04 February 2011
Physical health and mental health are inextricably linked. Action is needed to improve the physical health of people with mental health problems, and to make mental health a key public health priority.
Poor mental health is associated with an increased risk of diseases such as cardiovascular disease, cancer and diabetes, while good mental health is a known protective factor. Poor physical health also increases the risk of people developing mental health problems.
The Foundation has called for:
- an increased understanding of the links between physical health and mental health, and that improved mental health reduces the risk of cardiovascular and other diseases
- mental health to become an integral part of public health agenda, nationally and locally, and for proper investment in public mental health
- regular physical health checks and accessible physical health care for people with severe mental illness
- routine assessment of the psychological needs of patients suffering from chronic heart disease and other serious physical conditions
- a reduction in the inappropriate use of primary and acute hospital services by people with medically unexplained symptoms (MUS) by referrals to evidence-based psychological treatments.
It is not good enough that many people with mental health problems are likely to have their physical health needs unrecognised or poorly managed: those who use mental health services are less likely than the general population to be offered blood pressure, cholesterol, urine or weight checks, or to receive opportunistic advice on smoking cessation, alcohol, exercise or diet.
The Foundation has welcomed the recognition of the links between physical health and mental health in the Coalition Government’s Public Health White Paper Healthy Lives, Healthy People (2010), covering England. The paper rightly recognises mental health to be a key public health issue. White Paper: Healthy lives, healthy people: our strategy for public health in England
People with diagnoses of severe and enduring mental illnesses are at increased risk for a range of physical illnesses and conditions, including coronary heart disease, diabetes, infections, respiratory disease and greater levels of obesity.
The Royal College of Psychiatrists published in 2010 a paper on public mental health, No Health Without Public Mental Health. This included a summary of the research evidence demonstrating the links between mental health and physical health outlined below:
Depression is associated with 67% increased mortality from cardiovascular disease, 50% increased mortality from cancer, two-fold increased mortality from respiratory disease and three-fold increased mortality from metabolic disease.
Rates of depression are double in those with diabetes, hypertension, coronary artery disease and heart failure, and triple in end-stage renal failure, chronic obstructive pulmonary disease and cerebrovascular disease.
Depression almost doubles the risk of later development of coronary heart disease. Increased psychological distress is associated with 11%-increased risk of stroke. Depression predicts colorectal cancer, back pain and irritable bowel syndrome later in life
People with schizophrenia and bipolar disorder die an average 25 years earlier than the general population, largely because of physical health problems. Schizophrenia is associated increased death rates from cardiovascular disease (two-fold), respiratory disease (three-fold) and infectious disease (four-fold).
No Health Without Public Mental Health, Royal College of Psychiatrists, 2010
The Department of Health’s Improving Access to Psychological Therapies (IAPT) programme has published guidance on Medically Unexplained Symptoms. Medically Unexplained Symptoms Positive Practice Guide (PDF file, 300KB)
11% of adult health care costs in the UK are attributable to physical symptoms caused or exacerbated by mental health problems. Between 20% and 30% of consultations in primary care are with people who are experiencing medically unexplained symptoms and have no clear diagnosis.
The Coalition Government’s Public Health White Paper: Healthy lives, healthy people: our strategy for public health in England firmly links public health to the inequalities agenda set out by Sir Michael Marmot (Marmot (2010) Fair Society, Healthy Lives (PDF file, 25MB)) There will be a new public health premium, which will give councils money for delivering improvements in health inequalities - and it cites poor mental health alongside classic public health issues such as obesity and smoking.
The Foundation has published a series of reports on exercise, diet and smoking, and how they impact on both mental health and physical health.