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People With Mental Illness Die Up To Two Decades Earlier

A two-decade gap in life expectancy between people with mental illness and the general population has been described as a "human rights scandal", with a new report shining a light on the issue.

Doctor Joseph Firth, a senior research fellow at NICM Health Research Institute and lead author of a new Australian-led study, said the findings revealed global inequity for people living with mental illnesses.

"The disparities in physical health outcomes for people with mental illness are currently regarded as a human rights scandal," he said.

It has been recognised by medical literature for a long time that people with a mental illness appear to have shorter lives than those without one.

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While suicide contributes to approximately 17 percent of premature deaths, the majority of years lost are attributed to poor physical health and infectious diseases that affect more vulnerable people.

One 2013 study from ANU found among the Danish population, men with mental illness have a life expectancy approximately one decade shorter, while women with mental illness tend to have a life expectancy about seven years shorter than the general population.

A new meta-analysis, created by an Australian-led commission from Lancet Psychiatry into mental and physical health, has now looked into how life expectancy is shortened as a result of associated physical problems.

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The team of over 30 international researchers found that mental illness is associated with a broad range of physical burdens such as obesity, diabetes and cardiovascular disease.

The study reviewed almost 100 papers from across the globe published between 2000 and 2018 which examined the relationship between physical disorders, mental illnesses and alcohol and substance use.

Across all of the studies, the researchers found people with a mental illness have a life expectancy 20 years shorter than the rest of the population -- and the problem is getting worse.

What are the key health problems?

The researchers found the risk of cardiometabolic disease -- which includes a cardiovascular condition or metabolic diseases such as diabetes -- is nearly doubled for someone with a mental health disorder.

For patients with depression, the risk of developing a cardiac disease, hypertension, stroke or diabetes is approximately 40 percent higher.

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The only mental illness associated with a lower risk of cardiometabolic disease is anorexia. However, the study's authors point out patients with this condition are at a much higher risk for other severe health issues because of the physically-damaging behaviours associated with anorexia, such as osteoporosis.

Having a mental illness also holds an increased risk for infectious diseases such as HIV, Hepatitis C, Hepatitis B and syphilis.

The authors also note that medication used to treat psychotic disorders can have adverse effects on health, as some antipsychotic medications can affect the heart and also keep people sedentary or feeling lethargic.

The authors recommended that long-term studies of of antidepressants be conducted to understand the physical effects of these drugs.

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Firth noted in a media briefing that life expectancy is not the only important factor that could be observed from these studies -- quality of life was also impacted significantly.

"Patients with serious mental illness are two to three times as likely to have obesity, diabetes and cardiovascular diseases -- which impact on quality of life and recovery."

How can healthcare address these inequities?

Firth noted in a media briefing that treating the mind as a separate entity from the body -- known as dualism -- is an outdated approach to healthcare.

Instead, the researchers give a series of recommendations to try and address these issues, including changing the study curriculum for health professionals including dietitians and physiotherapists so that people with mental illness are treated comprehensively.

Doctor Simon Rosenbaum who led the policy recommendations section of the commission, said healthcare policies have to change so people living with mental illness benefit from public health interventions.

"The issue here is about equality. We know what works in the general population in terms of lifestyle-related intervention to relieve the burden of chronic disease with things like diabetes and heart disease," he said.

"Really we're just not applying those interventions at the moment to people living with mental illness."

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Rosenbaum believes that to narrow the gap in life expectancy, traditional mental healthcare must be rethought and the practitioners involved in treating mental illnesses need to be reassessed.

He added that exercise referrals and addressing smoking can be key components of mental health treatment, and that current policies in palliative care are "entirely under-utilised" due to lack of awareness and education.

"We need to make sure that these interventions are offered as part of standard care across the life course, regardless of diagnosis," he said.