Health care and mental illness
January 24, 2011 1 Comment
Blog Post by David Gardner, Professor of Psychiatry, Dalhousie University
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.