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Physical health and mental illness: A silent scandalI think it was about 10 years ago now, I remember Ireceived a phone call from a colleague of mine. He wasworried; a patient he was looking after had died. Myfirst thought: was it suicide? If it was, there would be aninquiry. It wasn’t; the patient had died of ‘natural causes’,of colon cancer. She was just 54 years old. In patients withschizophrenia, this form of cancer is much more commonthan it is in the general population (Hippisley-Cox et al.2007), but no one knew she had cancer; not her generalpractitioner, not her community nurse. It troubles medeeply that this lady died alone and probably in consid-erable pain. If anyone, perhaps someone who saw herregularly and knew her well, had asked her about anychanges in her bowel habits, might she have talked aboutbeing constipated, having diarrhoea, or bleeding? Maybe,and maybe something could have been done.

In the 20 years that I have been a mental health nurse,the life expectancy of patients with schizophrenia haslessened probably by about 10 years. Read though thepapers in this special issue and they all make this samepoint. Can you imagine any other area of medicine wherefalling life expectancy would be anything other than ascandal? A couple of months ago, a survey was publishedthat showed cancer survival rates to be worse in the UKthan most of the rest of Europe. The media response wasof disgust and outrage: ‘Our Cancer Shame’, the red topheadline. Research is published that shows patients withschizophrenia can expect to die 20 years younger than youor I; the silence is deafening.

Who is to blame? Listen to the chattering middle classof mental health nursing and they will tell you that it is thenasty pills and injections we give patents that make themfat and cause diabetes; an appealing fable, but one that isapocryphal, or at least highly inaccurate. Yes, cardiovascu-lar disease (CVD) is the major cause of death in patientswith schizophrenia, and yes, weight gain is a side-effectof some, but by no means all, antipsychotic drugs. Theproblem is that every other modifiable risk factor for CVD– poor diet, lack of exercise, smoking, drinking alcohol – isalso much more prevalent in patients with schizophreniathan in the general population. Take smoking as anexample, eight out of 10 patients with schizophreniasmoke. In fact, last year an incredible 44% of all thecigarettes consumed were by people with schizophrenia.

To reduce the CVD risk in schizophrenia patients, weneed to tackle these. When the question about whetherantipsychotic medication is life extending or shortening,the striking and counterintuitive truth seems to be thatpatients that stick with treatment live longer than thosewho don’t (Tiihonen et al. 2009). One of the other majorfactors associated with patients’ worsening mental healthis deinstitutionalization. It might not fit comfortably withour current fad for recovery-orientated working, but oneof the unintended consequences of the closure of ourasylums is that patients don’t live as long (Wahlbeck et al.2011).

As a mental health nurse, I have a deep sense ofshame at the state of the physical health of the people weserve. To my mind, our branch of nursing has neverreally been at ease with itself; I have always felt thatwe don’t really know what we are supposed to be doing.Are we therapists or custodians, prescribers, or socialworkers? Is physical health really our problem at all? Ithink the work of the mental health nurse is quitestraightforward. Our job is to promote health and enablethe people we care for to lead full and productive lives.To return to the patient with colorectal cancer, I thinkwe should have spotted it, we should have been thinkingabout her physical and mental health. Mental healthnursing is about doing what needs to be done, not whatwe are interested in doing. The poor physical healthof our patients is a silent scandal and something needs tobe done. I hope you find the papers in this special issueinformative and stimulating.

Richard GrayUniversity of East Anglia, Norwich, UK

Conflicts of interest

RG has received honoraria and provided consultancyto AstraZeneca, Bristol-Myers Squibb, Jannsen Cilag, EliLilly and Co., Otsuka Pharmaceutical Europe Ltd, Pfizer,received honoraria from AstraZeneca, Bristol-MyersSquibb, Jannsen Cilag, Eli Lilly and Co., Otsuka Pharma-ceutical Europe Ltd, Pfizer, Wyeth and had researchfunding from AstraZeneca, the Medical Research

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International Journal of Mental Health Nursing (2012) 21, 191–192 doi: 10.1111/j.1447-0349.2012.00832.x

© 2012 The AuthorInternational Journal of Mental Health Nursing © 2012 Australian College of Mental Health Nurses Inc.

Council, the National Institute for Mental Health, theDepartment of Health, Comic Relief.

REFERENCESHippisley-Cox, J., Vinogradova, Y., Coupland, C. & Parker, C.

(2007). Risk of malignancy in patients with schizophreniaor bipolar disorder: Nested case-control study. Archives ofGeneral Psychiatry, 64 (12), 1368–1376.

Tiihonen, J., Lönnqvist, J., Wahlbeck, K. et al. (2009). 11-yearfollow-up of mortality in patients with schizophrenia: Apopulation-based cohort study (FIN11 study). The Lancet,374 (9690), 620–627.

Wahlbeck, K., Westman, J., Nordentoft, M. et al. (2011). Out-comes of Nordic mental health systems: Life expectancy ofpatients with mental disorders. British Journal of Psychiatry,199, 453–458.

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© 2012 The AuthorInternational Journal of Mental Health Nursing © 2012 Australian College of Mental Health Nurses Inc.