the contribution of mental health services to tackling health inequalities dr alastair cook chair...
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The Contribution of Mental Health Services to Tackling Health Inequalities
Dr Alastair CookChair RCPsych in Scotland
Outline
• The health of people with mental health problems
• The impact of having a mental health problem as well as other long term conditions
• Mental health services and early years
• What do we need to do?
People with severe mental illness
• Die early– Life expectancy for men 20 years less than average– Life expectancy for women 15 years less
• Are more likely to have physical illness– Under 50s are 3x more likely to die from coronary
heart disease• Are less likely to receive interventions
Health-risk behaviours
• Smoking • In England– 21% of population smoke– 44% of people with common mental health
disorders– 64% of people with probable psychosis– 70% of mental health inpatients
• 42% of tobacco consumption by people with MH problems
http://www.natcen.ac.uk/our-research/research/cigarette-smoking-and-mental-health-in-england
Other factors• Obesity‘Obese persons had a 55% increased risk of
developing depression over time, whereas depressed persons had a 58% increased risk of becoming obese’
• Diagnostic overshadowing– Patients with CHD or diabetes less likely to receive
effective treatment if they had a mental illness
Example of inpatient data
• Local study in Lanarkshire (Wishaw)– All admissions from Jan 2005 – December 2007– 1199 people admitted– 1688 admissions
• 5 year follow up period– 100 deaths (8.3%)– 66 male, 34 female– 87 had substance misuse as primary or secondary diagnosis
Data & slides from McLaughlin et al WGH
Life expectancy (1)
Females (n=34)• Study population 49.9 years
[45.8-54.0]*
• North Lanarkshire 78.8• Scotland average 80.4
Males (n=66)• Study population 43.8 years
[41.4-46.3]*
• North Lanarkshire 74.3• Scotland average 75.8
2008-2010 figures from National Records of Scotlandhttp://www.gro-scotland.gov.uk/files2/stats/council-area-data-sheets/north-lanarkshire-factsheet.pdf
*[95% confidence interval]
Life expectancy (2)
History of alcohol or substance misuse in primary or secondary diagnosis
44.4 years [42.2-46.7]**[95% confidence interval]
NO history of alcohol or substance misuse in primary or secondary diagnosis
55.3 years [49.5-61.0]**[95% confidence interval]
Cause of death (n=100)Number (=%) Mean age at
death
Chronic liver disease 25
Cardiovascular disease 1148.3
Upper & lower respiratory disease 12
Other physical illness 21
Accidental/undetermined 18 42.6
Suicides 13 37.2
Alcohol consumption (1)FemalesStudy population n=34Known alcohol history n=26Unknown quantity n=8
Mean consumption (of those who drank alcohol)
= 204u/week [154-254]*
(14x) Safe limit =14u/week
MalesStudy population n=66Known alcohol history n=55Unknown quantity n= 11
Mean consumption (of those who drank alcohol)
= 285u/week [240-331]*
(14x) Safe limit =21u/week
*[95% confidence interval]
Life expectancy varies with Scottish Multiple Index of Deprivation
0 20 40 60 80
q1
q2
q3
q4
*t=-1.93, df=96, p=0.055
http://www.scotland.gov.uk/Publications/2009/10/28104046/14
Less deprived(includes n=1 from q5)
Most deprived
52.5 [47.3-57.7]*
45.0 [39.7-50.2]
45.4 [40.8-50.0]
45.0 [41.4-48.5]*
Life expectancy (years)
The impact of having a mental health problem as well as other long term conditions
• Depression is – 3x more likely in CHD– 2-3x more likely in diabetes– 3x more likely in COPD– Common (33 % of women and 20% of men) in
arthritis
Impact of this
• Somebody with depression is 3.5 times more likely to die after a heart attack
• Poor outcomes in diabetes
• 50% more acute exacerbations in COPD
Economic impact
• 12 – 18% of all spend on long term conditions is due to the effect of mental health problems
• Healthcare costs increased by 45%
• Increased lengths of stay in hospital
Mental Health Services and Early Years
• Impact of adverse childhood experience on physical and mental health in later years
• Need for a life-course approach
The range of mental health services
• Perinatal services• Child and Adolescent services• Addiction services• Adult (parental) mental health• Intellectual Disability services• Psychotherapy services• Interaction with Criminal Justice
What do we need to do?
• Acknowledge and recognise that poor mental health makes a significant contribution to the health inequalities in our society
• Improve physical care of those with severe mental illness– Earlier recognition– More proactive / assertive health promotion
What do we need to do?
• Improve mental health liaison services in Primary and Acute care
• Develop clinical pathways that support managing multiple diagnoses including mental health
• Be prepared to take a whole system approach (MH investment will save acute care costs)
What do we need to do?
• Review the roles of mental health services in supporting families – Earlier recognition and intervention– Role of adult services in supporting parents
• Recognise that resources need to be targeted to where the greatest need is known to exist.
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