People with serious mental illness are still
living 15-20 years less than the rest of the population, according to a
study from the Nordic countries.
The study, published in the December issue of
the British Journal of Psychiatry, shows that the life
expectancy gap has remained largely unchanged over the last 20
years – despite changes to the provision of mental health services
and improvements in public healthcare.
Researchers from the Nordic Research Academy
in Mental Health in Sweden studied the life expectancy of people
admitted to hospital for a mental disorder in Denmark, Finland and
Sweden between 1987 and 2006. They found that those with a mental
disorder had a two- to threefold higher mortality than the general
population in all three countries.
The gap in life expectancy did decrease
slightly between 1987 and 2006 in Denmark and Finland, especially
for women. Overall, however, progress was modest. The notable
exception was in Sweden, where no progress was made in reducing the
life expectancy gap for men with mental disorders.
Lead researcher Professor Kristian Wahlbeck
said: "Our study shows that major health inequalities persist
between people with mental disorders and the rest of the
population. Men with mental disorders still live 20 years less, and
women 15 years less, than the general population."
The researchers put forward several
explanations for the higher mortality rate among people with mental
disorders. Professor Wahlbeck said: "These include an unhealthy
lifestyle, inadequate access to good-quality physical healthcare,
and a culture of not taking physical disease into consideration
when treating psychiatric patients. In addition, people with mental
illness are more often poor, unemployed, single and marginalised –
all known risk factors for poor health and premature
Writing in an
editorial in the same issue of the British Journal of
Psychiatry, Graham Thornicroft, Professor of Community
Psychiatry at the Institute of Psychiatry, King’s College London,
described the study’s findings as “a scandal”.
Professor Thornicroft said: "Even in three
Scandinavian countries that provide among the best-quality and most
equitably distributed healthcare in the world, this mortality gap
has narrowed only by a modest extent over the past two decades and
remains stubbornly wide. There is now strong evidence that people
with mental illness receive worse treatment for physical disorders.
Medical staff, guided by negative stereotypes, often tend treat the
physical illnesses of people with mental illness less thoroughly
and less effectively."
Professor Thornicroft continued: "If such a
disparity in mortality rates affected a less stigmatised section of
the population, then we would witness an outcry. The fact that life
expectancy remains about 20 years less for men with mental illness
and 15-years less for women with mental illness, denotes a cynical
disregard for these lost lives and shows, in stark terms, by just
how much people with mental illness are valued less than others in
our society. This can justifiably be seen a violation of the ‘right
to health’ as set out in Article 12 ‘The right to the highest
attainable standard of health’ in the International Covenant on
Economic, Social and Cultural Rights."
Professor Wahlbeck called for clear health
promotion actions, improved access to healthcare for people with
mental illness, and stronger suicide prevention policies –
especially in Sweden – to help reduce the life expectancy gap.
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Wahlbeck K, Westman J, Nordentoft M, Gissler M and Munk Laursen T. Outcomes of Nordic mental health systems: life expectancy of patients with mental disorders. British Journal of Psychiatry 2011; 199: 453-458.
Thornicroft G. Physical health disparities and mental illness: the scandal of premature mortality. British Journal of Psychiatry 2011; 199:441-442