Managing the Physical Health Risks That Come With Severe Mental Disorders

Research has found that people with severe mental disorders (SMD) have an average life expectancy that is 10 to 20 years lower than the general population. This may seem unsurprising when considering the heightened risk of suicide among people with conditions such as major depressive disorder, schizophrenia and bipolar disorder. However, research has found that physical health risks are a major factor in the shortened life span of people with SMD. More importantly, many of these risks, such as diabetes and cardiovascular disease, are preventable, prompting the medical community to take action and push for more interdisciplinary care.

According to “Guidelines for the Management of Physical Health Conditions in Adults With Severe Mental Disorders,” released by the World Health Organization (WHO), individuals living with SMD are at a much higher risk for developing a number of physical health complications. These health risks include both non-communicable and communicable diseases.

There are many potential causes for the increased mortality of people with severe mental disorders. While individuals diagnosed with SMD do have higher rates of death due to unnatural causes, including accidents, homicide and suicide, the majority of deaths among this population can be attributed to chronic physical health conditions and diseases.

One of the most prominent links between mental and physical health is a person with SMD’s increased exposure to behavior-based risk factors. This can include smoking, substance abuse, lack of physical activity, unhealthy diets and engaging in risky behavior. The CDC reported in 2016 that 32 percent of adults in the United States with a mental illness reported current use of tobacco, compared to just 23 percent of adults in the United States with no mental illness.

People with SMD are also often prescribed psychiatric drugs, such as antidepressant or antipsychotic medications, which can have health-altering side effects like weight gain. This, in turn, can lead to a number of comorbidities, including obesity, insulin resistance, diabetes and cardiovascular issues.

There’s also the issue of accessibility. Many people with SMD do not have access to quality care for mental health issues, let alone interdisciplinary care that addresses comorbidities in a way that is holistic and effective. A report released in 2017 by the National Alliance on Mental Illness cited denial of care by insurers, high out-of-pocket costs, difficulties accessing psychiatric medications and problems finding providers in insurance networks as the most common barriers for people seeking mental health care. Because of these barriers, nearly half of all people with mental health conditions in the United States go without any treatment (PDF, 754 KB).

In light of this global health issue, WHO recently released its “Guidelines for the Management of Physical Health Conditions in Adults With Severe Mental Disorders” (PDF 2.3 MB). The report serves as a means for providers to enact systemic change but can also be a tool of empowerment for individuals with SMD and their caregivers to advocate for themselves.

“The main message for clinicians in WHO’s new guidelines on management of physical health conditions in adults with severe mental disorders is that it is important to pay as much attention to the physical health of people with severe mental disorders as to their mental health,” said Neerja Chowdhary, MD, from the department of mental health and substance abuse at WHO, in an interview with Healio Psychiatry.

WHO’s recommendations for the treatment of tobacco cessation, weight management, substance use disorders, cardiovascular disease, diabetes, HIV/AIDS and other infectious diseases examine decision making over the following:

Interactions Between Drugs to Treat Physical Health Issues and Mental Illness

Combining medications to address both physical and mental health can sometimes cause negative interactions. For example, pharmacological treatments for tobacco cessation can interact with antipsychotics or antidepressants to cause adverse side effects like nausea.

Independent Side Effects of Medications

Drugs used to treat SMDs can cause a number of side effects that affect an individual’s health. Weight gain is a common result, which can lead to other comorbidities such as cardiovascular disease. These medications can also affect current medical conditions such as diabetes — certain drugs have a higher propensity for directly affecting blood sugar.

When to Utilize Behavioral Interventions

When individuals with SMD are at risk for multi-drug interaction or adverse side effects caused by medication, they may instead choose to implement a care plan to change their behavior to address a physical health risk. For example, if a psychiatric medication is highly effective for a patient but they are experiencing weight gain, they may opt to address the health risk through exercise and nutrition with the help of a provider.

How People With SMD Can Improve Their Physical Health

With the guidelines set forth by WHO in mind, individuals with SMD and their caretakers can also advocate for themselves when working with a provider.

Ask for early and regular screenings for physical health risks.
For example, the American Heart Association recommends getting checked for blood pressure, cholesterol, weight and blood glucose.

Discuss drug options.
If you are concerned about side effects that you may experience due to a medication, you can talk with a provider about changing your medications.

Discuss behavioral interventions for physical health risks.
In cases where ceasing to take a medication is simply not an option, you may consider a plan to make behavioral changes. The United States Preventive Services Task Force provides recommendations on behavioral interventions for weight loss to prevent obesity-related problems in adults.

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Citation for this content: Nursing@USC, the online FNP program from the University of Southern California.