Improving the Physical Health of Rural People Living with Mental Illness

Abstract

Improving the physical health of people living with mental illness has become a national and international priority, and for good reasons. For every one person with a mental illness who dies from suicide, ten die prematurely due to avoidable physical health conditions such as cardiovascular disease, cancer, or respiratory disease. People living with mental illness can lead healthy productive lives. However, on average, people living with mental illness die between 50 and 59 years of age. While living with mental illness doubles the risk of early death, living with a mental illness in a rural community triples the risk of early avoidable death. Eighty percent of people with a mental illness also have a mortality-related physical health condition. Most of the causes of early premature death in people living with mental illness are avoidable and addressed with existing services and infrastructure; nonetheless, this disparity is growing. In Australia, the need to urgently address this issue is reflected in the physical health of people living with mental illness being listed as a priority in the Fifth National Mental Health Plan and the Equally Well National Consensus Statement.

The reasons for the poor health and early death of people with mental illness are complex and interrelated. However, they include poor access to services, stigma and discrimination, smoking, lifestyle factors, and the side effects of medication. The rate of early death of people with mental illness is twice that of the general population; in rural Australia this increases to three times the rate of early death. This could be due to people living in rural Australia having a higher burden of disease, higher rates of comorbidities, and fewer services. The challenge of addressing these disparities is compounded by geographical distances and a shortage of allied health and general and specialist medical and screening services.

This chapter reviews the epidemiology and the evidence on effective interventions and proposes a series of actions and clinical interventions for consumers, carers, and rural mental health workers. It also outlines actions rural clinicians can take to help address this national scandal, across the domains of a rights-based approach to care, ensuring physical health screening and treatment and lifestyle interventions and coordinating and integrating care. Finally, it provides examples of effective interventions in rural settings.

The fact that people with serious mental illness die an average of 20 years earlier than the rest of the population, the majority from preventable causes, is one of the biggest health scandals of our time, yet it is very rarely talked about.

Professor Sue Bailey (Rethink 2013)