PEOPLE WITH serious mental health problems are more likely to develop significant physical illnesses including coronary heart disease, diabetes and stroke and to die earlier.
Someone with schizophrenia has a much higher risk of cardiac disease and is more likely to die of a heart attack than someone who does not suffer a mental illness.
According to the World Federation for Mental Health (WFMH), about one in five people will have an episode of major depression in their lifetime. That number climbs to about one in two for people with heart disease, while the risk of coronary illness is double in people with a history of depression.
Last Sunday was World Mental Health Day and the WFMH chose to focus on the relationship between mental health and chronic physical illness as the theme for this year’s event.
While the link between mental illness and physical ill health is well documented, researchers have highlighted the importance of identifying and caring for the psychological or emotional impact on patients of a life-threatening condition.
A 2006 report by the Disability Rights Commission in the UK (now known as the Equality and Human Rights Commission) revealed higher rates of ischaemic heart disease, stroke, high blood pressure and diabetes among people with schizophrenia or bipolar disorder compared with the rest of the population.
In summary, the report entitled Equal Treatment: Closing the Gap – A Formal Investigation into Physical Health Inequalities Experienced by People with Learning Disabilities and/or Mental Health Problems, found that “someone with a major mental health problem is more likely to develop a significant illness like diabetes, CHD , stroke or respiratory disease than other citizens, more likely to develop it before 55, and – once they have it – more likely to die of it within five years”.
“This combination of facts means that people with schizophrenia die younger than other citizens, even after accounting for suicide. The same is true for people with bipolar disorder in relation to CHD, stroke and respiratory disease. People with depression also have higher risks of key physical illnesses than other citizens. The impact on them, their families, friends and fellow service users should not be underestimated.”
According to the World Health Organisation (WHO), “there can be no health without mental health”. A new report from the organisation found that people with mental health conditions experienced “substantial disability and premature death”.
While the report, entitled Mental Health and Development: Targeting People with Mental Health Conditions as a Vulnerable Group, focuses on mental health in low- and middle-income countries, the WHO points out that the problems described “are by no means confined to developing countries”.
According to the WHO, mental health conditions account for 13 per cent of the total burden of disease globally, and 31 per cent of all years lived with disability. “By 2030, depression alone is likely to be the single highest contributor to burden of disease in the world – more so than heart disease, stroke, road traffic accidents, and HIV/Aids.”
Prof Jim Lucey, a consultant adult psychiatrist and medical director of St Patrick’s University Hospital in Dublin, says major mental illnesses such as schizophrenia affect people biologically, psychologically and socially, and it is important that patients are treated in a holistic manner.
“If we are interested in the health of people with mental illness, we have got to be interested in their whole health. If we are really going to intervene in terms of recovery, we have got to empower people with mental illness to look after their body and their mind.”
Prof Lucey says people with mental health difficulties experience significant problems getting the same level of attention to their physical health as those without mental health problems.
“They find it very difficult to get investigated for routine illness or to get checked in terms of overall wellness, such as blood pressure monitoring, diabetes monitoring, cholesterol monitoring and weight gain.”
While Lucey says there is no single reason why people with mental health problems have difficulties accessing care, part of it could be attributed to the stigma that continues to surround mental illness.
Major mental illnesses jeopardise both mental and physical health, and this divisional bridge needs to be crossed, so that healthcare providers see the importance of providing holistic care or looking after the health of both the mind and the body, he says.
“If we value the reduction in mental health symptoms, that is great, but if we value overall function – life with living, with working, with relationships with being a whole human being – then we have to value the ability to maintain that over time. And, in fact, if our patients are dying four times more frequently of heart attack before the age of 50, then we are not addressing that,” he says.
According to the WFMH, one of the many risk factors associated with chronic illnesses is the emotional impact on people who are ill and their families. “Many chronic illnesses can have a strong effect on an individual’s mental and emotional status, and, in turn, undiagnosed mental disorders can affect a person’s ability to cope with an illness and participate in the treatment and recovery process.”
It is estimated that approximately one in four people with cancer will experience depression at some point after diagnosis. “Unfortunately, many people with cancer and their family members believe that it is quite normal to be depressed or sad if diagnosed with cancer – depression is sometimes viewed as being appropriate in these patients. However, it should never be appropriate for cancer patients to suffer with serious depression,” according to the WFMH.
Dr Paul D’Alton, head of the psycho-oncology service at St Vincent’s University Hospital in Dublin, the discipline that looks after the emotional and psychological wellbeing of cancer patients, says that about 40 per cent of people with a diagnosis of cancer will have a particular emotional or psychological reaction that warrants the intervention of a professional.
“It is not a crippling mental health difficulty so to speak, but a very understandable reaction to a very abnormal event. Your life is threatened . . . that rocks people fundamentally . . . we really need to educate the patient and their families about that. But almost more importantly, we need to provide education to healthcare providers to watch out for that level of distress, that that is a normal level and it is one that we can intervene in,” he says.
While psychological support for people suffering from serious physical conditions is available in other areas of the health service such as cardiac rehabilitation, cystic fibrosis and pain management, D’Alton believes a great number of Irish patients are not getting the support they need.
“We have a big job to do in making sure that that happens across the health service in Ireland,” he adds.
LIVING WITH PARKINSON'S: 'IT IS THERE EVERY WAKING MOMENT'
For Ann Keilthy, who was diagnosed with Parkinson’s disease at the age of just 44, the emotional impact of the diagnosis was the most difficult psychological aspect of the condition.
“I was in shock. At the beginning you really don’t know what it actually means. You are not aware that it is going to degenerate to the point where you won’t be able to move without medication or something else,” says Keilthy, who lives in Dublin.
“I don’t think anything prepares you for the gradual decline in your quality of life, although they say that if you are more positive about it that your quality of life is much better as a result.”
Keilthy was suffering from depression at the time and was “very anxious and very down”. She attended a psychiatrist and was put on antidepressant medication, which she says was helpful and continues to take today. She credits the loving support of her husband, Liam, and the help she received from the Parkinson’s Active Liaison Support (PALS), a branch of the Parkinson’s Association of Ireland for those diagnosed under the age of 55, as being instrumental in helping her over the very difficult early period post diagnosis.
“This was a big black cloud hanging over me and I really didn’t know how I was going to cope over the years with it,” she says.
Today, Keilthy works with PALS and the Parkinson’s Association of Ireland and has made it her mission to help others who are newly diagnosed and in that same difficult place she was 14 years ago.
There is no formal counselling or psychological support available for people with Parkinson’s in Ireland like there is for other chronic conditions such as cancer. Keilthy says this is something which is much needed.
“Parkinson’s takes over your life and while people say, ‘Don’t think about it, get on with your life’, it is there every waking moment. That is the most awful price that you have to pay.”
For help or support contact the Parkinson’s Association of Ireland on tel: 1800-359359.
