Severe mental illness puts people at far greater risk of early death from CVD, new report finds
People living with severe mental illness are around four times more likely to die early from cardiovascular disease than the general population in England, according to a new report we have published today with Centre for Mental Health, Equally Well UK, and the Royal College of Psychiatrists.
The report, Left Behind: A Policy Response to Cardiovascular Inequalities in Severe Mental Illness, sets out how people living with severe mental illness in England face a higher risk of heart and circulatory diseases, while being less likely to receive timely diagnosis, treatment and support.
Research cited in the report highlights that people with severe mental illness have a 47% lower likelihood of undergoing cardiac interventions, are 15% less likely to have a recent prescription for statins, and up to 66% of patients with SMI have undetected CVD prior to cardiovascular death.
People with severe mental illness are also more likely to be at risk of cardiovascular disease.
Obesity rates are 1.8 times higher for people with severe mental illness than in the general population, and it’s estimated that more than 40% of people with severe mental illness smoke. Smoking is estimated to account for around half of deaths among people living with severe mental illness.
The report argues that these stark inequalities in prevention, diagnosis and treatment of CVD in people with severe mental illness are driven by factors including deprivation, stigma and fragmented services, as much as by clinical risk.
Insight from patients in the report reveals how physical symptoms can be wrongly dismissed as part of a person’s mental illness, while mental and physical health services often operate separately, leaving people to navigate complex and disconnected services alone.
'Time to change the status quo'
We are calling on government, the NHS and local health systems to act.
Our six recommendations are: a 10-year target to reduce smoking prevalence among people with severe mental illness; better access to affordable, appealing healthy food; consistent weight management support; stronger monitoring and follow-up through the NHS Annual Health Check; liaison psychiatry input in specialist cardiology services; and wider use of the Lester Tool to improve physical health monitoring in psychiatric and primary care.
John Maingay, our Director of Policy and Influencing, said: “This report lays bare one of the country’s most persistent and unacceptable health inequalities. People living with severe mental illness are dying decades sooner than they should, often due to cardiovascular disease that has been missed, diagnosed too late, or not treated effectively.
“The odds are stacked against them at every turn. They are at higher risk of developing cardiovascular disease yet encounter barriers, including discrimination, when they do seek help. This injustice is often compounded by their ethnicity, sex, or postcode.
“It’s time to change the status quo and give people with severe mental illness access to effective cardiovascular care when they need it, so they can live in good heart health for longer.”
Bold ambition needed
The report comes as a new Mental Health Strategy and a Modern Service Framework for Severe Mental Illness are expected to set future priorities for care. Its authors say cardiovascular health must be treated as a central part of that work.
Andy Bell, chief executive of Centre for Mental Health said: “That people living with severe mental illness can expect to die up to two decades before the rest of the population is one of the starkest health inequalities that exists in Britain today and a clear injustice.
"Entrenched discrimination and disadvantage don’t only affect the risk factors for cardiovascular disease amongst people with a mental illness. They also stop people getting the right help early on, or the necessary treatment when they become unwell. But this is not inevitable. It needs bold ambition, effective implementation, and reliable data to track progress.”
Dr Ed Beveridge, Royal College of Psychiatrists’ Expert on Physical Health, said: "People living with severe mental health conditions are significantly more likely to die early and cardiovascular disease is implicated in about half of these cases. We know that this is at least partly because they often have worse access to health care and the impact of mental illness is often not sufficiently taken into account when physical conditions are being addressed.
“It is absolutely vital that we ensure people living with mental health conditions have equitable access to screening and treatment, to minimise the risk of preventable death and help them lead lives which are healthier as well as longer. I am very pleased to have been involved in this important piece of work, whose recommendations have the potential to make a real impact on our patients' lives.”
Robert's story
Robert, 62, from north-west London, lives with cyclothymia and post-traumatic stress disorder (PTSD), alongside episodes of irregular heart rhythm (arrhythmia), high blood pressure, a thyroid condition and high cholesterol.
The mental health campaigner and researcher says: “I take 12 or 13 tablets every day. It feels like a real cocktail, and I worry about how my medicines interact. I would like clearer information and reassurance about this, but I simply cannot get them.
“When I was diagnosed with an arrhythmia, I was already managing my mental health conditions, and sadly it added another layer of worry that still affects my daily life. That worry can disrupt my sleep and make my previously settled routine harder to maintain, even though sleep is especially important for my mental health.
“I want healthcare professionals to consider my physical symptoms and any changes in my sleep and mental health together, rather than treating them as separate issues. Sadly, that has not always been my experience.
"My strongest message is that a mental health diagnosis should never mean that someone’s physical health receives less attention. We need to be understood as whole people, with concerns and needs that do not fit neatly into separate services.”