Dimensions of improvement: The physical health of people with mental illness

The article analyzes a recent meta-analysis of mortality in mental illness, which has concluded that mental health conditions constitute a population attributable risk (PAR) of 14.3% and are, therefore, responsible for more than 8 million annual deaths worldwide, ahead of ischaemic heart disease, stroke, chronic obstructive pulmonary disease (CORP) and HIV/AIDS. It is proved that this huge death rate is partially attributable to an increased likelihood of people with a mental illness developing physical health problems. This is particularly the case in cardiovascular disease (CVD), by far the largest contributor to worldwide disease-related mortality, where diagnosis is as much as two and a half times more likely for people with major depressive disorder or schizophrenia, and may yet be even higher for people with bipolar disorder. It is clear that international governments and social services need to take heed of this looming public health crisis and implement new strategies and services capable of breaking the cycle and preventing early deaths. However, the global health budget is not unlimited and therefore it is crucial that the strategies prioritised are taken forward, and are efficient, evidence-based, and flexible enough to draw significant outcomes from a variety of contexts. The only way these three criteria can be satisfied, is through a concrete understanding of the causes of reduced physical health in people with mental illness. Mental health and physical health are so interlinked, maybe it is unhelpful to think of them as two separate entities and just focus on promoting health in general. The reintegration of psychiatric care and general somatic services, with an ultimate goal of providing optimal services to this vulnerable patient population, seems to represent one of the most important challenges for psychiatric care today.  Integrated treatment programmes in which medical providers are supported to treat common mental health problems offer a chance to treat ‘the whole patient’, an approach that is more patient-centred and often more effective than an approach in which mental health, acute and chronic physical health, reproductive health, and chronic pain problems are each addressed in a different ‘silo’.