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Here’s what fair treatment of the mentally ill looks like

The poor physical health of people with mental illness has been known about for decades — one of the first studies in this area was published as far back as 1934. A National Summit on Mental Health and Physical Health is being held in Sydney today to identify actions that could be taken in the “immediate, short and long term” to address this. Mark Ragg writes:

A whole bunch of people in important positions are getting together today with the opportunity to make a real difference for one of the most disadvantaged groups of people in this flat brown land. They’re gathering at Sydney’s Parliament House for the national summit of health and mental health ministers who will discuss the physical health of people with mental illness, and expectations are high.

For it won’t just be the ministers present who have to reconcile stakeholders’ wishes, ideology and budgetary reality. They’ll be surrounded by consumers, mental health commissioners, advocates and others who all want to see something solid happen. Spectacular isn’t necessary. Real is enough.

And this is why.

People with a serious mental illness die young, probably 25 years earlier on average than they should. And they don’t die necessarily of suicide, as significant a problem as that is. They die of all those run-of-the-mill conditions that get everybody else — heart attacks, diabetes, kidney failure, lung cancer. All are preventable to some extent, but not yet in that group of marginalised people.

The lifespan of people with serious mental illness is similar to that of an average person in the times of Parkes and Barton. On any given day, a person with serious mental illness is roughly twice as likely to die as a person without serious mental illness, even after adjusting for socioeconomic status.

Why?

At one level it’s complex — people with serious mental illness may find it hard to get help, to follow advice, to eat well, to keep appointments, to navigate a complex system. And some of the drugs used to treat psychotic illnesses pack the kilos on very quickly.

But at another level, it’s straightforward. Those who look after people with mental illness have not bothered to take good care of their physical health. Partly that’s a systemic and structural issue — mental healthcare and physical healthcare are divided at many levels.

But it’s also a matter of personal responsibility — many health professionals stigmatise people with mental illness, feeling their lives aren’t as important, that they don’t need all the investigations offered other people for their illnesses, and sometimes even that their cancers don’t need treating.

There’s been a real shift in thinking in the past five years or so. Nurses, psychiatrists and policy-makers have begun to recognise that if everybody else is encouraged to eat well, get some exercise and quit smoking, then, well, people with mental illness should be offered the same advice.

That shift is stronger in the mental health sector than the rest of the health system, and it still has a way to go before it is the norm. And there is still a long way to go before people with mental illness are routinely offered the same investigations and treatments of their symptoms of heart disease, cancer and other physical illnesses as others.

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