


Winning the mental illness battle, but losing the war

Louise Pascale Ramp Up 10 Sep 2012
Obese man smoking and watching basketball game

Obesity related health risks kill more schizophrenia sufferers than other associated health risks, such as suicide. Credit: Digital Vision (Thinkstock)


In the United States Autumn of 2006 psychiatrist Dr Joe Parks and his peers released a report that would send ripples through the psychiatric community. An analysis of mortality data from across the country, it confirmed people with serious mental illness were dying on average 25 years earlier than the general population. The compounding reasons why were something Dr Parks had seen for many years in his own practice.

'I just had too many patients where I was able to help them with their moods, with their psychosis but during all that time they were getting heavier and heavier. They're getting hypertensive, they're getting diabetic, they'd get asthma', he says via telephone from his home in the US.

'You'd put them on steroids because their asthma's wheezing so bad, the wheezing destabilises their mood and you end up with somebody that you'd worked with them for 15 years and they're not psychotic. Their mood is stable, they're not cutting themselves, they're not taking too much crack or drinking too much liquor anymore and they die because they're 260 pounds of a heart attack in the middle of an asthma attack. I just kept on having patients die that I was personally treating.'

While suicide and injury account for about 20 per cent of deaths, Dr Parks' findings demonstrated 80 per cent of premature deaths of people with schizophrenia or serious mental illness were due to medical conditions such as cardiovascular, pulmonary and infectious disease. For many consumers these could be avoided, particularly those suffering from the effects of obesity or smoking. Yet the weight gain and diabetes can also be attributed to most second-generation antipsychotic medications.

'These drugs are by and large effective but they don't fix things completely. And if the initial dose gets someone 60 per cent better that doesn't mean if we double the dose we get 100 per cent better', explains Dr Parks. 'Once people get their initial improvement we keep piling them more and more with pills and we don't recognise that it's reducing marginal improvement, often with more problems.'

Here in Australia those who are being treated for mental illness are often encouraged to make sure they eat and sleep well, with daily exercise. While this assists with the treatment of mental illness, it can also help close the mortality gap.

'I think there are a lot of things that can be done about that 25 year number. A lot of it is lifestyle choices, being more active, walking more, food choices, choice around smoking', he says. 'I find that when I address the physical things in my patients it helps my relationship. People do want their physician, whether that is a psychiatrist or general practitioner to look at them as a whole person and consider all their health and not just be treating just one system or just one body part. I find it more satisfying and successful to practice this way.'

Dr Parks research also revealed that people with serious mental illness had poorer access to the monitoring and treatment of their physical health conditions. To combat this Parks wants to see more of his peers adopt a policy that allows for integrated mental health and physical healthcare. That includes encouraging patients to be equal partners in their care and treatment. However, to achieve a joint responsibility a new dialogue needs to be created with physicians and patients need to ask more questions about their care. If established correctly most physicians would embrace this dialogue, Parks believes. However, he cautions, 'they don't like direct challenges but most of them are ok with questions. If you have a physician that isn't ok with questions you probably need another physician.'

Yet regardless of whether the physician is unhappy or not with the scrutiny, Dr Parks believes strongly that consumers 'have an absolute right to know how a serious mental illness diagnosis will currently impact on their expected lifespan.'

Importantly, Dr Parks research does not stand-alone. In Finland, Dr Jari Tiihonen of the Department of Forensic Psychiatry at the University of Eastern Finland found Finnish patients with schizophrenia have a lifespan more than 20 years shorter than the general population. The most common reason also being cardiovascular illnesses as those with schizophrenia were found to smoke 15-25 per cent more than the general population.

Furthermore it is not just those in the psychiatric fraternity who can benefit from this research. Dr Parks found when talking to physicians in emergency departments they are treating patients with serious mental illness who have the same risk of having a heart attack as someone who had already had one.

When treating these people Parks believes the physician's first response should not be to call the psychiatrist. 'The first thought on your mind should be - here's somebody that has two to three times the usual rate of hypertension, [and is] more likely to have diabetes. They're less likely to have it diagnosed, they're less likely to have it treated. I better check for that stuff because I can treat that quick and easy. We'll get them to the psychiatrist after that', says Dr Parks.

Dr Parks is in Australia for a tour of forums and seminars on what his research revealed and to discuss integrated models of care for people with serious mental illness. During his two-week stay he will be addressing consumers, NGO's and health practitioners.

'I'm coming to Australia because I really want people to be more aware of the extent to which people with serious mental illness have multiple chronic health conditions', he says. 'People think they're worried about people with serious mental illness committing suicide. But far more people with serious mental illness die of heart disease, hypertension, respiratory illness or diabetes, than die of suicide.' This is not only alarming for Dr Parks, but something he feels personally responsible for.

'If our goal is for people with mental illness to recover and have a full life in the community then we need to keep them alive. No-one recovers from schizophrenia if they die from a heart attack at 50.'

Louise Pascale is an independent journalist and producer living in South Australia.

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