A problem worth solving #4?—?Those living with mental illness tend to die young from physical illness.

Inspired by Victoria's Royal Commission into Victoria’s Mental Health System, and my lived experience of mental illness and of the system, these research papers provide the short and (not so) sweet low down on the remaining problems worth solving.

Often invisible, but oh so real, mental illness remains a neglected health issue. The system is overloaded and we must find alternative, workable solutions for 'consumers' as they meet one of life's greatest challenges.

Yes, mental illness is primarily about the brain (and nervous system). However, the brain controls the body, and as they say, the body keeps the score.

With this in mind, allow me to take you on a short journey on why mental illness often leads to premature death from physical manifestations. Let me begin by introducing you to the biggest culprit of all, Cardiovascular Disease (CVD), and its good friend sedentary behaviour.

A confronting life expectancy gap and ‘diagnostic overshadowing'.

A well researched observation is that people living with chronic mental illness typically live between 10–25 years less than the average person. This is a confronting yet seldom discussed statistic. If you know a thing or two about statistics and standard deviation, you would appreciate how ludicrous this difference is. This mortality gap is more than anything we have seen when comparing ethnicities, social classes, or education levels.

And, the vast majority of deaths within the mentally ill population are not due to suicide. In fact, for every person with a mental illness who dies from suicide, about 9 will prematurely die due to chronic physical diseases (premature death in this context refers to deaths at least 12 years earlier than the average life expectancy for each respective gender).

These chronic diseases include CVD and stroke, cancer, type 2 diabetes, chronic kidney disease, and respiratory conditions such as chronic obstructive pulmonary disease.?

Also of note is that almost 80% of people living with mental illness also have a mortality-related physical illness, and 55% have two or more comorbid conditions.

The problem is, when people living with mental illness see their general practitioner (GP), their mental health condition can mask and distract attention away from coexisting physical illnesses. This is a phenomenon known as ‘diagnostic overshadowing’ and it results in many chronic but treatable physical health conditions going undiagnosed or misdiagnosed, and untreated.

I suspect diagnostic overshadowing is one of the main problems 2022 Young Australian of the Year Dr. Daniel Nour?aimed to address when he founded non-for profit Street Side Medics, which is a GP led, truly mobile, medical clinic which collaborates with pre-existing homeless charities, shelters, and services to provide primary healthcare specifically for the homeless community.??

What is cardiovascular disease and its prevalence among the mentally ill?

CVD is used to describe many different conditions affecting the heart and blood vessels. CVD is already the leading cause of death in Australia, accounting for 26% of all deaths.?

However, for someone living with a mental illness diagnosis, that risk doubles. The more serious and chronic the mental illness, the greater their exposure to cardiovascular disease tends to be. One international major study found that if a person has a serious mental illness, they are six times more likely to die from CVD. Now that's crazy.

What causes cardiovascular disease?

The main risk factors for CVD include poor diet, diabetes, arterial hypertension, obesity, smoking, and a sedentary lifestyle, as well as stress, older age, male gender, and a family history of CVD.?

Therefore, for the most part, CVD is preventable,?because most of the risk factors listed above can be addressed by lifestyle changes.?

Meanwhile, research has clearly documented the tendency for those with serious mental illness to live relatively sedentary lives. For example, there is evidence to suggest that less than half of people with ‘serious mental illness’ meet recommended physical activity levels of 150 minutes of moderate-vigorous physical activity per week. Research also suggests people with mental health issues tend to engage in sporadic physical activity rather than building sustainable physical activity habits.

But why are the mentally ill more sedentary?

Those living with mental illness face a range of unique challenges which affect the person’s motivation & energy levels, ability to form habits, and their overall relationship with exercise.

And then, the effects of obesity/poor physical health, lack of resources/professional support, poor social skills, low self-esteem, and insufficient coping mechanisms tend to prevent behaviour change and and compound their resistance to a more active lifestyle.?

Low motivation and a lack of emotional regulation are also strongly linked with poor diet and smoking.

Further, the severity of medication side effects is often downplayed, especially their tendency to induce fatigue and low energy levels. Psychotropic medications in particular are shown to have a direct adverse relationship with cardiometabolic health, particularly antipsychotics.

But are the mentally ill just being lazy?

In some circumstances, possibly. But in the vast majority of cases, the answer is simply no. In any case, it is very simplistic way of looking at it. It also presupposes that sedentary behaviour is a choice we make, which is not always true.

For example, for someone who are acutely unwell, just getting out of bed is a near impossibility, let alone the thought of participating in group exercises or attending their local gym. For those who have never experienced this before it can be a difficult situation to relate with, and can be misinterpreted as someone that is simply not disciplined or motivated enough. But for those who have, is goes far beyond this; it is a frightening, hopeless, and desperate experience. You become disabled in the full sense of the word.

Even if you are more moderately unwell, the demands of life and those that rely on you can easily become overwhelming, and make prioritising health and fitness a 'choice' not exactly within arms reach. It is also worth noting that those facing long term moderate mental health issues have access to far less specialised mental health care, even though the longevity of their struggles certainly warrant it. The longer ones spends on struggle street, the more difficult it becomes teach them new tricks.

Overall, the causal factors behind sedentary behaviour among the mentally ill are complex, and some may question whether the chicken or the egg came first. But what we do know is that established risk factors such as smoking and diet do not fully account for the increased risk of CVD in the mentally ill.?

We know that tailored exercise programs work

We also know targeted and progress-oriented exercise programs that are appropriately supervised have been shown to sustainably alleviate the symptoms of mental illness and can reduce the barriers to which consumers often refer. In particular, trainers need to have a firm grasp on behavioural activation and motivational techniques.

So, is exercise 'prescribed' or an established part of clinical care?

Unfortunately not, stay tuned to find out…

About the Author:?Heath Mitchell works as a personal injury lawyer (including psychiatric injury) and as a volunteer peer worker in the mental health industry. With lived experienced of mental illness, he is devoted to progressing mental health care and advocating for consumers.

?'I once lived in a dark house with Bi-Polar disorder. I have since fixed the lights, and they have moved out. I now carry a torch at all times. If we cohabitate again, I will not be alone, and they will know the house rules. I am in control.'

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Are you experiencing psychological distress?

?Support is available!?I am not a doctor or clinician. I write from my own experiences and research only. If you are experiencing psychological distress please reach out to your treating practitioner or one of the resources below. You have more options than you think.

Lifeline Australia?—?Call 13 11 14 — Lifeline is staffed by volunteer telephone crisis supporters who are ready to take calls 24/7.

Carers Australia?—?Call 1800 242 63 — Counselling, emotional and psychological support services for carers and their families.

Relationships Australia?—?Call 1300 364 277 — Relationship support services for individuals, families and communities.

NACCHO?—?Call 02 6246 9300 — National Aboriginal Community Controlled Health Organisation.

Suicide Callback Service?—?Call 1300 659 467 — Free, professional 24/7 telephone and online counselling to people who are affected by suicide.

Mensline Australia?—?Call 1300 789 978 — Supports Australian men and boys dealing with family and relationship difficulties. 24/7 telephone and online support.

Beyond Blue?—Call 1300 22 4636 — Telephone and online support for those experiencing depression or anxiety.

Butterfly Foundation?—?Call 1800 33 4673 — Information, counselling and treatment referral for people with eating disorders.

Kids Helpline?—?Call 1800 551 800 — Free, private and confidential 24/7 phone and online counselling service for young people aged 5 to 25.

1800 RESPECT?—?Call 1800 737 732 — Counselling and support service for people impacted by sexual assault, domestic or family violence and abuse.

Open Arms?—?Call 1800 011 046 — Veterans & Families 24/7 Counselling and support services.

QLife?—?Call 1800 184 527 — Australia-wide anonymous, LGBTI peer support and referral services.