More support needed to close mental health mortality gap

A major report calls for ‘urgent’ global reform to include lifestyle interventions in mental health care, with physical health conditions responsible for 70% of the deaths of people with severe mental illness.
 
Published in The Lancet, the report, Implementing lifestyle interventions in mental health care, also reveals a reduced life expectancy of up to 15 years for people with mental illness due to greater lifestyle risk factors such as high smoking rates, low physical activity and poor diet.
 
The report was written by a team of 30 authors from 19 countries, including lead author Dr Scott Teasdale, a Senior Research Fellow with UNSW Sydney.
 
Researchers reviewed 89 recent lifestyle interventions, targeting physical activity, nutrition, smoking cessation and sleep, to determine the most effective approaches.
 
Dr Teasdale said while such lifestyle interventions are key to mental health care, structural change is essential to support such interventions, with the report also making multiple recommendations to reduce structural barriers.
 
‘This is not just about individual behaviour change, it’s about transforming systems to support health and wellbeing,’ Dr Teasdale said.
 
At present, people with severe mental illness die, on average, 13 to 15 years earlier than the general population. These deaths are largely due to preventable conditions such as cardiovascular disease and diabetes.
 
Dr Ken McCroary, RACGP Expert Committee – Quality Care Deputy Chair, said funding primary care to improve the health gap for severely mentally ill people is ‘a no-brainer’.
 
‘The majority of mental health management, support and treatment in this country is performed by GPs; not psychologists or psychiatrists or credentialled mental health workers, it’s GPs,’ he told newsGP.
 
‘But for some reason we’re not always at the table when people are making plans or policy for mental health management, despite being the lead, like we are in most other conditions.’
 
Dr Michael Tam, a fellow member of the Expert Committee – Quality Care, echoes Dr McCroary’s view that primary care is not adequately funded.
 
‘From a primary care perspective, there is a great need that comprehensiveness and continuity of care, and complex consultations are prioritised and remunerated, or at least not disincentivised in the remuneration system,’ he told newsGP.
 
‘And one would argue that that is occurring now, and I think it does need to be some structural addressing of that.’
 
The report notes several barriers to implementing interventions, including inadequate reimbursement mechanisms, impractical clinical guidelines, and challenges associated with delivering interventions in rural and low-resource settings.
 
It also reports broader barriers such as a lack of resources (time, money, infrastructure, equipment, training) and competing priorities.
 
Dr McCroary said the system ‘disincentivised’ GPs from spending more time with people with mental health issues and making a difference ‘to their really poor outcomes’ due to their higher risk for metabolic dysfunction.
 
‘Our system is also disincentivising workforce distribution to areas of more significant need,’ he said.
 
‘So, the poor areas have more drugs, violence, all that sort of stuff, but we have less GPs and we have less remuneration for working with individuals in those regions.’
 
Dr Teasdale said increased funding, upskilling of mental health staff and enabling access to a broader range of allied health professionals is vital to better incorporating lifestyle interventions into care.
 
‘Mental health services have traditionally focused on medications, crisis care and therapy, and lifestyle hadn’t been prioritised – in funding, training or service delivery,’ he said.
 
‘We previously didn’t have the evidence on the benefits of lifestyle changes, but that’s no longer the case.’
 
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health disparity life expectancy lifestyle lifestyle intervention mental health