Mental Health Commission report – people with severe mental illness denied access to essential healthcare services.

People with serious mental illness have a high risk of heart disease yet a new report has found that people in long term psychiatric care in Ireland are not adequately monitored for serious physical illnesses, including cardiovascular disease.

The report, ‘Physical Health of People with Severe Mental Illness’, found that people with severe mental illness in Ireland were being denied access to essential physical healthcare services, which the Mental Health Commission said it believed was, “both discriminatory and a breach of human rights.”

For the report Dr Susan Finnerty, Inspector of Mental Health Services, reviewed the physical healthcare and monitoring of 100 residents in 10 mental health in-patient continuing care centres in 2018.

She said that many of the residents included in the review had lived in these centres for a very long period of time, sometimes for decades.

According to the review, “many have spent most of their adult lives in wards of old asylums prior to their closure. Others are admitted to these centres because of ongoing severe mental illness. The majority of the residents were over 60 years of age.”

Research has shown that people with severe mental illness die on average between 15 and 20 years earlier than the rest of the population and are 2.5 times more likely to die from cardiovascular disease.

Several risk factors affect the physical health of people with severe mental illness include higher levels of smoking, lower levels of exercise, and obesity, which may be caused by the medication used to treat their psychiatric illness.

According to the report, anti-psychotic medication, which is used to treat people with serious mental illness, “adds to the burden of long-term physical illness mediated by iatrogenic [drug induced] weight gain, hyperlipidaemia [high cholesterol] and diabetes.”

Adults with diabetes are also at an increased risk of dying from heart disease or stroke.

People on anti-psychotic medication for serious mental illness need regular monitoring to check for a number of things including weight, blood pressure and lipids or cholesterol levels, they also require regular electrocardiograms or ECGs to monitor their hearts.

The report found that 71 per cent of those reviewed were on anti-psychotic medication and 42 per cent had one or more symptoms of metabolic disease including cardiac problems.

According to the report, only a quarter or 25 per cent had their BMI monitored, waist circumference was only carried out in 9 per cent and monitoring of blood lipids and ECGS was only carried out in two thirds of residents.

Dr Finnerty said, “These findings are of serious concern and show that residents in long-term care in mental health inpatient units are not adequately monitored for serious physical illness which they have a higher risk of developing than the general population.”.

As part of her report, the Inspector explained that people with a severe mental illness may die between 15 and 20 years earlier than the rest of the population, while research in the United Kingdom has estimated that 40,000 deaths could be avoided each year if individuals with serious mental illness were afforded the same amount of physical healthcare as the general population. The equivalent number of deaths annually based on Ireland’s population would be almost 3,000.

Dr Finnerty added that the findings of her report were particularly concerning as many of those who live or reside in continuing care mental health units are vulnerable, elderly, have poor communication abilities and are at high risk of cardiac disease and metabolic syndrome (a cluster of the most dangerous heart attack  risk factors).

The Mental Health Commission has written to the HSE seeking an action plan to address the concerns raised in the report.