Mortality gap for people with serious mental illness is increasing

This is leading to a ‘persistent and increasing’ mortality gap, where people with schizophrenia and bipolar disorder are at a greater risk of premature death compared with the general population – despite many improvements in mental health care.

The findings, published in the BMJ medical journal, highlight the challenge faced by the UK government’s recent mental health strategy, which states that “fewer people with mental health problems will die prematurely.”

Dr. Uy Hoang, an academic clinical fellow in the Department of Public Health at Oxford University, who led the work, says: "More needs to be done to understand the reasons for the increasing mortality gap. And a lot more can be done to identify and treat patients to reduce the number of preventable deaths."

The research team from the University of Oxford and the Institute of Psychiatry analyzed records for all people with schizophrenia or bipolar disorder discharged from inpatient care in England.

They compared the risk of death in the 12 months following discharge with mortality rates in the general population for each year from 1999 to 2006.

They found a significant increase over this period in the mortality gap between patients with schizophrenia or bipolar disorder, and the general population.

By 2006, the risk of death in the year following discharge had reached double the average risk for the population as a whole.

This widening disparity occurred as mortality rates in the general population declined, while those in people with serious mental disorders did not.

About three quarters of the deaths among those with schizophrenia and bipolar disorder were from natural causes. And it was increasing disparities in deaths from heart and respiratory diseases that in large part drove the widening mortality gap.

The researchers say they are encouraged that the UK government has recognized and prioritized the importance of preventing premature mortality in its recently published mental health strategy.

"We do welcome the focus on this mortality gap. It will present a real challenge to the government’s reforms of mental health services," says Dr. Hoang.

Professor Peter Kinderman of the University of Liverpool, who was not involved in the study, says: "We know some of the risks – people with serious mental health problems are at risk from lifestyle factors (smoking, drinking, lack of exercise, poor diet) but also potentially from the medication that is prescribed, often for very long periods ... And, when physical problems are identified, people with mental health problems often receive inadequate care. So it’s vital that mental health services improve – to give people the care they need and to avoid inappropriate forms of care – and work better with physical health services and primary care."

Provided by Oxford University