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Focus on: People with mental ill health and hospital use

Mental ill health will affect us all at some point in our lives; whether personally, in our families, communities or workplaces. At any one time, one in six adults has a mental health problem, and one in a hundred of us has a serious mental illness (SMI) (HM Government, 2011).

Previous studies have shown that those with mental ill health die younger and a greater proportion have poor physical health, compared with the general population. The mortality rate for those aged under 75 (premature mortality) in those with SMI is more than three times higher than that for the general population (QualityWatch, 2015). This means that individuals with SMI die on average 10 to 17 years earlier (Davies, 2013). When it comes to disease-specific mortality, the death rate from respiratory disease and diseases of the digestive system is four times higher in mental health service users compared with the general population and 2.5 times higher for death from circulatory diseases.

Such disparities in mortality have been recognised for at least 25 years (Newman and Bland, 1991) and the cause of which is often linked to poor physical health (Health and Social Care Information Centre, 2013a). Mental ill health does not occur in isolation. It has been estimated that 46 per cent of people with a mental health condition also have a long-term physical health diagnosis (Naylor and others, 2012). In particular, those with mental ill health have high rates of respiratory, circulatory and infectious disease, obesity, abnormal lipids and diabetes (De Hert and others, 2009). A Finnish study estimated that up to 50 per cent of the increased mortality in those with mental ill health was due to underlying physical health conditions (Joukamaa, 2001). Some of the reasons for the prevalence of long-term physical health conditions and poor outcomes among people with mental ill health are:

- a higher occurrence of risk factors for many chronic diseases and some types of cancer (smoking, obesity, lack of physical exercise, harmful alcohol consumption and poor diet) compared with other populations
- the iatrogenic effects of some psychiatric medications, increasing the risk of obesity
- poorer access to physical healthcare than the population as a whole (Thornicroft, 2011).

Drawing on the links between physical and mental health, a recent report from the Chief Medical Officer (Davies, 2013) highlighted that approximately 60 per cent of the excess mortality in those with mental illness is avoidable. Considering physical health alongside mental health is imperative in order to address the disparities in life expectancy between those with and those without mental ill health.