factors often lead to people with mental illness not receiving adequate health ... This consumer summary describes the main findings of the study. More detailed ...
Duty to Care Physical illness in people with mental illness
Consumer Summary
$FNQRZOHGJPHQW 7KLV VWXG\ ZDV IXQGHG E\ WKH 1DWLRQDO +HDOWK DQG 0HGLFDO 5HVHDUFK &RXQFLO 7KH RULJLQDO FRQVWUXFWLRQ RI WKH :$ /LQNHG 'DWDEDVH ZDV IXQGHGE\WKH/RWWHULHV&RPPLVVLRQRI:HVWHUQ$XVWUDOLD
7KH 8QLYHUVLW\ RI :HVWHUQ $XVWUDOLD ,6%1
7KLV ZRUN LV FRS\ULJKW ,W PD\ EH UHSURGXFHG LQ ZKROH RU LQ SDUW VXEMHFW WR WKH LQFOXVLRQ RI DQ DFNQRZOHGJPHQW RI WKH VRXUFH DQG QR FRPPHUFLDO XVDJH RU VDOH 5HSURGXFWLRQ IRU FRPPHUFLDO SXUSRVHV UHTXLUHV WKH ZULWWHQ SHUPLVVLRQ RI 7KH 8QLYHUVLW\ RI :HVWHUQ $XVWUDOLD 6WLUOLQJ +LJKZD\ &UDZOH\ :$ 7KLV UHSRUW PD\ EH GRZQORDGHG IURP WKH 'HSDUWPHQW RI 3XEOLF +HDOWK ZHE VLWH DW www.dph.uwa.edu.au
)ROORZ WKH OLQNV 5HVHDUFK SURJUDPV &HQWUH IRU +HDOWK 6HUYLFHV 5HVHDUFK 'XW\ WR &DUH &RSLHV RI RWKHU UHSRUWV LQ WKLV VHULHV FDQ DOVR EH GRZQORDGHG IURP WKLV ZHE VLWH (QTXLULHV FRQFHUQLQJ WKLV UHSRUW VKRXOG EH GLUHFWHG WR 5HEHFFD &RJKODQ &RQVXPHU /LDLVRQ 2IILFHU &HQWUH IRU +HDOWK 6HUYLFHV 5HVHDUFK 'HSDUWPHQW RI 3XEOLF +HDOWK 8QLYHUVLW\ RI :HVWHUQ $XVWUDOLD 6WLUOLQJ +LJKZD\ &UDZOH\ :$ 3KRQH )DFVLPLOH HPDLO UFRJKODQ#GSKXZDHGXDX &RYHU DUWZRUN E\ &DUROLQH 8VHG ZLWK SHUPLVVLRQ
Duty to Care Physical illness in people with mental illness Consumer Summary
5HEHFFD&RJKODQ 'DYLG/DZUHQFH '·$UF\+ROPDQ $VVHQ-DEOHQVN\ 'HSDUWPHQWRI3XEOLF+HDOWK DQG 'HSDUWPHQWRI3V\FKLDWU\DQG%HKDYLRXUDO6FLHQFH
,QWURGXFWLRQ
3HRSOH ZLWK PHQWDO LOOQHVV DUH DPRQJ WKH PRVW PDUJLQDOLVHG SHRSOH LQ RXU FRPPXQLW\ 7KH FRQVHTXHQFHV RI PHQWDO LOOQHVV RIWHQ H[WHQG EH\RQG WKH GLUHFW V\PSWRPV RI WKH LOOQHVV WR DIIHFW SHRSOH·V VRFLDO DQG HFRQRPLF ZHOO EHLQJDQGDOODVSHFWVRIWKHLUOLYHV7KHDLPRIWKLVVWXG\ZDVWRH[DPLQHWKH SK\VLFDOKHDOWKRISHRSOHZLWKPHQWDOLOOQHVV 3HRSOHZLWKPHQWDOLOOQHVVDUHRIWHQLVRODWHGIURPIDPLO\DQGIULHQGV0HQWDO LOOQHVVFDQDOVRDIIHFWSHRSOH·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² 7KH VWXG\ FRPSDUHGGHDWKVWKHWRWDOQXPEHURIFDQFHUVWKDWZHUHGLDJQRVHGDQGKRVSLWDO DGPLVVLRQUDWHVLQSHRSOHZLWKPHQWDOLOOQHVVZLWKWKHJHQHUDOSRSXODWLRQ 7KLV FRQVXPHU VXPPDU\ GHVFULEHV WKH PDLQ ILQGLQJV RI WKH VWXG\ 0RUH GHWDLOHGUHSRUWVIURPWKHVWXG\DUHDOVRDYDLODEOHDQGFDQEHGRZQORDGHGIURP ZZZGSKXZDHGXDX
%DFNJURXQG
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·W EH FDOOHG XSRQ WR GLDJQRVH SK\VLFDO LOOQHVVHV 7KH VHSDUDWLRQRIPHQWDOKHDOWKVHUYLFHVKDVOHGWRIUDJPHQWHGFDUHIRUSHRSOHZLWK PHQWDOLOOQHVV
3
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² DQG LQFOXGHV DSSUR[LPDWHO\ SHRSOH ZKR ZHUH UHFRUGHG RQ WKH 0HQWDO +HDOWK ,QIRUPDWLRQ 6\VWHPGXULQJ WKLV WLPH 7KH V\VWHP LQFOXGHV SXEOLF DQG SULYDWH KRVSLWDO DGPLVVLRQV IRU PHQWDOLOOQHVVFRPPXQLW\SV\FKLDWULFVHUYLFHVDQGRXWSDWLHQWFOLQLFVDVZHOODV UHVLGHQWV RI OLFHQVHG SV\FKLDWULF KRVWHOV 7KH V\VWHP GRHV QRW FRYHU SHRSOH VHHNLQJWUHDWPHQWIRUWKHLUPHQWDOLOOQHVVIURPJHQHUDOSUDFWLWLRQHUVRUZKRVHH SULYDWHSV\FKLDWULVWVLQWKHLUFRQVXOWLQJURRPV
4
'HDWK
'HVSLWHWKHPDMRUFKDQJHVLQWUHDWPHQWRIPHQWDOLOOQHVVWKHGHDWKUDWHVIURP DOO PDLQ FDXVHV RI GHDWK ERWK QDWXUDO DQG XQQDWXUDO UHPDLQ FRQVLGHUDEO\ KLJKHU LQ SHRSOH ZLWK PHQWDO LOOQHVV WKDQ WKH JHQHUDO SRSXODWLRQ )LJXUH VKRZVGHDWKUDWHVSHUSHRSOHSHU\HDU IURPWKHPDLQFDXVHVRIGHDWK LQ :$ IRU SHRSOH ZLWK PHQWDO LOOQHVV DQG WKH :$ SRSXODWLRQ 2YHUDOO WKH GHDWKUDWHRISHRSOHZLWKPHQWDOLOOQHVVZDVWZRDQGDKDOIWLPHVKLJKHUWKDQ WKHJHQHUDOSRSXODWLRQRI:$ Figure 1: Death rates in people with mental illness compared to theWA population Cancer Heart attack Other heart disease Stroke Other circulatory disease Mentally ill
Respiratory system diseases
WA population
Accidental Suicide 0
50
100
150
200
250
Death rate
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
5
6XLFLGH
$ERXWRIVXLFLGHVLQ:$LQ²RFFXUUHGLQSHRSOHZKRKDGFRQWDFW ZLWKPHQWDOKHDOWKVHUYLFHV7KHFRQWULEXWLRQRIPHQWDOLOOQHVVZRXOGEHHYHQ JUHDWHU EHFDXVH D SURSRUWLRQ RI WKH RWKHU VXLFLGHV ZRXOG EH SHRSOH ZLWK PHQWDOLOOQHVVZKRZHUHQ·WLQFRQWDFWZLWKPHQWDOKHDOWKVHUYLFHV,QSHRSOH ZLWK PHQWDO LOOQHVV VXLFLGH UDWHV ZHUH VHYHQ WLPHV KLJKHU WKDQ WKH RYHUDOO VXLFLGH UDWH IRU WKH :$ SRSXODWLRQ $W KLJKHVW ULVN ZHUH SHRSOH ZLWK VFKL]RSKUHQLDDIIHFWLYHSV\FKRVHVDQGGHSUHVVLYHGLVRUGHU Figure 2: Suicide rates by time since discharge from inpatient care Suicide 400 rate 300
Males Females
200
100
0 0
5
10
15
20
Weeks since discharge
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
6
KRVSLWDO DUH RQO\ NHSW LQ IRU VKRUW SHULRGV EHIRUH GLVFKDUJH WR KRPH FDUH 5HVHDUFK VXJJHVWV WKDW FRPPXQLW\ FDUH RXWVLGH KRVSLWDOV DQG RWKHU PHQWDO KHDOWKFDUHIDFLOLWLHVPD\SODFHSHRSOHDWJUHDWHUULVNRIVXLFLGH Figure 3: Relative risk of suicide by year of first contact with mental health services 1.8 Relative risk 1.6 of suicide 1.4 1.2 1 0.8 0.6 0.4 0.2 0 1980
1984
1988
1992
1996
Year of first contact
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
+,9
1LQHWHHQ SHUFHQW RI SHRSOH ZLWK +,9 KDYH KDG FRQWDFW ZLWK PHQWDO KHDOWK VHUYLFHVSULRUWREHLQJKRVSLWDOLVHGIRU+,97KLVZDVPRUHWKDQWKUHHWLPHV WKHH[SHFWHGQXPEHUEDVHGRQWKH+,9UDWHLQWKHJHQHUDOSRSXODWLRQ0RVW DWULVNZHUHSHRSOHZLWKSV\FKRVHVDOFRKRODQGGUXJGLVRUGHUVDQGSHUVRQDOLW\
7
GLVRUGHU 7KH VHULRXVO\ PHQWDOO\ LOO DUH DW JUHDWO\ LQFUHDVHG ULVN RI +,9 LQIHFWLRQGXHWRLQWUDYHQRXVGUXJXVHDQGKLJKULVNVH[XDOEHKDYLRXUV
9LUDO+HSDWLWLV
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
6H[XDOO\7UDQVPLVVLEOH'LVHDVHV
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
8
&DQFHU
Figure 4: Cancer incidence and death rates in people with mental illness compared to the WA population 400 rate per 100,000 350
Mentally ill
300
WA population
250 200 150 100 50 0 Incidence rate
Death rate
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·WJHWFDQFHUDQ\PRUHWKDQDQ\RQHHOVHEXWWKH\ DUHPRUHOLNHO\WRGLHRILWDQGVRRQHU
9
+HDUWGLVHDVH
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igure 5: Heart disease hospitalisation and death rates, by principal psychiatric diagnosis Dementia Alcohol/Drugs
Hospitalisation
Schizophrenia
Death
Affective psychosis Other psychoses Neurotic disorder Personality disorder Adjustment reaction Depressive disorder 0
0.5
1
1.5 rate ratio
10
2
2.5
3
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
,QMXULHV
,QMXULHVDUHDPDMRUFDXVHRIKRVSLWDOLVDWLRQLQ:$3HRSOHZLWKPHQWDOLOOQHVV ZHUHDWKLJKULVNIRUDOOW\SHVRILQMXULHVSDUWLFXODUO\LQMXULHVLQIOLFWHGE\RWKHUV DFFLGHQWDO SRLVRQLQJV DQG DGYHUVH GUXJ UHDFWLRQV3HRSOHZLWKPHQWDOLOOQHVV ZHUH PRUH WKDQ WKUHH WLPHV PRUH OLNHO\ WR EH YLFWLPV RI LQMXULHV LQIOLFWHG E\ RWKHUV DQG DOPRVW WKUHH WLPHV DV OLNHO\ WR EH KRVSLWDOLVHG IRU DFFLGHQWDO SRLVRQLQJSDUWLFXODUO\SRLVRQLQJE\WKHUDSHXWLFGUXJV$GYHUVHGUXJUHDFWLRQV ZHUH PRVW FRPPRQO\ FDXVHG E\ FDUGLRYDVFXODU DJHQWV DQDOJHVLFV DQG DQWLELRWLFV+RVSLWDOLVDWLRQUDWHVIRUDGYHUVHGUXJUHDFWLRQVZHUHWZRDQGKDOI WLPHV KLJKHU IRU SHRSOH ZLWK PHQWDO LOOQHVV WKDQ WKH JHQHUDO SRSXODWLRQ 3HRSOHZLWKPHQWDOLOOQHVVZHUHPRUHOLNHO\WREHKRVSLWDOLVHGIROORZLQJD URDGLQMXU\GHVSLWHEHLQJOHVVOLNHO\WRRZQDFDU 3HRSOH ZLWK PHQWDO LOOQHVV XQGHUJRLQJ VXUJHU\ ZHUH PRUH OLNHO\ WR KDYH FRPSOLFDWLRQV OHDGLQJ WR KRVSLWDO UHDGPLVVLRQ HYHQ WKRXJK WKH\ ZHUH OHVV OLNHO\WRUHFHLYHFHUWDLQW\SHVRIVXUJLFDOSURFHGXUHV :RPHQ ZLWK PHQWDO LOOQHVV ZHUH DW JUHDWHU UHODWLYH ULVN WKDQ PHQ RI LQMXULHV LQIOLFWHG E\ RWKHUV 2QH LQ HYHU\ IRXU ZRPHQ KRVSLWDOLVHG GXH WR LQMXULHV LQIOLFWHG E\ RWKHUV ZHUH XVHUV RI PHQWDO KHDOWK VHUYLFHV 3HRSOH ZLWK PHQWDO LOOQHVVDUHDWULVNRIYLROHQWYLFWLPLVDWLRQ6XEVWDQFHDEXVHDQGKRPHOHVVQHVV PDNHFULPLQDOYLFWLPLVDWLRQPRUHOLNHO\
11
&RQFOXVLRQVDQG5HFRPPHQGDWLRQV
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
12