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‘Whole person approach’ needed to treat mind and body

12:00am | & Health

The old saying ‘healthy body, healthy mind’ suggests a strong link between physical and mental wellbeing, but also implies that one springs from the other.

In other words, if your look after your physical health, good mental health will follow. In reality it’s not always as that simple, and now a new report from Public Health England suggests a kind of negative mirror image.

It clearly shows that people with severe mental illness also suffer significantly worse physical health compared to the general population. To paraphrase the old saying and turn it around: ‘Unhealthy mind, unhealthy body’.

The report is based on data from GPs in England for patients under the age of 75. It was prompted by inequalities already known to exist in people with severe mental illness, who die on average 15 to 20 years earlier than the general population. It is part of wider work to improve the physical health of people with mental illness by having better-informed action plans, increasing early detection and expanding access to physical and follow-up care.

‘Severe mental illness’ (SMI) refers to people who have received a diagnosis of bipolar affective disorder or schizophrenia, or who have experienced an episode of psychosis. The report found patients with SMI have a higher prevalence of:

  • obesity (1.8 times more prevalent than the general population)
  • diabetes (1.9 times)
  • Chronic Obstructive Pulmonary Disease (2.1 times)
  • stroke (1.6 times)
  • heart failure (1.5 times)
  • Coronary Heart Disease (1.2 times)
  • asthma (1.2 times)

Patients with SMI are also around twice as likely to have multiple physical health conditions as the general population. The report also highlights that the greatest inequalities are among younger people (aged 15 to 34) with SMI. They are five times more likely to have three or more physical health conditions than the general population and also suffer further from a higher prevalence of:

  • obesity (3 times more prevalent than the general population)
  • diabetes (3.7 times)
  • hypertension (3.2 times)

Professor Julia Verne, Head of Clinical Epidemiology at Public Health England, said: “It’s unacceptable that people with severe mental illness live with more ill health and die up to 20 years younger than the rest of the population. We need to look beyond mental illness to a ‘whole person approach’ to health care, helping to improve peoples’ lives.

“It’s vital that people experiencing severe mental illness are supported to improve their physical health, including better access to support and services such as screening programmes, health checks and stop smoking services.”

Mark Winstanley, from mental health charity Rethink, responded: “It’s hugely concerning that the average life expectancy of someone living with serious mental illness is the same as the life expectancy of the average adult in the 1950s. The physical health needs of people experiencing serious mental illness must be taken into consideration alongside their mental health needs.”

National Institute for Health and Care Excellence (NICE) guidelines recommend that GPs monitor the physical health of patients with SMI, who should have at least one annual physical health review. It should include (among others) checks on weight or BMI, metabolic status, pulse and blood pressure monitoring, as well as appropriate interventions and support with recovery.

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