Health care and mental illness

Blog Post by David Gardner, Professor of Psychiatry, Dalhousie University

Read also Cardiovascular Disease responsible for shorter life expectancy in people with mental illness

The health care received by people living with a major mental illness (outside of mental health care) is less frequent, of a lower standard, and leads to poorer outcomes when compared to the general population. This has been found in studies of people with a mental illness who also have hypertension, diabetes, HIV/AIDs, a major cardiovascular event, and so on. Two reports have offered striking examples of this. Druss and colleagues reported that post-myocardial infarction elderly patients with schizophrenia or a mood disorder were much less likely (relative risk reductions of 59% and 35% respectively) to undergo cardiac catheterization as someone without a mental disorder. Young & Foster, in a follow-up study to Druss et al, also found mental illness to be associated with fewer revascularization procedures (e.g., 30% reduction in people with schizophrenia post MI). Of most concern, they also found an 86% increase in the in-hospital mortality rate in patients with schizophrenia. Is the poorer health care and outcomes due to problems with access, treatment recommendations, treatment refusal, inadequate follow-up or monitoring, poor adherence, or are the underpinnings (at least in terms of poor outcomes) biologically based? Probably “all of the above” is the right answer, but what do we do about it? There are some things we can’t change (e.g., biology) and some things we can, though with much effort in some cases. At the very least we should be offering to our patients the same health care opportunities that are offered to other patients with the same medical problems, whether that be smoking cessation options, healthy lifestyle supports, or post MI best practice procedures and care. 

 Druss BG, et al. Mental disorders and use of cardiovascular procedures after myocardial infarction. JAMA. 2000; 283: 506-11.

Young JK, Foster DA. Cardiovascular procedures in patients with mental disorders. JAMA. 2000; 283:3198.

David Gardner is a co-author of Antipsychotics and Their Side Effects, published by Cambridge University Press.

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One Response to Health care and mental illness

  1. James J. Amos, MD says:

    I really appreciate your remarks about the challenges in providing psychiatric care to patients with comorbid medical illness, an issue with which Psychosomatic Medicine specialists and those with dual training in psychiatry and internal medicine, neurology, and family medicine wrestle with daily. I co-staff our Complexity Intervention Unit (CIU), also called the Medical-Psychiatry Unit, the preferred name being the former (CIU), which admits patients who have both acute psychiatric and medical illness. Often these patients are taking multiple antipsychotics as antipsychotic polytherapy. Some of their medical complications due to the antipsychotics can include metabolic syndromes, frank Diabetes Mellitus, and Clozapine Induced Gastrointestinal Hypomotility (CIGH).

    One of my former teachers, Dr. Roger Kathol, has a great deal to say about the difficulty of integrating medical and psychiatric care in the mentally ill. His position would be in accord with yours in many respects although he would emphasize the health care system delivery barriers that interfere with providing quality health care to those with complex physical and mental illness. One small example of his position can be found on his website at: http://www.cartesiansolutions.com/faqs/FAQ10_outcomes.shtml.

    Although in my work as a psychiatric consultant I deal mainly with the short term effects of conventional and atypical antipsychotics in patients suffering from delirium, I can attest to the usefulness of your addition to the literature on the long term factors in treating patients with members of this class of medications.

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