this effected any other group of people, society would be up in
with a mental illness have shockingly bad physical health compared
to the rest of the population. And a report by the Disability Rights
Commission accuses the health service of blatant discrimination
in not ensuring their health needs are met. Adam James
looks at improvements being made, and examines whether it will be
enough to prevent the NHS being sued
Chadwick was diagnosed with manic depression in 1987. Statistics
show she is significantly more likely to have heart disease, suffer
a stroke, obesity, respiratory disease or, indeed, develop cancer.
that Lauren’s GP was aware of this. For the six years Lauren
was his patient, he never gave her a full physical check-up. If
he had he might have found the cancerous tumour the size of an egg
in Lauren’s breast. Eventually, it was a nurse at Lauren’s
new GP surgery who found the lump. Within five day chemotherapy,
radiotherapy and surgery were organised for the cancer which had
spread to other parts of the 41 year old’s body.
now 56, feels “extreme anger” towards her first GP.
“I did feel let down,” she says. “I felt that
he would not have treated me like that if I didn't have a mental
experience of Lauren [not her real name] is common, it seems. A
hard-hitting Disability Rights Commission (DRC) report released
in September complained of a culture among health professionals
of “complacency” and “lazy fatalism” of
accepting that people with mental health problems (as well as the
learning disabled) “just do” die younger, are incapable
of looking after their health or attending GP appointments.
DRC’s report was based on its own quantitative research into
eight million primary care records, plus qualitative research with
one health board in Wales and three England primary care trusts
(PCTs). This provided “the strongest evidence base [of its
kind] anywhere in the world”, said the DRC
found that people with mental health problems, particularly those
diagnosed with a severe mental illness (SMI) have higher rates of
obesity, smoking, heart disease, diabetes, respiratory disease,
and stroke than the rest of the population. Specifically, it found
that women diagnosed with schizophrenia are 42% more likely to get
breast cancer. The investigation also revealed an alarming new finding
– that people diagnosed with schizophrenia are 90 per cent
more likely to have bowel cancer, the second most common killer
disease in Britain.
the poor socio-economic status of SMI people is one cause for this
inequality, said the DRC. But it also accused the health service
of blatant discrimination. The DRC reported, for example, that almost
half of respondents in its survey complained of “barriers”
when arranging to see their GP – such as derogatory reception
staff, inflexible appointment systems, lack of knowledge on the
side-effects of powerful psychiatric medication, or being struck
off from GP lists for being too demanding.
findings should make policy-makers sit bolt upright in attention.
Indeed, the DRC’s call to arms is that professionals and organisations
providing GP and primary care services should “act now”
to tackle inequalities in primary healthcare provision for SMI people.
The DRC’s report, entitled Equal Treatment: Closing the Gap,
calls nationally for SMI people to be specifically targeted for
health checks and for an end to “diagnostic over-shadowing”
whereby professionals effectively ignore an SMI person’s physical
ill health by presuming every ailment is related to their mental
government says it recognises the problem. Infact, the health minister
Rosie Winterton said she agreed with the "broad thrust”
of the raft of DRC recommendations.
in August the Department of Health sent best practice guidance to
PCT managers on how to improve the physical health of SMI people.
£7m was also allocated to eight PCTs to employ “well-being”
nurses to work in partnership with GPs, health and mental health
staff to deliver health checks and blood tests to SMI people, advise
them on diet and exercise, and support them to access primary care
services. The initiative was heralded as part of the government’s
bid to make mental health nurses work "holistically”
guidance showcased eight Well Being pilot projects which, from 2004
to this year, were provided (for free) to the NHS by pharmaceutical
firm Eli Lilly. Working alongside a PCT, one Well Being nurse ran
health check-ups and health living advice either at SMI people’s
home or clinics. The nurses also organised healthy living groups.
As published in the guidance, some of the projects led to a reduction
in alcohol of 57%, 32% in smoking reduction, and a 60% increase
in activity levels, as well as boosting patient self esteem.
results have been absolutely outstanding,” says Mark McKeown,
manager for the Well Being pilots.
of the nature of mental illness, people are loathe to go to GP practices
because when they go the focus always ends up on their mental health,
even though they might of gone, for example, because of problems
with their tonsils.
even with the best will in the world GPs don’t have time to
spend time with [SMI] people. A GP could not do in seven minutes
what we do. The Well- Being programmes are offering a service which
makes sure [SMI) people do not fall through the loop.”
enthuses that improving the physical health of SMI people could
be “the next big thing” in mental health. Yet it might
be fear of ending up in court that, ultimately, drives the NHS to
provide better primary care to SMI people.
DRC warns that if there is no genuine improvement, the NHS could
feel the force of the Disability Discrimination Act. From December,
a “Disability Equality Duty” means SMI patients could
sue trusts for not making “reasonable adjustments” in
providing equal access to primary care services.
“reasonable adjustments” might mean GPs – or nurses
- having to give more consultation time to SMI people with difficulty
retaining information, or ensuring that people with agoraphobia
do not have to wait in a busy GP waiting room.
changes are not being made we do have enforcement powers,”
says Liz Sayce, the DRC’s director of communications. “If
we find action is not in place nor is robust enough to close gaps
of inequality, then there will be process of alerting services that
they have those commitments.”
Department of Health said it is to convene a meeting of senior staff
to work with the commission on a response to the report. This will
be published early next year.
concerns have been aired that “well being” nurses will
be insufficient to address both the scale of the problem and the
“complacency” mind-set within the health service.
example, Judy Dean, a clinical project manager with Cambridgeshire
and Peterborough Mental Health Partnership NHS Trust, has led health
improvement programmes for SMI people. This included brokering partnerships
with local council services who provided venues for swimming and
is adamant that to affect change for SMI people means making sure
everyone involved in a SMI person’s care works holistically.
“Appointing well being nurses is not going far enough,”
she argues. “It’s an awful lot to expect one individual
to do. To have one or two nurses for one PCT is laughable really.
The emphasis should be much more on a multi-agency approach, with
the person’s care-co-ordinator taking responsibility.”
who is a nurse, says this would ensure that improving the physical
health of SMI people is “part of a full package, and not an
afterthought.” She adds: “This is an issue of people’s
also insists that improving the physical health of SMI people needs
more “mainstreaming”. The DRC report observes that,
too often, the health needs of SMI people are “off-loaded”
onto specialist services rather than being addressed through primary
care. The DRC is also recommending that GP contracts contain incentives
to routinely run physical health checks on SMI people.
guidance is a worthwhile step…but it’s crucial there’s
national leadership on this issue,” says Sayce. She also questions
how the 64 PCTs not included in the government’s £7m
package are expected to improve their service to SMI people.
we are saying to the government and those who commission services
is that the evidence [for discriminatory practice] is now here,
“ she says. “And they should use this to build action
plans that bring about change.”
Floyd is a “Well-Being” nurse who for two years worked
in Brixton with 200 people diagnosed with a SMI. Attached to a South
London and Maudsley NHS Trust community mental health team, Floyd
ran a clinic, providing full health check-ups and healthy living
advice including examining the side effects of psychiatric medication.
A client would be seen around six times over two years. Floyd also
ran weekly healthy living groups, providing advice on eating healthily
and exercise for 15-20 clients per group. The Well Being programme,
funded by Eli Lilly through private nursing firm Inventive Solutions,
has now ended. But Floyd is working with South London and Maudsley
NHS Trust to train new Well Being nurses
people who came to my clinic had not seen a GP for 10 years. Or
I might measure a person’s blood pressure and find it to be
so high that I would immediately refer them to a GP for blood pressure
was rare for me to see someone who did not have a physical health
need that needed immediate addressing. Of the 200 people I saw,
around 10 had a life-threatening condition, such as blood pressure
or cholesterol levels that were so high that they could have had
a major coronary event, such as a stroke. By picking up high blood
pressure for one client, her consultant said I could have prevented
her from dieing
people just needed encouragement or health education. For example,
despite presumptions, many people with a SMI do actually want to
give up smoking. Also, somebody might be eating a takeaway meal
around four times a week, so we might try to bring it down to one
takeaway a week.
"A lot of people do not understand the basics of looking after
themselves. It’s also about getting people used to going to
see their GPs, and hopefully not reliant on seeing me.”
this issue effected any other group of people, society would be
up in arms.
Killer facts (taken
from DRC report, Equal Treatment: Closing the Gap)
with schizophrenia are 42% more likely to get breast cancer.
People with schizophrenia 90% more likely to get bowel cancer
People with schizophrenia or bipolar disorder 60% more
likely to have ischaemic heart disease; 80% more likely to have
a stroke; 30% more likely to have hypertension
33 per cent of people with schizophrenia and 30% with bipoloar are
obese, compared with 21% of rest of population
* 61% of people with schizophrenia and 46% with bipolar disorder
smoke, compared with 33% of the rest of population
22% of people with coronary heart disease and schizophrenia die
after five years; 8% die in rest of population
19% of people with diabetes who have schizophrenia die after five
year; 9% die in rest of population
28% of people who have had a stroke and have schizophrenia die after
five years; 19% of people with bipolar disorder die; 12% of people
with no serious mental health problems die
* This article originally appeared in Mental
Read for yourself:
The Disability Rights Commission's
report, Equal Treatment: Closing the Gap.
15, 2006: NHS could be sued over inadequate physical health care
for mentally ill and learning disbled - Disability Rights Commission
warns health service “complacency” in accepting that
people with mental health problems and learning disabilities “just
do” die younger could be breaking the law
do you think? Email your comments on the above
article to the editor using the form below. Selected comments will
© 2001-7 Psychminded Limited. All
about this article