Clinical Network for Mental

Health

With the exception of London, all the areas with a rate of more than 2,000 years of life lost per 100,000 patients are

clustered together in the north

2

Have you heard the news?• Total Military casualties Afghanistan -

http://www.bbc.co.uk/news/uk-10629358

• Annual Homicides

• Annual fatal RTA`s

• Suicides in 2012

• Annual Premature death in persons with Mental ill health.

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Under 75 Mortality

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495

.6

459

.8

516

.3

516

.3

491

.4

380

.2

493

.0

486

.2

472

.4

518

.8

442

.1

521

.7

508

.5

426

.1

15

59

.2

14

77

.6

15

69

14

26

.7

15

58

14

97

.8

17

68

.1

13

82

.9

17

50

.9

15

66

.4

16

14

.5

12

73

.2

14

94

.2

15

86

0.0

200.0

400.0

600.0

800.0

1000.0

1200.0

1400.0

1600.0

1800.0

2000.0

Under 75 Mortality Rates per 100,000 population (DSR)by Local Authority - 2010/11

General Population DSR Mental Health Population DSR

‘Excess’ Mortality - What does this mean?

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• Excess rate of 1,000 = roughly 1,000 more deaths in this cohort per 100,000 than in ‘general’ population – or …

• 100 xs for every 10,000 people - or….• 10 xs for every 1,000 people – or ….• 1 xs in every 100 (1%) - diagnosed with a serious

mental illness (= contact with specialist secondary mental health services in previous three years)

What does this mean?

• Each CCG area loses on average 50 lives

• Across the network approx 700 lives (14 CCGs)

• 1.5 life per year per practice (~540 practices)

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Is Suicide Prevention important?

• How much effort do you put into this?

• How much do you worry about it?

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MH Deaths by Key Disease Areas

Based on National Data (MH bulletin)

• 20% - Cancers • 22% - Circulatory Diseases• 12.3% - Respiratory Diseases• 10.9% - Digestive Diseases• 13.8% - External Causes (5.9% Suicides)• 7.1% - Diseases of the Nervous System• 5.5% - Mental and Behavioural Disorders

• Local data not available.

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To Put this into Perspective

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• 700 potential unnecessary deaths in SMI cohort

•Target = reduce the gap between general population mortality and SMI mortality in under 75

How about by disease area?Between 19 and 74

• you are nearly 4 x more likely to die of respiratory disease.

• Gastro-intestinal disease? 4x again

• Cardiovascular? 2.5 x extra

How do we do this? Reduce smoking!

• 1 in 6 of all deaths in England attributed to Smoking which addresses multiple causes of death

• Current (national) smoking prevalence = ~20%

• Among Mental Health Patients estimated to be twice this • Therefore 40% of Mental Health Patients Smoke (this

figure higher for some conditions)

• 1/3 of all tobacco is smoked by those with mental health conditions (higher consumption = higher risk?)

• Leads to increased risk of developing cancer, respiratory and cardiovascular diseases

• Targeted intervention to reduce smoking levels will help save lives – ‘Reduce the Gap’

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The gap in life expectancy from preventable physicalillness Lawrence et al BMJ 2013

retrospective analysis of population based registers

• Life expectancy since the 50`s has been improving for the General population.

• It hasn`t for people with mental illness.

• THE GAP IS CONTINUING TO WIDEN!

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Premature death among people with mental illness BMJ EDITORIAL 2013

• We continue to disregard the physical health needs of people with mental illness and act as if they are of less worth than others. We now know that these forms of discrimination can have lethal consequences.

Graham Thornicroft BMJ 2013;346:f2969

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Summary – 2 a day!

• The mortality gap among people with mental illnesses is around 15 years for women and 20 years for men

• We are coming to understand that this excess mortality is not the result of higher suicide rates, but rather a combination of socioeconomic, healthcare, and clinical risk factors.

• NICE Guideline PH48 Smoking cessation in secondary care: acute, maternity and mental health services

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Summary: we need to create a culture that will reduce xs mortality.

• The health care community must integrate physical and mental health care.

• We must have a culture of harm minimisation

• We take Nicotine management as seriously as any other addiction and set our services up to address this!

• We promote smoking cessation as part of our organisations, staff and patients.

• This needs Board to ward sign up!

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