The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness

Abstract

Executive SummaryThe poor physical health of people with mental illness is a multi-faceted, transdiagnostic, and global problem. Physical health disparities are observed across the entire spectrum of mental illnesses, in low, middle-and high-income countries. This stems from both a heightened risk of physical diseases in people with mental illness, along with their reduced access to adequate healthcare. The high rates of physical comorbidities (and typically-poor clinical management of this) drastically reduces life expectancy, and also increases the personal, social and economic burden of illness across the lifespan.This Commission has brought together an international team of researchers, clinicians, and key stakeholders from various backgrounds and professionally / personally-relevant experience, in order to summarize advances in understanding on this topic, and present clear directions for health promotion, clinical care and future research. The breadth and multifactorial nature of physical health disparities across the range of mental health diagnoses poses an almost limitless number of potential considerations. Therefore, rather than attempting to cover all of the different possible combinations of physical-mental comorbidities individually, the aim of this Commission was to: (i) establish highlypertinent aspects of physical health-related morbidity and mortality which apply transdiagnostically, (ii) highlight the common modifiable factors driving these disparities, (iii) present actions and initiatives for health policy and clinical services to address these issues, and (iv) identify promising areas for future research towards discovering novel solutions. This was addressed across 5 different Parts of the Commission: Parts 1 and 2 determined the scope, priorities and key targets for physical health improvement across multiple mental illnesses. Parts 3, 4 and 5 discussed emerging strategies and produced recommendations for improving physical health outcomes in people with mental illness. Leaders and contributors for each Part are shown in the Appendix (pg.1) . Part 1: 'Its more than premature mortality'Part 1 identified almost 100 systematic reviews/meta-analyses examining the prevalence of physical comorbidities in mental illness. Around 70% of the meta-research focused on cardiometabolic diseases; consistently reporting that mental illnesses were associated with 1.4-to 2-fold increased risk for obesity, diabetes and cardiovascular diseases compared to the general population. Although mostly studied in 'severe mental illness' ('SMI', and particularly psychotic disorders), the prevalence of cardiometabolic diseases was similarly elevated across a broad range of other diagnoses, including substance use disorders (SUDs), and 'common mental disorders' ('CMDs', such as depression and anxiety). Part 2: Key modifiable factors in health behaviours and health servicesPart 2 built on the findings of Part 1 with a hierarchal evidence synthesis of modifiable risk factors for physical diseases in mental illness. The bu...

Keeping the body in mind: A qualitative analysis of the experiences of people experiencing first‐episode psychosis participating in a lifestyle intervention programme

“…Health promotion lifestyle interventions have been successful in reducing the cardiometabolic risk factors of people with SMI (Fernández‐San‐Martín et al ). Lifestyle interventions are now recognized as first‐line treatment for both treating and protecting living with a mental illness and endorsed by WHO (Firth et al ; WHO ). Recent large randomized controlled trials have utilized group‐based lifestyle interventions to improve dietary intake and increase physical activity (Bartels ; Daumit et al ; Green et al ), with the addition of health coaching support in two of these studies (Bartels ; Daumit et al ).…”

Test–retest reliability, validity, and correlates of the 2‐min walk test in outpatients with depression

“…When exploring correlates of the 2MWT, we did observe that the variability in SIMPAQ walking and SIMPAQ incidental physical activity remained significantly associated with the variability in the 2MWT in the final backward regression model. Existing research has already established that people with depression are less physically active than matched controls from the general population (F. Schuch et al, ; Vancampfort, Firth, et al, ) and that physical inactivity and poor physical fitness are associated with mental and physical comorbidities in people with mental illness (Firth et al, ). Our previous research has demonstrated this also applies to people with depression in Uganda (Vancampfort, Van Damme, et al, ).…”

Recommendations for dietetics in mental healthcare

“…The poor physical health of people with mental illness is increasingly being recognised as a critical area of health inequality across modern‐day society . This is perhaps best characterised by the severely reduced life expectancy observed among these populations because people with mental health conditions (across a broad spectrum of diagnoses) die 10–30 years younger than the general population, primarily as a result of physical health causes (as opposed to mental health causes) .…”

“…The 2019 World Congress of Psychiatry saw the official launch of the report from the Lancet Psychiatry Commission on ‘protecting physical health in people with mental illness’ . The commission incorporated 42 international expert researchers and clinicians from a range of relevant professions, collaborating together to better define this growing problem, as well as to present new opportunities for addressing the health disparities facing people with mental illness when continuing to provide appropriate mental health recovery.…”

“…The dietary risks of people living with mental illness were clearly described, with a greater frequency of excessive and unhealthy dietary intakes compared to people without mental illness . The reasons for this are often multifactorial and include an increased appetite and disordered eating behaviours, a preference for highly processed convenience and fast foods, low motivation, and low confidence with food preparation .…”