A SUPPLEMENT published today by the Medical Journal of Australia, and produced by the Mitchell Institute at Victoria University, aims to fill gaps in knowledge about effective physical health care for people living with serious mental illness.
Being Equally Well: ending the neglect of physical health for people with serious mental illness comprises two systematic reviews, a narrative review and four Perspectives on the subject.
In an editorial published in the Journal itself, to accompany the Supplement, coordinating editors Professor Rosemary Calder AM, Professor James Dunbar, and Professor Maximilian de Courten, wrote that people living with serious mental illness die up to 20 years prematurely from chronic physical health conditions.
“Most of these early deaths are from preventable health conditions including cardiovascular disease, smoking-related respiratory illness, diabetes, and cancer,” Calder and colleagues wrote.
“Primary care is not organised to provide this group with screening for cardiometabolic risk factors.
“Current policies addressing this disparity in Australia and comparable countries have been ineffective. They largely fail at the frontlines of care because they do not account for how frontline staff work.
“The Being Equally Well national policy roadmap proposes changes needed in both specialist mental health and primary health care and how to achieve these.”
The issues and recommendations set out in the Supplement include:
- lack of coordination between primary, secondary and tertiary care services was a central issue – “Collaboration by the Royal Australian College of General Practitioners and the Royal Australian and New Zealand College of Psychiatrists to integrate their guidelines and develop shared care protocols is a critical recommendation”;
- consumers and carers identified as priorities the barriers of fragmented care and the complex difficulties navigating the health system, as well as the importance of support from community and peer groups – “Investment in a workforce of nurse navigators is proposed to actively support consumers and to integrate the care they require from both primary and specialist mental health services; expanded roles for community pharmacists would provide medication management to high needs individuals and facilitate shared care with allied health professionals; development of peer worker roles is a high priority for consumers, as evidence indicates benefits of enhanced comprehensive care”;
- health impacts of medications were a major concern, particularly the prevalence of metabolic syndrome – “The case for early use of antidiabetic medication is discussed in the supplement; lessons from the use of clozapine are revealing; despite the metabolic impacts, people receiving clozapine therapy have a longer life expectancy; monitoring is mandatory, which may explain this result”;
- benefits of nutrition interventions in improving the mental and physical health of people with serious mental illness were considered – “Evidence indicates that they are particularly effective when led by dietitians; and,
- lack of shared and consistent information between mental health and primary care services underlies inadequate service provision and exacerbates poor capacity to monitor and evaluate both health care and health outcomes – “A systematic national approach to quality improvement is proposed by establishing a national clinical quality registry and an annual report to the Australian Council of Health Ministers”.
Calder and colleagues wrote that “similar enhancements in health care have successfully reduced deaths and disability from conditions such as stroke”.
“Tailored shared care health services and support have been implemented to improve the physical and mental health care of cancer patients,” they concluded. “People with serious mental illness need the same commitment and attention to reduce preventable deaths and serious physical illness.”
- Cate Swannell