Case for change

This page outlines the factors that can mean shorter lives for people living with a serious mental illness.  It describes the inequality gaps influencing life expectancy and why its important that London makes changes to improve the serious mental illness mortality gap.

What is the serious mental illness mortality gap and why do we need to address it?

In London and across the country, people with a serious mental illness (SMI) can expect to live between 15 and 20 years less than the general population. The difference in life expectancy is known as the SMI mortality gap. Mostly it is because of preventable and treatable physical illness. It is one of largest health inequality gaps England faces.

Despite having a higher risk of poor physical health, people living with SMI are routinely missed for preventative interventions, diagnosis and treatment for physical health risks and conditions. Causes of the SMI mortality gap can be broadly be grouped into three inequality gaps:

1. Health and wellbeing gap: ethical and legal case for change

A health and wellbeing gap is caused by health risks and behaviours. Mental ill health, the side effects of treatment for these conditions, and high levels of social deprivation lead to significant inequalities in health and wellbeing.

Many of the physical health conditions seen in people living with SMI are associated with preventable risk factors such as smoking, physical inactivity, obesity, substance misuse and side effects of psychiatric medication [1] Two thirds of people with SMI die from preventable physical illnesses. Many of these illnesses are caused by smoking.

Commissioners and providers have legal duties to address inequalities for those with protected characteristics, which include mental health, as described in the Care Act (2014), the Health and Social Care Act (2012) and the Equality Act (2010).

2. Care and quality gap: clinical case for change

The care and quality gap relates to healthcare use. It is about the ability to access the right care at the right time and benefit from existing provisions. Inequitable healthcare and lack of reasonable adjustments to general medical services mean that people with SMI are less able to access or benefit from current health services. This contributes to a higher incidence of physical ill health and poorer treatment outcomes.

3. Cost and efficiency gap: economic case for change

Inefficient resource allocation and failure to focus on prevention leads to higher levels of incidence and complications from long-term conditions. It leads to costly and poor outcomes, including higher levels of emergency care, prolonged acute hospital stays and long-term unemployment.

There is a clear economic case for change to invest in lower-cost preventative interventions and enhanced service models to address these inefficiencies.

[1] World Health Organisation – Information sheet: Premature death among people with severe mental disorders

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