Schizophrenia and the Longevity Gap
The psychiatric system has been criticized from a number of directions and on a number of occasions. Some of these criticisms are right to be listened to – take, for example, patient-focused care or the need for more holistic care for people with severe mental illness on release from a ward or clinic.
One issue that perhaps has not had enough focus is the severe shortening of life of people diagnosed with schizophrenia.
Schizophrenia is not inherently a “life-shortening”1 disease, yet individuals diagnosed with it often have a significantly reduced life expectancy. Life expectancy amongst people diagnosed with schizophrenia can be 15 to 20 years less than the general population. The longevity gap may actually be increasing. This is a drastic statistic. Indeed, it is a shameful fact that a stigmatized group of people should live such shortened lives in our contemporary community.
However, to make a fair criticism of psychiatric practice, we must inquire about the source of this shortened life expectancy. There is some complexity of the degree to which physical mortality can be associated with psychiatric intervention. It has been observed that people diagnosed with schizophrenia often die from preventable causes, such as cardiovascular disease, infections, obesity, respiratory diseases, and cancer.
It has further been observed that people with schizophrenia have a higher level of smoking than the whole population. Other factors include substance abuse, sedentary life-style and disease-related factors such as metabolic abnormalities. Other causes include suicide, homicide and accidents. People with schizophrenia are more likely to be victims of violence and self-harm. Stigma and mistreatment of people with schizophrenia may also contribute to poorer outcomes.
The arising question of whether we may criticize psychiatric practice for these factors leading to life shortening may be subtle. In many cases, psychiatric medication itself may contribute to factors, such as certain antipsychotic medications contributing to metabolic changes. While psychiatric medications can significantly improve mental health, some antipsychotic medications may contribute to physical health issues, such as metabolic changes. Which means we need a balanced approach when planning treatment. In many cases, medical intervention early in the course of schizophrenia can set the consumer on a positive path to physical as well as mental health. On this basis we have some ground for questioning contemporary psychiatric practice for insufficient focus on physical care. Certain changes must be made.
This can be achieved through the use of integrated care by psychiatrists, with co-location of physical and mental heath services, shared protocols and information sharing and additional intervention by doctors into patients’ physical health. Anti-smoking, anti-obesity and exercise prescription and campaigns would be a useful addition. Future research must focus on co-morbidity – causes and solutions. In all cases of schizophrenia, physical health as well as mental health must be kept at the forefront by all treating doctors.
1https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9777663/#:~:text=Schizophrenia%20is%20a%20life%2Dshortening,increasing%20longevity%20gap%20over%20time.
Dr. Richard Schweizer, Policy Officer at One Door Mental Health richard.schweizer@onedoor.org.au.
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Dr Richard Schweizer