Worldwide, mental disorders contribute to 7 per cent of the global burden of disease as estimated by disability adjusted life years and this is rising especially in low- and middle- income countries (LMIC) . In addition to causing a large proportion of morbidity, mental disorders – especially severe mental disorders (SMD) – are linked with poorer health outcomes and increased mortality. SMD are defined as a group of conditions that include moderate to severe depression, bipolar disorder, and schizophrenia and other psychotic disorders.
People with SMD have a 2-3 times higher average mortality compared to the general population, which translates to a 10-20 year reduction in life expectancy . People with bipolar disorder and schizophrenia have been shown to have higher rates of mortality in both high and low-income settings. The majority of these premature deaths are due to physical health conditions. Access to comprehensive health services which offer health promotion, screening and treatment for physical as well as mental health conditions remain out of reach for the majority of people with severe mental disorders. For those who are able to access health care, the care received is often of poor quality and physical health conditions are often overlooked.
To help address this inequity, WHO has released, for the first time, evidence-based guidelines on management of physical conditions in adults with severe mental disorders.
Recommendations cover lifestyle changes, psychosocial support and medicines
The new Guidelines include recommendations for treating people with severe mental health disorders who have cardiovascular disease, diabetes, HIV/AIDS, tuberculosis and hepatitis B and C, and those with tobacco dependence, who engage in harmful use of alcohol or other substances and/or who are overweight. Recommendations relate to lifestyle changes such as a healthier diet, increased physical activity and tobacco cessation; psychosocial support; and medicines, taking into account possible interactions between different medicines prescribed for mental and physical health conditions.
A resource for health workers
The Guidelines are primarily intended for use by health-care workers providing services for people with severe mental disorders at all levels – in primary health facilities, specialist facilities and hospitals. Policy-makers and health-care planners at local and national levels, mental health programme managers and people living with severe mental disorders and their families will also find them useful.
Individual-level interventions, health systems issues and social contexts
The Guidelines recommend that programmes for improving the health of people with severe mental disorders and increasing their life-span include individual health-care interventions, health-systems adjustments and actions that can be taken at the community level. Training of health workers, supply of appropriate medicines and adaptation of health information systems to collect data on service utilisation need to be put in place if not already established.
At the individual level, risk factors for poor physical health (such as smoking, an unhealthy diet or lack of regular exercise) and physical health conditions need to be identified and treated.
At the health system level, mental health practitioners need to be better able to provide advice on and treat physical health conditions, and physical health clinicians need to be better able to address the needs of people with severe mental disorders.
In the wider social context, strategies that involve the wider community, such as peer and family support and stigma reduction programmes, should be considered.
In order to evaluate the impact and usefulness of the Guidelines and identify areas where improvement is needed, WHO will collect regular feedback from ministries of health.