In the latest of a series of blogs about #mentalhealth, an NHS England (London) awareness campaign for mental health care across the capital, a Darzi Quality Improvement Fellow from South London and Maudsley NHS Foundation Trust highlights how the effect physical health problems have on mental health and vice versa is one of the biggest challenges the health system and wider community needs to address:
We know that people with some mental illnesses such as psychosis are at risk of dying earlier than those without.
This mortality gap, known as the ‘stolen years’ is estimated at between 10 to 20 years and a large part of it is due to preventable and treatable physical health conditions.
This tells us the services we are providing are not adequate or appropriate to meet their needs. It reveals a shocking inequality within our health system and has been argued by some to reveal something deeply concerning about how we value the lives of those with these conditions.
I have had an opportunity this year to contribute to a London-wide project focused on this issue, run by Healthy London Partnership, which is focused on closing this mortality gap. While I know an inequality between the two exists, I also believe there is reason to be optimistic.
The scope of the programme extends across all health sectors, identifying system changes that can promote better access to physical health promotion, disease prevention and treatment for those with mental illness. The efforts of those who have campaigned tirelessly for years to move this issue up the political agenda have come into fruition and this issue has become a genuine priority.
This issue is also a priority for me personally.
A few years ago I was told that a patient I’d previously looked after had died age 29. His death certificate reported ‘natural causes’. He died of heart problems usually not seen until late in life. He had diabetes, breathing problems worsened by smoking and was very overweight. He also had psychosis, which for him meant constant voices commenting and criticising all he did, mocking him and calling him fat and useless. When he tried to exercise his voices laughed and shouted at him. Despite all this he was warm, kind, charming and funny and never failed to ask how I was when we met.
I find it difficult to accept that losing someone aged 29 from diseases not usually seen until you are much older is ‘natural’. This young man managed more mental distress day in day out than many of us could ever imagine. His story is extreme but the problems it reveals are not unusual.
The impact of physical health problems on mental health and vice versa is one of the biggest challenges the health system and wider community needs to address.
We have known about this issue for a long time but it is complex and many different factors contribute to it. Some mental health conditions, for example, are associated with symptoms that affect motivation and concentration or are treated with medications that can have side effects of weight gain or sedation. A more fundamental difficulty in ensuring that those with mental health problems get appropriate physical health care relates to the way that mental and physical health services have grown up separate from each other.
One size does not fit all and many of the current systems we have to deliver physical health care simply aren’t sufficient or appropriate for those dealing with a difficult mental health problem as well. A ten-minute GP appointment is stressful enough but it becomes even more so when your symptoms affect your concentration, your ability to communicate your thoughts or make you too scared to leave the house.
Funding and availability of professionals or peer support with the time and skill to support in this area is limited. Safe and welcoming community spaces to meet friends; to have the opportunity to exercise at your own pace without judgement and with support from people who understand mental health symptoms are essential but lack clear funding. The gym, for many, is not a welcoming place but if you haven’t exercised in years, have lost your confidence because of illness or feel paranoid and scared in busy places – it is the last place you want to be.
When I first learnt that this young man had died I was angry at a health care system that had so evidently failed him and angry that, ultimately, I had failed him too.
The responsibility lies now with commissioners, providers and communities to work together with those who experience or care for people with mental health problems to rethink, redesign and evaluate how we deliver much needed changes.
From what I have seen the appetite to do this is there. Some of the solutions emerging are hugely exciting. Sporting Recovery in Peckham is an initiative run by two volunteers supporting those with psychosis and other conditions to lose weight, stay out of hospital and take up voluntary and paid work.
These are the sorts of initiatives that change and save lives and it’s something that we should value and support. London can be a difficult city to live in, particularly for those with physical or mental health problems but it is also resourceful and innovative. As my current home I hope that it will soon be a place where the lives of those with mental illness are valued equally as those without.
She currently holds a Darzi Fellowship supported by the Healthy London Partnership and is taking a lead role, through Healthy London Partnership, in a London-wide initiative to reduce the premature mortality of people with serious mental illness.
Mary came to medicine with previous degrees in Politics, Philosophy and Economics, completed a National Institute of Health Research (NIHR) Academic Foundation Programme at the Institute of Neuroscience in Newcastle and an NIHR Academic Clinical Fellowship at the Institute of Psychiatry, Psychology and Neuroscience (IoPPN). She undertook her core training and specialty training on the Maudsley Training Programme following a year secondment in the Research and Development team at NICE on the Chief Medical Officer’s Clinical Advisors Scheme.
As Clinical Fellow at the IoPPN her research interests are in service improvement, treatment and service gaps in UK Mental Health provision and cognitive and negative symptoms of schizophrenia. She co-authored a national review chapter on Parity of Esteem in the Chief Medical Officer’s 2014 report on Public Mental Health. Mary also developed and ran with the National Psychosis Service the first specialist clinic dedicated to the assessment and treatment of cognitive and negative symptoms in schizophrenia.
She is involved in clinical research, service development initiatives and a Kings Health Partners strategic academic network aimed at exploring and addressing the mortality gap in people with serious and enduring mental illness.