HA
Member
We can't sacrifice the body in treating mental illnesses
Andre Picard
October 18, 2007
Mortality from cardiovascular disease has steadily fallen over the past few decades to the point where cancer is on the verge of surpassing heart disease as Canada's number one killer.
The improvements in diagnosis and treatment of heart disease and stroke, and to a lesser extent prevention efforts, have been steady and impressive.
But one significant portion of the population has not benefited substantially from these advances - people living with mental illness.
In Canada, someone born today can expect to live in excess of 80 years, most of that time in good health.
But if you suffer from a major mental illness - conditions that affect between 5 and 10 per cent of the population - it shaves 25 years or more off your life expectancy.
A diagnosis of mental illness often translates into an early death sentence.
We speak often - though too often in hushed tones - of the tremendous toll that suicide takes on populations with illnesses such as depression, schizophrenia and bipolar disorder. Rarely acknowledged is that the vast majority of people with mental illness die prematurely not because of the illnesses attacking their minds, but the ones destroying their hearts.
In a commentary published this week in the Journal of the American Medical Association, John Newcomer, a psychiatrist at the Washington University School of Medicine in St. Louis, Mo., draws attention to the shortcomings in cardiac care among people with mental illness.
It makes for fascinating, if demoralizing, reading.
The leading cause of preventable death in North America is smoking. While fewer than 20 per cent of adults now smoke, among people with serious mental illness the smoking rate hovers between 50 and 80 per cent. While they represent a tiny fraction of the population, people with mental illness consume more than 40 per cent of all cigarettes.
Contrary to popular belief, most people suffering from mental illnesses are productive members of society, holding down jobs, raising families, doing volunteer work and so on. But at times, depression, schizophrenia or bipolar disorder can be debilitating.
The disabled, perversely, are often condemned to poverty.
Few things are worse for your health than a low income. No money usually means no roof over your head, an abysmal diet, exposure to environmental hazards, and an ever-present danger of physical violence. It's easy to see how life expectancy can plummet, especially when depression and other mental illnesses are thrown into the mix.
These conditions are often treated with powerful medications. One of the most common side effects of antidepressants is weight gain; other therapies drive up blood pressure and cholesterol. None of this is good for the heart.
Mental illness often frightens members of the public, in large part because of erroneous stereotypes, such as the belief that the mentally ill are violent. (The reality is that they tend to harm themselves, not others.)
Health professionals too have their prejudices and fears. The article by Dr. Newcomer underscores the reality that a diagnosis of mental illness often blinds doctors and nurses to other concerns. When someone is treated for depression, mania, psychosis or other mental-health conditions, their routine health needs are often overlooked.
If people are suicidal, no one checks their blood pressure. If they are hearing voices, they probably don't get their cholesterol checked. A huge U.S. study showed that one-third of diabetics with mental illness received no diabetes medication, and that two-thirds of hypertensives with mental illness received no drug treatments for their high blood pressure.
This benign neglect occurs despite the knowledge that people suffering from mental illness are about twice as likely as others to also have serious physical problems - and heart-related problems in particular - such as diabetes, high blood pressure and obesity.
Lack of prevention efforts is only part of the issue.
When a heart attack or stroke occurs, people with mental illness are far less likely to get treatment. They have fewer bypasses and angioplasties than patients with identical symptoms but no diagnosed mental health problems.
The result, according to one study, is that after a heart attack, a person with depression is about 20 per cent more likely to die, and a schizophrenic about 35 per cent more likely.
The Roman poet Juvenal said that what people should desire is Mens sana in corpore sano - a healthy mind in a healthy body. When a mind is not healthy, we should not blithely sacrifice the body, too. When we treat people with mental illness, we should care for their hearts as well as their minds.
To do otherwise - as we do now - is heartless.
apicard@globeandmail.com
Andre Picard
October 18, 2007
Mortality from cardiovascular disease has steadily fallen over the past few decades to the point where cancer is on the verge of surpassing heart disease as Canada's number one killer.
The improvements in diagnosis and treatment of heart disease and stroke, and to a lesser extent prevention efforts, have been steady and impressive.
But one significant portion of the population has not benefited substantially from these advances - people living with mental illness.
In Canada, someone born today can expect to live in excess of 80 years, most of that time in good health.
But if you suffer from a major mental illness - conditions that affect between 5 and 10 per cent of the population - it shaves 25 years or more off your life expectancy.
A diagnosis of mental illness often translates into an early death sentence.
We speak often - though too often in hushed tones - of the tremendous toll that suicide takes on populations with illnesses such as depression, schizophrenia and bipolar disorder. Rarely acknowledged is that the vast majority of people with mental illness die prematurely not because of the illnesses attacking their minds, but the ones destroying their hearts.
In a commentary published this week in the Journal of the American Medical Association, John Newcomer, a psychiatrist at the Washington University School of Medicine in St. Louis, Mo., draws attention to the shortcomings in cardiac care among people with mental illness.
It makes for fascinating, if demoralizing, reading.
The leading cause of preventable death in North America is smoking. While fewer than 20 per cent of adults now smoke, among people with serious mental illness the smoking rate hovers between 50 and 80 per cent. While they represent a tiny fraction of the population, people with mental illness consume more than 40 per cent of all cigarettes.
Contrary to popular belief, most people suffering from mental illnesses are productive members of society, holding down jobs, raising families, doing volunteer work and so on. But at times, depression, schizophrenia or bipolar disorder can be debilitating.
The disabled, perversely, are often condemned to poverty.
Few things are worse for your health than a low income. No money usually means no roof over your head, an abysmal diet, exposure to environmental hazards, and an ever-present danger of physical violence. It's easy to see how life expectancy can plummet, especially when depression and other mental illnesses are thrown into the mix.
These conditions are often treated with powerful medications. One of the most common side effects of antidepressants is weight gain; other therapies drive up blood pressure and cholesterol. None of this is good for the heart.
Mental illness often frightens members of the public, in large part because of erroneous stereotypes, such as the belief that the mentally ill are violent. (The reality is that they tend to harm themselves, not others.)
Health professionals too have their prejudices and fears. The article by Dr. Newcomer underscores the reality that a diagnosis of mental illness often blinds doctors and nurses to other concerns. When someone is treated for depression, mania, psychosis or other mental-health conditions, their routine health needs are often overlooked.
If people are suicidal, no one checks their blood pressure. If they are hearing voices, they probably don't get their cholesterol checked. A huge U.S. study showed that one-third of diabetics with mental illness received no diabetes medication, and that two-thirds of hypertensives with mental illness received no drug treatments for their high blood pressure.
This benign neglect occurs despite the knowledge that people suffering from mental illness are about twice as likely as others to also have serious physical problems - and heart-related problems in particular - such as diabetes, high blood pressure and obesity.
Lack of prevention efforts is only part of the issue.
When a heart attack or stroke occurs, people with mental illness are far less likely to get treatment. They have fewer bypasses and angioplasties than patients with identical symptoms but no diagnosed mental health problems.
The result, according to one study, is that after a heart attack, a person with depression is about 20 per cent more likely to die, and a schizophrenic about 35 per cent more likely.
The Roman poet Juvenal said that what people should desire is Mens sana in corpore sano - a healthy mind in a healthy body. When a mind is not healthy, we should not blithely sacrifice the body, too. When we treat people with mental illness, we should care for their hearts as well as their minds.
To do otherwise - as we do now - is heartless.
apicard@globeandmail.com
