UK: BMJ article: Severe mental illness: 120 people die in England every day from preventable conditions, psychiatrists warn

This is most of the article —

Over a three year period nearly 90 000 people with a severe mental illness (SMI) have died from physical health conditions that could have been prevented, the Royal College of Psychiatrists has said.

Data from NHS England and the Office for National Statistics show that 130 400 adults with SMI died prematurely (before the age of 75) between January 2020 and December 2022.[1] Of these, the college estimated that around two thirds (86 934) were from preventable conditions such as respiratory disease, heart disease, and liver disease.
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[1] is https://fingertips.phe.org.uk/profi...age/181/sex/4/cat/-1/ctp/-1/yrr/3/cid/4/tbm/1

In light of these findings, the college has urged the government to take immediate action to “close the mortality gap between people with SMI and the rest of the population.” Currently, adults with a severe mental illness, such as bipolar disorder or schizophrenia, have a life expectancy that is 15 to 20 years below the general population.
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The college has said that NHS England should widen access to annual physical health checks to ensure that everyone with an SMI is assessed. Currently only 59% of people in this group are being reached. It has suggested that access could be improved by providing the checks through community health hubs and mental health services, and by supporting those who are hardest to reach to attend these appointments.

Public health campaigns, including those tackling smoking and obesity, should also be adapted to ensure they make it easier for those with SMI to make positive changes, the college said.
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It isn't just those with severe medical mental illness who die before their time. It also affects those who are wrongly diagnosed or undiagnosed, and mental illness isn't part of the picture.

I knew someone who was, very belatedly, diagnosed with ovarian cancer. But before that the doctors couldn't identify her problem so they treated her with anti-depressants because they thought she was attention seeking, a hypochondriac, and depressed for no reason. I have never heard of anti-depressants as a successful treatment for ovarian cancer (sarcasm). The woman concerned was in her early 70s, and not prone to depression, nor was there any evidence that she was ever mentally ill. Because she hadn't been diagnosed with cancer for most of the time she was ill she wasn't even prescribed pain relief.
 
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Arnie Pye said:
It isn't just those with severe medical illness who die before their time. It also affects those who are wrongly diagnosed or undiagnosed, and mental illness isn't part of the picture.

I knew someone who was, very belatedly, diagnosed with ovarian cancer. But before that the doctors couldn't identify her problem so they treated her with anti-depressants because they thought she was attention seeking, a hypochondriac, and depressed for no reason. I have never heard of anti-depressants as a successful treatment for ovarian cancer (sarcasm). The woman concerned was in her early 70s, and not prone to depression, nor was there any evidence that she was ever mentally ill. Because she hadn't been diagnosed with cancer for most of the time she was ill she wasn't even prescribed pain relief.
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And those diagnoses given to avoid considering the physical illness she did have

sorry but I’m suss too, particularly knowing what I know about the personality type of those involved here they definitely do these things and always trust the story to their advantage

I suspect a lot of these were people with health conditions bunged under the ‘dont treat’ stream by this ‘functional’ push based only on don’t like their face and building kingdoms claiming send them off to our CBT unit will get em out of your hair, don’t give them the time of day because they’ll be frequent flyers you’ll never get rid of lies

then having the gall to try and pretend those they did this god awful violation too died because they were ‘mentally ill’ and so they look after the mentally ill they just don’t do their check ups

sorry but I smell it from here

So we’ve papers saying DONT do the better safe than sorry when someone has in particular even as only one symptom extracted to divert them eg breathing issues or palpitations or anything you could bs might be anxiety in A&E

and now everyone is supposed to go along with the same people doing that pretending and deluding themselves they cared about these people and now just ‘if only they had check ups’?!!

yeah eventually some of these people might come across to the poorly trained tgat us too many that they are mad when it’s the vile situation they are out in making them upset and sound like they are describing a hard-to-believe situation (is that situation thd mad bit? But if you prefer not to believe it exists then it’s like the post office guy who gif told he had delusions of grandeur that the post office were after him trying to chase him gif money etc)

it’s about time all this came out

and the ones selling and doing the mad bit - which is the nonsense of selling physical symptoms now means ‘their mind’ so send them through our third way - get treated for it


This makes me so infuriated when people treat others with threats and appallingly abusive then try and smile to the world pretending they aren’t the harmers, and that *innocent face* ‘they don’t understand why they didn’t come in for check-ups it must have been their innate illness not trying to keep themselves safe from a system that taught them all they would get is abuse’
 
Amw66 said:
https://www.bmj.com/content/387/bmj.q2236?utm_id=BMJ005

90, 000 people over 3 years .
The cognitive dissonance in medicine never fails to astound.
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Is this the good ones treating real mental illness

or the psychosomatic ones who made a career out of the very point being to label then drive mad the physically ill based on propaganda and purely to sell building kingdoms?

I think there needs to be proper investigation and more data on this and I have a horrible feeling many might have originally been ill with whatever killed them and now died under a label pretending it was somehow their fault or deficiency due to ‘mental illness’ and not then actually being sent away by using that as a weapon to not treat them.
 
Sean said:
The mental health movement has gone too far, and too often in the wrong direction.
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These guys are charading under the real stuff and have been destroying that

I suspect it’s the same playbook we’ve seen where you go opt a few patients to say they are recovered snd be evangelical (cos they’ve now got a new meaning in life/career by doing that)


All the fake trandmsdiagnostic courses (that’s not psychology - you need to work out cause yo match treatment that doesn’t harm - but they’ve push that lie thru the sector too as if nothing can harm, when it used to be very well know even choosing between counselling or CBT for a similar thing was crucial to get right) to get people mislabelled into re-education courses that don’t help their health just change their values re what ‘normal’ is as behaviour, then dismantling the proper architecture for the serious stuff

look at what’s been happening in Essex and they reckon they aren’t unusual/the only area
 
I think its a combination of
  1. once you have a "label", for some conditions-MI being one of them- everything is attributed to the label
  2. Side effects of drugs can be significant and tend to be played down ( look at recent apology re drug withdrawal from RC after years of campaigning by patients)
  3. Patients tend to be on drugs long term - I don't know how much research looks at effects of long term use, or even multiple drug interactions over various time periods (I havn't looked so this is an uninformed statement)
Another group " falling through the cracks...."
 
Amw66 said:
https://www.bmj.com/content/387/bmj.q2236?utm_id=BMJ005

90, 000 people over 3 years .
The cognitive dissonance in medicine never fails to astound.
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My schizophrenic cousin was one of these people. He had taken to drinking very heavily as it seemed to block out the voices in his head far better than any medication.

He never went to the doctor for anything. I think a lot of mentally ill people avoid the medical profession as much as possible. In the end he developed agonising stomach pains and went to the doctor. They knew he was an alcoholic schizophrenic, who never went to the doctor unless things were very serious, but the GP said he probably had stomach flu and sent him home. He was found dead on the floor 3 days later from a burst duodenal ulcer. I don't know if he would have been treated any better had he not been mentally ill. I would have thought the fact that they knew he was an alcoholic should have set off alarm bells.

He was a gentle soul, who deserved better. There doesn't seem to have been any real progress in the treatment of conditions like his in all the years I have had ME. My cousin was diagnosed and then abandoned by the medical profession, much like the treatment of patients with ME. If you think there is stigma attached to telling people you have ME, imagine what it is like if you tell them you have schizophrenia!

Perhaps if the head of the psychiatric profession hadn't spent his whole career obsessing over patients who don't actually have mental health conditions, some progress would have been made.
 
Spartacus said:
My schizophrenic cousin was one of these people. He had taken to drinking very heavily as it seemed to block out the voices in his head far better than any medication.

He never went to the doctor for anything. I think a lot of mentally ill people avoid the medical profession as much as possible. In the end he developed agonising stomach pains and went to the doctor. They knew he was an alcoholic schizophrenic, who never went to the doctor unless things were very serious, but the GP said he probably had stomach flu and sent him home. He was found dead on the floor 3 days later from a burst duodenal ulcer. I don't know if he would have been treated any better had he not been mentally ill. I would have thought the fact that they knew he was an alcoholic should have set off alarm bells.

He was a gentle soul, who deserved better. There doesn't seem to have been any real progress in the treatment of conditions like his in all the years I have had ME. My cousin was diagnosed and then abandoned by the medical profession, much like the treatment of patients with ME. If you think there is stigma attached to telling people you have ME, imagine what it is like if you tell them you have schizophrenia!

Perhaps if the head of the psychiatric profession hadn't spent his whole career obsessing over patients who don't actually have mental health conditions, some progress would have been made.
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Yep it’s weird it seems to be a specialism where they don’t do clinical research of the type where they get to the bottom of what the mechanism of the condition is or the biological issues to develop better solutions. And everyone just accepts it. And a lot of the drugs aren’t great fits as far as working vs horrid side effects most others wouldn’t want either.

I can see that they were missing the point if they thought giving him a lecture if alcohol was the solution when they had no viable better alternative and refused to understand that. Doesn’t take a lot of insight just have to believe and see the meds for some. But apparently we have to be careful because you put off patients seeking help’. Yet I think it’s still like this because no one is talking about it and pushing that profession for better solutions because they are silenced by that bs

But maybe because it’s mental health that not being deemed as a treatment issue for them to solve. Just ‘how do we get them to take it anyway and worse force them to say they are happy with it’ . So rolled in with other pretty blunt ways of dealing with people that don’t involve listening to them I wonder why they don’t understand it’s a medical profession way of acting problem (and understanding that others haven’t been great) and hide in their holes kidding themselves it’s ’the Patient’.

Then again a lot of the cancer treatments leave people harmed (screwing up teeth if they are near area, exhaustion, debility from other ops ir treatment) and I’m not sure that bit is rolled into the aftercare - I mean shoving them off to the fatigue clinic isn’t good either.
 
Sean said:
The mental health movement has gone too far, and too often in the wrong direction.
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It keeps being pointed out that a mental health crisis is growing. The mental health movement, especially the biopsychosocial model, has been growing for about 2 decades. A huge chunk of it is actually mislabeled health problems, but that's part of the mental health renewal.

Coincidence? Unlikely. Cause? Likely partly. Is there an actual crisis of mental health, more significant than before? Unlikely. Mental health care is simply terrible in general, based on neither science nor humanities, about where medicine was at the turn of the 20th century.

The idea of expanding anything before it showed any result is normally considered absurd, but here we are, with a "growing" crisis, real or mislabeled. The problem remains the same: the problem is completely mishandled, and the solution is always to do more of what fails.
 
Spartacus said:
Perhaps if the head of the psychiatric profession hadn't spent his whole career obsessing over patients who don't actually have mental health conditions, some progress would have been made.
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The lost opportunity costs from this reckless indulgent decades-long frolic into psychosomatics are just stunning, and compounding rapidly.

What I don't get is what the hell does the medical profession think the outcome for them of all this is going to be? There is no way this can end well for anybody, and the longer they delay genuine reform the worse it it gets for them, as well as their patients.
 
Sean said:
The lost opportunity costs from this reckless indulgent decades-long frolic into psychosomatics are just stunning, and compounding rapidly.

What I don't get is what the hell does the medical profession think the outcome for them of all this is going to be? There is no way this can end well for anybody, and the longer they delay genuine reform the worse it it gets for them, as well as their patients.
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I think something worth adding to the list with this sector in the U.K. is that most inpatient care is I think now done via private providers (paid fir by nhs ) and this has been grown over this period.

whilst iapt was put in and sucked funding out of local actual mental health teams with qualified staff , and services designed to pick up autism (not strictly a ‘mental health’ condition either but Uk has muddied that of recent years and bad suppprtvwill cause issues they then term as that or actively cause trauma etc) avoid issues being bigger there than necessary etc because it’s a condition that responds to early support and adjustments in long term outcome just got removed.

I struggle to get my head around what their thinking was and any good explanation for those choices based on logical thinking and knowledge and literature known on all these things at the time. They just removed the scientific psychology and science from mental health and all sorts of other conditions. And turned it into behavioural re-education based on their screwed own ideas if what normal is, not what makes people healthy or happy.

yes it’s been a failure but there’s part of me that has a horrible feeling some peoples vision/mission wasn’t genuinely about improving mental health but was opportunistic given the unique power that system provides

sadly there are some that see those with certain situations as ‘the problem’ rather than really thinking in terms of illnesses or medical conditions. Which was very old school. And not either medicine or psychology. The same people with that same mindset of force en to act right by bullying and re education or write em off can’t literally can’t ‘fix’ it because they can’t see nevermind ‘so’ the real subject at hand. They think they are managing some alternate level of the criminal justice / old school education system. You know the days where you had bad kids with literally ‘school for bad boys’ (there was one called that exact name local to me in the 80s/90s) just having the name rebranded to make it seem more understanding.
 
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Sean said:
What I don't get is what the hell does the medical profession think the outcome for them of all this is going to be? There is no way this can end well for anybody, and the longer they delay genuine reform the worse it it gets for them, as well as their patients.
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I doubt that more than maybe a few hundred get it, out of tens of millions. They just don't see it, they're trained by the failing system. This is partly because of the complete separation between physical and mental health, ironically on the basis of a magical duality between mind and body that is used to free everyone from responsibility. It's very obviously abused to escape accountability, and is beloved by self-serving interests who don't value the long-term greater good. The biggest drivers are the insurance industry, who would actually make giant long-term savings if the systems were competent, but it would involve short-term disruption and losses. This can't happen on a volunteer basis, this is why we have governments. But the governments are advised by the same systems that have always failed at this. It's a stalemate.

If anything, most seem to think that the solution is to do more biopsychosocial, more of the problem. They just don't see the problem for what it is, they work in echo chambers insulated from real world data and hostile to other fields of expertise, which basically means that medicine has to come up with solutions to non-medical problems while having no relevant expertise, such as engineering or information technology. This is where the pandemic was failed, and if COVID had the potential to kill 500M people, this is who many would have died. They just got lucky, and still killed 20M+ and disabled 100M+.

The profession seems to be willing to lay the blame anywhere but on them. You can see how obsessed most seem to be about tiktok and social media being the new source of everything wrong. It's the same old process they've always used to blame anything but themselves. Because they are not accountable.

The solution probably involves some sort of shift away from top-down expertise onto a mixed system that allows significant bottom-up representation and genuine accountability. Technically this would be elections, but health care is not impacted by changes in government, because ultimately all important decisions are made by physicians, or on their advice. A shift away from a technocratic/aristocratic model towards a representative model, where patients have influence on the system and can hold it accountable. This is unlikely to happen until AI takes over most medical decisions.

Health is too important to be left to physicians. They only see a small part of the whole, and because of how medical culture works, sick people are never involved, since being ill is incompatible with working in health care. It's a system identical to having only the richest people make all economic decisions. There is no such thing as benevolent systems with top-down decision-making. The myth of benevolent medicine needs to be shot twice in the back of the head and buried down the deepest grave. Nothing works like that. Accountability is what brings benevolence, it isn't a thing in itself.
 
rvallee said:
I doubt that more than maybe a few hundred get it, out of tens of millions. They just don't see it, they're trained by the failing system. This is partly because of the complete separation between physical and mental health, ironically on the basis of a magical duality between mind and body that is used to free everyone from responsibility. It's very obviously abused to escape accountability, and is beloved by self-serving interests who don't value the long-term greater good. The biggest drivers are the insurance industry, who would actually make giant long-term savings if the systems were competent, but it would involve short-term disruption and losses. This can't happen on a volunteer basis, this is why we have governments. But the governments are advised by the same systems that have always failed at this. It's a stalemate.

If anything, most seem to think that the solution is to do more biopsychosocial, more of the problem. They just don't see the problem for what it is, they work in echo chambers insulated from real world data and hostile to other fields of expertise, which basically means that medicine has to come up with solutions to non-medical problems while having no relevant expertise, such as engineering or information technology. This is where the pandemic was failed, and if COVID had the potential to kill 500M people, this is who many would have died. They just got lucky, and still killed 20M+ and disabled 100M+.

The profession seems to be willing to lay the blame anywhere but on them. You can see how obsessed most seem to be about tiktok and social media being the new source of everything wrong. It's the same old process they've always used to blame anything but themselves. Because they are not accountable.

The solution probably involves some sort of shift away from top-down expertise onto a mixed system that allows significant bottom-up representation and genuine accountability. Technically this would be elections, but health care is not impacted by changes in government, because ultimately all important decisions are made by physicians, or on their advice. A shift away from a technocratic/aristocratic model towards a representative model, where patients have influence on the system and can hold it accountable. This is unlikely to happen until AI takes over most medical decisions.

Health is too important to be left to physicians. They only see a small part of the whole, and because of how medical culture works, sick people are never involved, since being ill is incompatible with working in health care. It's a system identical to having only the richest people make all economic decisions. There is no such thing as benevolent systems with top-down decision-making. The myth of benevolent medicine needs to be shot twice in the back of the head and buried down the deepest grave. Nothing works like that. Accountability is what brings benevolence, it isn't a thing in itself.
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The thing is that the people being asked are the people ‘in it’ in general so of course they say more biopsychosocisl when that’s what advantages them

noome is going to think beyond the system with all its weird silos it has been trained to think is normal and the weird propaganda it gets fed that most patients ‘brought it in themselves by bad behaviour’ and that they’ve just got to find it

if that attitude drives you mad you don’t work in that system (and they call you names to delegitimise your testimony and say ‘but you don’t know culture snd complications’ which is just hugging the old bigotry and crap chute systems)
 
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