Premium
Physical health and severe mental illness: If we don't do something about it, who will?
Author(s) -
Gray Richard,
Hardy Sheila,
Anderson Kathryn Hoehn
Publication year - 2009
Publication title -
international journal of mental health nursing
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.911
H-Index - 54
eISSN - 1447-0349
pISSN - 1445-8330
DOI - 10.1111/j.1447-0349.2009.00640.x
Subject(s) - surprise , life expectancy , mental illness , tragedy (event) , medicine , worry , population , mental health , psychiatry , health care , schizophrenia (object oriented programming) , psychology , social psychology , anxiety , environmental health , economics , economic growth
Physical health and severe mental illness: If we don't do something about it, who will? If you are a mental health nurse working in clinical practice , chances are that you have done or will do a risk assessment sometime today. As practitioners, we worry, quite rightly, about patients with severe mental illnesses, such as schizophrenia, committing suicide. We use risk assessment tools to try and predict patients who are at particularly high risk and then plan appropriate intervention. When our patients do kill themselves, we will often hold an inquiry to determine whether the treating team did everything they could have done to prevent the tragedy occurring. It will come as no surprise then that patients with severe mental illness (SMI) have a dramatically reduced life expectancy compared to the general population. In the USA, adults with severe mental illness die 25 years younger than other Americans (NAMI 2007). What might come as a surprise is that most patients with SMI die from cardiovascular disease (CVD) or from a sequelae of metabolic complications, not suicide, and that life expectancy for patients with SMI is actually decreasing (Fontaine et al. 2001). One of us vividly remembers caring for a patient who died suddenly in his 50s from CVD; he was overweight, had a terrible diet, smoked, and drank. After his death, there was no inquiry, no questions were asked about the care and treatment the health-care team looking after him provided. This is perhaps the real tragedy of 21st century mental health care. We can imagine no other area of medicine where the life expectancy of a patient population getting worse would be anything other than a scandal. At a public debate about physical health and SMI at the (world famous) Maudsley Hospital in 2003, the debate was not about what we can do to improve physical health and increase life expectancy; instead it was about whether primary or secondary care was responsible. Ultimately, responsibility for the physical health care of people with SMI does lie (in most countries) with primary care, but all nurses have a duty to promote health (Hardy 2009). Why then do our patients die? Patients with SMI may have an inherent vulnerability to CVD and other comor-bities (Chwastiak et al. 2006; Lawrence et al. 2003); lifestyle risk factors (obesity, smoking, lack of exercise, and a poor diet) are also prevalent (Robson & Gray 2007). Even …