Global commission into health inequities of mental illness gives blueprint for change
17 July 2019
Findings released today by a commission into health inequities experienced by people with mental illness lays bare their drastic physical health challenges, and recommends changes to health policy and treatment innovations to tackle what is regarded as a “human rights scandal”.
Today’s publication - The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness (opens in a new window) - is (opens in a new window) - is the culmination of over 12 months of research conducted by a taskforce of more than 30 international experts, led by researchers from NICM Health Research Institute at Western Sydney University, The University of Manchester, UNSW Sydney, King’s College London and Orygen National Centre of Excellence in Youth Mental Health.
The researchers’ ground-breaking report has four key aims including: establishing extent of physical health disparities in people with mental illness; highlighting key modifiable factors that drive poor health, presenting initiatives for health policy and clinical services to address these issues, and identifying promising areas for future research into novel solutions.
The Lancet Psychiatry Commission found a broad range of mental illnesses are associated with a lifelong burden of obesity, diabetes, and cardiovascular disease – which contributes towards a gap in life expectancy of around 20 years for people with mental illness. Key risk factors include higher rates of smoking, sleep disturbance, physical inactivity, unhealthy diet, the side effects of many psychiatric medications, and a lack of access to adequate physical healthcare.
Recommendations include adopting an ‘early intervention’ approach towards protecting physical health from initial stages of illness, and the provision of multidisciplinary lifestyle treatments, targeting a range of health behaviours, such as physical activity and healthy eating. Alongside this, recommendations for better integration of physical and mental healthcare, and evidence-based use of both psychiatric and cardioprotective medications for people with mental illness, are also provided.
The chair of the commission, Dr Joseph Firth, senior research fellow at NICM Health Research Institute, Western Sydney University and honorary research fellow at The University of Manchester, said the study was an important step towards addressing the entrenched and profound physical health inequities experienced by people with mental illness.
“The disparities in physical health outcomes for people with mental illness are currently regarded as a human rights scandal,” Dr Firth said.
“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, while contributing towards a 20-year gap in life expectancy currently experienced by this underserved population.
“These comorbidities begin to arise early on, and affect people with mental illness across the entire lifespan. Clearly, protecting the physical health of people with mental illness should be considered an international priority for reducing the personal, social and economic burden of these conditions.”
Lifestyle section lead of the commission and UNSW Sydney academic, Dr Simon Rosenbaum, said that lifestyle interventions to improve physical health must become a core component of mental healthcare, from the very initiation of treatment.
“Our commission found that although there is increasing attention towards the lifestyle risk factors in mental illness, there is still a widespread lack of implementation of evidence-based lifestyle interventions for these populations.
“We must take 'what works' from effective interventions for improving physical activity, diet and cardiovascular health in the general population and find innovative and cost-effective ways for making these interventions a standard part of care for those treated for mental illness."
Dr Brendon Stubbs, co-senior author of the commission and National Institute for Health Research Clinical Lecturer at King’s College London, said, “The high rates of preventable physical health conditions in people with mental illness has to stop. Through this commission we have set out ambitious goals to provide an opportunity and directions to help people with mental illness improve their physical health and not only add years to their life, but also add life to their years.”
NICM Health Research Institute’s Professor Jerome Sarris, a co-author in the commission, said that the large disparities in physical health experienced by people with mental illness is an ongoing and possibly worsening health issue in some areas and that urgent action was needed to protect this vulnerable population.
“The connection between physical and mental health is now more recognised than ever. Although this inequity is increasingly gaining attention, further investment, intervention and research are urgently required to address the premature mortality and lifelong burden of poor physical health associated with mental illness,” Professor Sarris said.
The commission also involved researchers from The University of Adelaide, University of York, The University of Queensland, and over a dozen other institutions, in addition to clinicians, and key stakeholders from a wide range of backgrounds and professional or personal experience in the topic.
The report and recommendations are available online today at https://doi.org/10.1016/S2215-0366(19)30132-4, (opens in a new window) but will be launched formally at the 19th WPA World Congress of Psychiatry to be held in Lisbon, Portugal, in August.
This work was supported in part by the National Institute of Health Research (NIHR) using Official Development Assistance funding (Grant: 17/63/130: NIHR Global Health Research Group: Improving Outcomes in Mental and Physical Multimorbidity and Developing Research Capacity (IMPACT) in South Asia at the University of York). JF is supported by a Blackmores Institute Fellowship. NS is funded in part by the NIHR Collaboration for Leadership in Applied Health Research and Care Yorkshire and Humber (NIHR CLAHRC YH). DSi is supported in part by an NHMRC Early Career Fellowship (APP1111136). SR is supported by an NHMRC Early Career Fellowship (APP1123336). FG is funded in part by the NIHR Biomedical ResearchCentre at South London and Maudsley NHS Foundation Trust. FG is also supported by the Maudsley Charity, King’s College London, and the South London Collaboration for Leadership in Applied Health Research and Care Funding. JS is supported by an NHMRC Clinical Research Fellowship (APP1125000). JTo is supported by a NARSAD Young Investigator Grant from the Brain and Behavior Foundation. Brendon Stubbs is supported by a Clinical Lectureship (ICA-CL-2017-03-001) jointly funded by Health Education England (HEE) and the National Institute for Health Research (NIHR). Brendon Stubbs is part funded by the NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust. Brendon Stubbs is also supported by the Maudsley Charity, King’s College London and the NIHR South London Collaboration for Leadership in Applied Health Research and Care (CLAHRC) funding. GT is supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South London at King’s College London NHS Foundation Trust, and the NIHR Asset Global Health Unit award The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. GT receives support from the National Institute of Mental Health of the National Institutes of Health under award number R01MH100470 (Cobalt study). GT is supported by the UK Medical Research Council in relation the Emilia (MR/S001255/1) and Indigo Partnership (MR/R023697/1) awards. The views expressed in this Commission are those of the authors and not necessarily those of the acknowledged institutions.