What lies beneath Reversing the onset of type 2 diabetes for people with severe mental illness

Queenslanders diagnosed with severe mental illness, such as schizophrenia, face a tenfold greater risk of premature death from chronic physical disorders than suicide. Yet physical health receives far less attention. To better detect and offset the increasing incidence of type 2 diabetes in this group, Queensland Health is stepping up screening, detection and management of co-morbid physical health conditions across the state’s adult mental health services. Queensland Health’s Donna Carmichael reports why this is important for all health professionals to be across.

An historical perspective The relationship between diabetes and mental health is not new. In the early 1920s, some doctors studied and published their case notes of increased numbers of patients with schizophrenia (then called Dementia Praecox) who developed type 2 diabetes when compared to general community rates. In the 1950s, with the advent of the first range of medicines, antipsychotics radically changed mental health treatment and provided far better outcomes for people with psychosis, including schizophrenia. A downside, however, was further adding to the risk of developing type 2 diabetes. Sometimes type 2 diabetes was noted with very rapid onset of starting antipsychotic medication, while others developed the condition years into treatment. . .. risk of mortality from chronic physical disorders (including diabetes) is 10 times higher than suicide ...

It is estimated that as many as 20 to 30 per cent of people with schizophrenia will develop type 2 diabetes or pre-diabetes during the course of their mental health treatment. The reason behind this is multi-faceted, taking into account risks associated with the mental illness itself, genetics, poor diet, physical inactivity, smoking, social health determinants (for example limited income, accommodation and food security), and possible side effects of medications, such as weight gain. What’s clear, as noted in the National Mental Health Commission’s 2012 report card on mental health and suicide prevention, is that the risk of co-morbid physical health conditions, including type 2 diabetes, can be reduced – if not prevented – via healthy lifestyle choices: improved nutrition, increased exercise, and reduced drug/ alcohol consumption and smoking. In 2012, the Commission described the poor physical health and early deaths of people in Australia’s mental health community as a national disgrace. It also highlighted a 10 to 32 year mortality gap between the general population and those with severe mental illness. Of note, the risk of mortality from chronic physical disorders, including diabetes, cardiovascular disease, cancer

and chronic lung disease, is 10 times higher than that of suicide, yet receives far less attention. In Queensland, a separate project entitled “activate: mind & body” that ran from 2008 to 2012, with the objective of improving the physical and oral health of people with severe mental illness, collected similar data over a two-year period. Associate Professor David Crompton, Executive Director of Metro South Addiction and Mental Health Services, said it was concerning that mortality in Queenslanders with severe mental illness was approximately two-and- a-half times higher than the general population and above published rates elsewhere in Australia. The data also indicated that people with severe mental illness were less likely to be provided with treatment and rehabilitation for physical health conditions. Here, Associate Professor Crompton said the association between schizophrenia and diabetes had been recognised for well over a century (see fact box, right). “Diabetes (type 2) remains prevalent among people with schizophrenia, but for many it is left undiagnosed,” Associate Professor Crompton said.

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