Mental Health Matters: caring for the physical health of patients with SMI

There is extensive evidence of the increased mortality and morbidity of people with severe mental illness, mainly due to non-communicable diseases (NCDs). Patients with severe mental illness die over 20 years earlier than they would have done, had they not had a severe mental illness.

The causes of this premature mortality and excessive morbidity are multi-factorial. The spiral into deprivation experienced by many with severe mental illness is associated with homelessness, unemployment and poverty. There is a significant genetic component with well-known links between diabetes and schizophrenia. Linking all these conditions is the effect of smoking on NCDs which amongst people with severe mental illness can be as high as 70%. The interaction between the various NCDs is complex and cumulatively increases the risk of early death.

Health professionals’ attitudes to this group of patients may contribute to the delayed identification and poorer outcomes. Medication used for managing psychosis may also adversely affect morbidity.

The life time prevalence of psychosis is around 4%, with the vast majority of these patients living in the community. As such, family doctors have a very clear role in the management of their physical health needs. We therefore have a responsibility to address the premature mortality and morbidity experienced by this group.

For all these reasons, a task group of the WONCA Working Party for Mental Health, led by Alan Cohen (UK) and Kim Griswold (USA) has developed guidance to enable family doctors to care more effectively for their patients with severe mental illness.

We first provide an overview of general principles, followed by fact sheets on diabetes, smoking and respiratory disease, alcohol and substance misuse, and cardiovascular disease.

• General Principles for the Management of the Physical Health of People with a Severe Mental Illness

• Diabetes Type 2 in People with a Severe Mental Illness Fact Sheet

• Smoking, Smoking cessation, and Respiratory Disease in People with a Severe Mental Illness Fact Sheet

• Alcohol and Substance Misuse in People with a Severe Mental Illness Fact Sheet

• Cardiovascular Disease in People with a Severe Mental Illness Fact Sheet

We also provide a set of powerpoint slides, covering each of these four clinical areas.

• Physical health and People with a Severe Mental Illness: Diabetes

• Physical health and People with a Severe Mental Illness: Respiratory Disease

• Physical health and People with a Severe Mental Illness: Substance and Alcohol Misuse

• Physical health and People with a Severe Mental Illness: Cardiovascular Disease

We encourage you to use these when organising educational events for your primary care colleagues.

All documents available here