Life gap widens for mentally ill

THE widening gap between the life expectancy of people with mental illness and Australia’s general population is a problem that requires urgent government attention, according to three leading academics.

They were hoping for more than just a motherhood statement from the nation’s political leaders after last Friday’s National Mental Health Summit in Sydney, convened to address the high rates of premature death and adverse health outcomes for people with mental illness.

Professor Tim Lambert, director of the Concord Centre for Cardiometabolic Health in Psychosis in Sydney, said while suicide accounted for around 20% of premature deaths in those with a mental illness, physical disorders — particularly cardiometabolic problems — were responsible for almost 80%.

“The life expectancy gap is widening by about 0.7% each year”, Professor Lambert told MJA InSight.

“We could keep these people alive longer with basic services but we cannot get governments to invest in them.”

Professor Lambert was responding to Australian research, published in the BMJ, which found the life expectancy gap between those with mental illness and the general population increased from 13.5 to 15.9 years in men and from 10.4 to 12.0 years in women between 1985 and 2005. (1)

The authors of the study, which involved data from 292 585 WA psychiatric patients, also found that 77.7% of excess deaths were due to physical health conditions, including cardiovascular disease (29.9%) and cancer (13.5%).

Professor Alan Lopez, head of the School of Population Health at the University of Queensland, agreed that not enough was being done to help people with mental illness to receive care for their physical problems, but was more optimistic about the future.

“Australia has been very successful at focusing attention and resources on the things that kill us — tobacco, drink-driving, HIV — but we have not done so well in areas such as this”, Professor Lopez told MJA InSight.

“I think the movement has started, however. There is recognition that this is important and that the physical ailments of those with mental illnesses can be treated, and there is recognition that we are not treating them as well as we could.

“We need to do better. But I am an optimist and I believe we can and will.”

Professor Brenda Happell, chair of mental health nursing at Central Queensland University in Rockhampton, told MJA InSight that the stigma surrounding mental illness continued to be an issue within the ranks of health care professionals.

“[Life expectancy in those with mental illness] is incredibly complex”, she said. “People with mental illness don’t tend to get the same level of care, and stigma is a really big factor.”

Professor Happell said there was a tendency to treat just their mental illness, believing any physical problems were “just a symptom of their mental illness”.

“Most health care professionals still don’t have a very positive attitude to mental illness”, she said. “They’re not confident about treating it and there is still a degree of fear and apprehension.”

Professor Lambert, who was preparing to act as a convenor at the National Summit of Mental Health Ministers when he spoke to MJA InSight, said antipsychotics were one of many risks for the mentally ill and "to put the widening gap down to them alone is just rot”.

“After the first 2 years or so the risk of the antipsychotics is diluted by other risk factors like family history, lifestyle and bad circumstances", he said.

“Just changing their medications is not the answer. Things have to be put in context.”

Professor Lambert said that in Australia in 1904 life expectancy was 58 years for women and 55 for men. “Now it’s in the 80s or close to it, for both. That’s a huge improvement.

“But for those with mental health issues life expectancy is now in the 50s. That’s 25 years lost. Either things are getting worse for those with mental illness or all the advantages available to the general population are not being passed on.”

1. BMJ 2013; 346: f2539