You don’t have to read health stories for long before you start spotting patterns. There’s one I’ve noticed that goes like this: A health charity releases a report, usually an important piece of work that raises issues that are well deserving of our attention. The Chief Executive/Publicity Officer/Campaign Manager of the charity then releases sound bites to the media to draw attention to the issue - invariably accompanied by words such as ‘shocking’ and ‘scandalous’, since as the Chief Executive of last month’s charity-in-the-news declared her issue to be a ‘shame on the nation’ you have to at least match her rhetoric or your own cause might seem in some way inferior - and a demand is made that something has to be done. Finally, a Health Minister is dragged onto the scene to declare that, of course, the Government is planning to do something, and gives a knee-jerk promise of action with little regard to the evidence of what might actually make a difference.
The most recent offering of this kind comes from the charity Rethink Mental Illness. The report raises the important issue of increased rates of physical illness in the mentally unwell, the adjectives (from the BBC news story)are ‘systemic’, ‘chilling’ and ‘biggest health scandal’, the Minister was Norman Lamb, and the non-evidence-based solution? Health checks.
The fact that people with serious mental health problems are more likely than the general population to develop problems with their physical health is very significant. It is a difficult problem to solve, and worthy of grown-up debate and imaginative, concerted efforts to work on it - but it is not a scandal. It is not a scandal because, sadly, it is not in the least bit surprising. We have always known that physical and mental illness often go together. People who are anxious or depressed are more likely to drink excess alcohol; people with heart disease are more likely to get depressed; schizophrenia is linked to poverty - since it’s hard to earn a lot of money when you have an illness as serious as schizophrenia - and poverty is associated with worse physical health outcomes - I could go on.
Just because the association is predictable, does it mean we have to accept it? Of course not - or at least we should be trying to do as much as we can to do something about it. What we need, however, is a mature conversation free from hyperbole and emotive words like ‘chilling’, or meaningless headline-grabbing numbers like ’33,000 avoidable deaths’. What is an avoidable death after all? The best any of us can do is to try to delay our death, and there must be more to measuring the value of our lives than the number of days in our existence. For some patients with severe mental health problems it is a triumph just to get up in the morning and get the children to school on time - we need to celebrate this rather than give a lecture about smoking every time we see them.
The danger if we do not move beyond the sound bites is that we will end up with the solutions we deserve - like health checks. Unlike the claim in the news article, there is no evidence that health checks ‘could save thousands of lives’. In fact, the lack of evidence behind routine health checks is quite startling, yet they make better politics than they do medicine, and so the Government remains wedded to the idea.
Despite my frustrations at the way this has been presented, I actually think the report by Rethink Mental Health makes good reading. There are moving stories of patients who struggled to access their GP, or who felt ignored when they got there; innovative projects are highlighted, like the proactive care of in-patients with diabetes in the Solent Trust; and important issues are raised, like the need to tailor stop-smoking projects to suit the needs of patients with mental health problems.
We don’t need another round of health checks, but we do need thoughtful innovation. If patients find it hard to access their GP, why not pilot sending GPs into secondary care? A GP could run a drop-in clinic in psychiatry out-patients to attend to physical problems. Not only might this be less threatening for the patient, but the GP could concentrate on the physical, knowing that someone else was looking after the mental well-being of the patient that day. Why not get dieticians into psychiatric clinics, or set up a gym? If we have cardiac rehab and respiratory rehab, why not get some physiotherapists to develop mental health rehab? Maybe these things are happening already - well let’s spread the word.
Most importantly of all, we need to scrutinise every health policy from the perspective of the mentally ill, especially considering the effects of the Inverse Care Law. For instance, when the Government insists that patient choice is paramount, and that Trip-Advisor websites are the way forward, what if you don’t have the means to access that choice? When GP surgeries are filled up with routine reviews of patients who are not ill, in order to fulfil the requirements of a Government-driven Quality and Outcomes Framework, is that going to make it more or less easy to access your GP if you are suffering from a mental illness? In short, we need to consider mental illness far more often, and not just when the latest report comes out.