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Mentally ill under-treated for physical health

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These patients are a vulnerable group who should be receiving closer surveillance and more active treatment of medical conditions, but instead the reverse seems to apply.
Dr Alex Mitchell
A study reported in the December issue of the British Journal of Psychiatry shows that individuals diagnosed with mental illness are less likely to receive the proper treatment than those without mental health diagnoses. The meta-analysis used 61 studies on conditions including cardiovascular disease, diabetes, cancer, arthritis, osteoporosis and HIV. Overall the under-treatment of those with severe mental illness was estimated at 10 per cent.

Dr Alex Mitchell, an honorary senior lecturer at the University of Leicester and consultant at the Leicestershire Partnership NHS Trust, gave ScienceOmega.commore detail on the findings of the new research, and suggested ways that the healthcare community may look to address this worrying inequality.

In a number of previous studies, Dr Mitchell and various colleagues have documented inequalities in aspects of the care provided to patients with mental health diagnoses, as opposed to patients without comparable mental disorders. As well as generally poor medical care, Dr Mitchell and his co-authors have identifiedlower rates of invasive coronary interventions and higher mortality rates following cardiac events among patients with mental illness. This is particularly in evidence among schizophrenia patients, whose case highlights the high rates of mortalitythat can result from suboptimal medical treatment.

It has been found that the preventive care offered to mental health patients – such as screening procedures and counselling – is often inadequate, although it is sometimes superior to that individuals without psychiatric disorders.

High mortality rates as a consequence of under-treatment are just one of the myriad reasons that this problem needs to be addressed. Patients with mental illness are an already vulnerable group with high rates of medical and metabolic problems and a very high incidence of background risk factors such as smoking, hypertension and being overweight. It has also been shown that mental health patients are very often prescribed medication which is at risk of worsening their physical health.

In spite of these issues, Dr Mitchell pointed out that preventive efforts can be seen to be lacking. As far as metabolic screening is concerned at least, rates of surveillance of those prescribed antipsychotic medications appear to be low.

"We were surprised by the extent and prevalence of the problem when combined with all the other types of under-treatment," said Dr Mitchell. "These patients are a vulnerable group who should be receiving closer surveillance and more active treatment of medical conditions, but instead the reverse seems to apply."

According to Dr Mitchell, there are broadly speaking two potential reasons for the inequalities unearthed by the study to exist.

"The first possibility is that patients with mental illness reject medical treatment," he stated. "Whilst this is true in very severe cases, it is unusual across the rest of the spectrum. Indeed, medical attendance and compliance is usually fairly high in mental health groups; evidence shows that quality of care is often suboptimal even when attendance is high."

"The second possibility is that clinicians sometimes take less care (or are less comfortable) about offering appropriate medical treatment when a patient is known to have mental health problems," Dr Mitchell suggested.

It could also be the case that clinicians worry about interactions between treatments for mental health when prescribing medicines for common conditions. Encouraging psychiatric patients to ask for help in terms of medical advice and lifestyle counselling could be one way of trying to ensure that they are diagnosed with and treated for common medical conditions. The main methods of tackling the problem, according to Dr Mitchell, should be to raise awareness of the problem, and to emphasise prevention in high risk groups.

The conclusions of the study highlight the importance of maintaining the best standards of care in terms of both physical and mental health, rather than forsaking one for the other where mentally ill patients are concerned. To facilitate this, it will first be necessary for clinicians to think of mental illness and physical illness as often co-occurring. It could also be useful, Dr Mitchell pointed out, to train psychiatrists in basic medical care and, conversely, to train physicians in the basics of psychiatric care.

The introduction of better, mandatory monitoring systems – for example, in the guise of primary care Quality and Outcomes Framework targets – could see an improvement. Setting targets or providing incentives at an organisational level might also, Dr Mitchell suggested, go some way to facilitating timely diagnosis and treatment for the mentally ill.

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Posted by Omkarr singh on Friday, January 04, 2013. Filed under . You can follow any responses to this entry through the RSS 2.0

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