In the government’s proposal for a new Step-up Plan for mental health, the goal is to increase the life expectancy of people with mental disorders and drug problems. It is both gratifying and important, but concrete measures are needed now. We know what is needed to equalize the large difference in life expectancy between psychiatric patients and the general public. There are several reasons why people with serious mental disorders live shorter lives. Patients with schizophrenia, bipolarity or severe depression have a genetically increased risk of cardiovascular disease. In addition, smoking, stress, side effects from medication, little physical activity and poor nutrition increase the likelihood of falling ill. Better prevention of cardiovascular disease in the last fifty years has resulted in a sharp reduction in deaths. For example, only seven percent of adults in Norway smoke daily, according to figures from Statistics Norway. For people with mental disorders, the situation is completely different. They smoke to a far greater extent, and among those with the most serious mental disorders such as schizophrenia, the Directorate of Health states that more than fifty percent smoke. This causes many health problems. We also have figures that show that physical illnesses are detected later for psychiatric patients. For some conditions, such as narrow blood vessels in the heart, it is less likely that an investigation will lead to the correct treatment if you also have a serious mental disorder. There is also little doubt that deductibles for health services act as a barrier to health care. Many of our patients cannot afford it. If the patients are to live longer, there are two concrete conditions in particular that we should start with. First, we have to help the patients to change their lifestyle. Quitting smoking is probably the most important single measure to increase the lifespan of the patient group and shrink the so-called “prevention gap”. Effective smoking cessation programs must be offered to all smokers. This does not happen today. So we need to get better at identifying and treating somatic illness in people with serious mental disorders. It is then a prerequisite that the somatic health service, i.e. that which concerns the body, also reaches these patients. Here we need to make better use of the treatment in psychiatric inpatient wards and outpatient clinics. GPs must offer annual health checks and, if necessary, visit patients to reach them. The proposal for a new Escalation Plan emphasizes the GP’s role, and recommends increased use of annual checks. In somatic wards, health care must be arranged in a better way for these patients. Perhaps, for example, an admission is needed instead of day treatment in order to carry out the planned examination. Not everything can be solved by healthcare professionals. We also need strong political forces to quickly be able to help more people. The Government and the Storting can remove barriers that prevent patients from seeking medical attention. Vulnerable groups should not have to pay deductibles. For example, annual check-ups with the GP should be free. The penalty fee for not showing up to class was removed in mental health care. Nevertheless, it is often the same patients who can struggle to follow up an outpatient appointment at somatic departments. A penalty fee of NOK 1,500, which is sent to debt collection with accrued interest, promotes illness and not health. This must go. The required changes in the health service must come from both outside and inside. A comprehensive plan as proposed in the Escalation Plan will give this work a boost. We must reduce what a former health minister called “the ugliest health gap”. The changes that must take place in mental health care to achieve this require motivated professionals, and not least a strong management that provides the necessary resources to change practice. We professionals in mental health care must take the greatest responsibility by lifting this task as one of the most important things we do. We need to develop safe and effective methods to help patients to change their lifestyle, identify somatic disease with preliminary stages and ensure that treatment is offered. Mental health care has a major responsibility for increasing the life expectancy of this patient group. It is also undeniable that good treatment of the mental disorder itself contributes to a longer lifespan. Finally: The most important measure to improve the health and life expectancy of people with serious mental disorders and substance abuse disorders is to prevent the development of mental and physical illnesses. Equalizing social and economic differences through reducing poverty and ensuring good living conditions and a safe upbringing for children and young people will make an important contribution to this. School meals and more physical activity in school are some concrete measures that politicians are encouraged to introduce. (The author writes on behalf of the working group in the Norwegian Medical Association behind the report “Better health and longer life for people with serious mental illness or drug and addiction disorders”. The group consists of Paul Joachim Bloch Thorsen, Inger Margrete Hageberg, Torgeir Gilje Lid, Nina Wiggen and Håvard Midgard.)
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My patients die prematurely – Statement
