continuing care and advice from health professionals in improving physical health is key (SANE 2013). Nurses who are working as nurse practitioners have the potential to work and specialise in the care of those who are mentally ill, incorporating primary care to complement the psychological treatment in their advanced practice.

Addressing mental illnesses in primary care settings will delay disease progression, improve survival outcomes and reduce the healthcare costs of associated non-communicable diseases (WHO 2013).

Across the summit, key stakeholders confirmed that gaps in training, communication and resources across the health sector were primary issues when combating poor physical health. Identification, intervention, treatment and management of mental illness are important components in addressing the burden of chronic disease in Australia. Access to collaborative care programs to support long-term whole-of-health approaches can address complex health issues (NMHC 2012 p 31).

For nurses, education in mental health should take place in the context of their primary area of practice. Equipping nurses with the knowledge and skills to identify and manage both the mental and physical needs of patients is critical to ensuring all the health needs of the person as an individual are met.

Nurses, themselves, also need to accept and practise in the knowledge that holistic care requires an integration of both the mental and physical needs of those for whom they provide care.

Adjunct Professor Debra Thoms is chief executive of the Australian College of Nursing.
Article acknowledgement: Andrew Watkins CNC Keeping the Body in Mind Project, The Bondi Centre, SESLHD, Sydney

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