A recent phenomenon is that people with schizophrenia are at higher than average risk of physical ill health, and die earlier than the general population from natural causes. The fatal conditions include cardiovascular, respiratory and metabolic disorders.
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Although death by suicide in schizophrenia has received much needed attention, death from cardiovascular disease is far more common, accounting for up to 75 percent of deaths. The causes of physical health problems include factors associated with mental illness and its treatment, poverty, poor housing, higher rates of smoking, poor diet and lack of exercise.
Dynamics
Despite the high rates of physical health problems, mental health service users report that health care workers overlook their physical health needs. Service users would like mental health practitioners to do more for their physical health. Rethink interviewed 2,998 mental health service users, over half of whom lived with a diagnosed severe mental illness. Nearly one third said regular physical health checks were in their top three priorities for improving services. Mental health practitioners may feel unable to provide physical health input. Also there may be a feeling that people with mental health problems will not be interested in physical health education and support. In fact, much health promotion is simple and well received by service users. One review showed that people with schizophrenia benefited from a variety of behavioural interventions and achieved weight loss and lifestyle change.
Another study found little evidence to support one intervention over another, but argued that moderately strenuous exercise was important.
Health policy
Many guidelines reflect the need to incorporate physical health care into mental health provision, including NICE in the UK. In primary care, the prodigy website provides practical and accessible advice.
However, a review of international guidelines for physical wellbeing in SMI has found that recommendations are variable. UK guidelines failed to address the specifics of physical health monitoring and lifestyle intervention, while United States guidelines were more descriptive. Field studies suggested that all guidelines were inadequately implemented in practice.
The DoH in the UK has recommended wide-ranging action to enable the general population to choose healthier lifestyles in the Choosing Health white paper.
In the UK the National Health Service (NHS) is deeply split along physical/mental lines. Instead of treating whole people, services tend to treat parts of people separately.
The commissioning framework to support the physical health needs of people with severe mental illness recommends a holistic approach with interagency collaboration.
Medication
The current medical view is that all patients suffering from schizophrenia must take medications for the disorder. These antipsychotic medications have adverse effects such as weight gain and induce feelings of fatigue that inhibit physical activity. The request for the schizophrenia sufferer to exercise for cardiovascular health then give medications (originally named "major tranquilizers") that inhibit activity is a double bind.