People accessing mental health services have more than twice the mortality rate than the general population and people with experiences labelled as psychosis have more than three times the overall risk of premature death. (Cunningham et al., 2014).
Drivers of poor physical health include exposure to known risk factors such as:
- low socio-economic status resulting in restricted access to employment, social stigma, isolation, poverty and poor housing
- medication side effects and in particular their contribution to cardiovascular disease, obesity, metabolic syndrome and type 2 diabetes
- reduced access to and quality of health care due to financial barriers, stigma and discrimination
- systemic issues in healthcare delivery, such as the separation of physical, mental health and addiction services and a need for more clarity regarding the roles and responsibilities for the physical health of people experiencing mental health and addiction issues.
Primary and secondary care workforces (across both physical and mental health and addiction NGO and specialist services) have a fundamental role to play in improving the physical health of people. Training may be required to increase skill and confidence levels in both settings. There is support for workers in both primary and secondary healthcare settings to take on responsibility for monitoring and screening procedures related to the physical health of this population group (Ministerial Advisory Committee on Mental Health, 2011).
For people accessing mental health and addiction services, in particular those prescribed anti-psychotics and opioid substitution medication, routine screening and monitoring for health issues is essential. However, systematic reviews confirm inequities in terms of early diagnosis, use of monitoring and provision of treatment for physical health problems (Te Pou, 2017).
The New Zealand Mental Health Metabolic Working Group (2008) suggests a range of monitoring timeframes for people treated with antipsychotic medications, depending on the specific medication and the aspect of health being monitored (Te Pou, 2014).