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 published by the British Heart Foundation (BHF) 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 severe mental illness have undetected cardiovascular disease (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 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.
Centre for Mental Health, Equally Well and BHF are calling on government, the NHS and local health systems to act. They recommend 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 and stronger monitoring and follow-up through the NHS Annual Health Check.
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.”
John Maingay, Director of Policy and Influencing at British Heart Foundation (BHF), 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…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.”
Robert Koch, who 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, said: “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…
“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.
“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.”
