Study reveals treatment and screening inequalities for patients with mental health problems

Patients with mental health problems may not be receiving the appropriate screening or treatments for illnesses including heart disease and stroke, a report from The University of Nottingham has shown.

The research, led by Professor Julia Hippisley-Cox in the University's Division of General Practice and commissioned by the Disability Rights Commission, found some evidence that patients with mental health problems, such as schizophrenia, were also more likely to suffer from conditions like high blood pressure and epilepsy and may not always be given adequate access to preventative health care.

The research was an analysis of the clinical records of 1.7 million people registered with 242 general practices contributing to the QRESEARCH database. This database is based on the EMIS clinical system, the system of choice for more than half of general practitioners in the NHS. The database enables researchers to quickly detect regional and national trends of disease and illnesses.

The study found that patients with mental health problems are more likely to have higher levels of risk factors that could increase their chances of suffering from illnesses such as heart disease than other patients without mental health problems. For example, obesity was present in one-third of those with schizophrenia, compared to 21 per cent of the remaining population and 61 per cent of people with schizophrenia were smokers, compared to 33 per cent of people without mental health problems.

The study also found:

• Ischaemic heart disease is more common in people with schizophrenia (four per cent) and manic depression (five per cent) compared to the remaining population (three per cent)
• Stroke is more common in people with schizophrenia (two per cent) and manic depression (1.5 per cent) compared to the remaining population (one per cent)
• High blood pressure is more common in people with schizophrenia (12 per cent) and manic depression (15 per cent) compared to the remaining population (10 per cent)
• Epilepsy is more common in people with schizophrenia (0.7 per cent) and manic depression (0.7 per cent) compared to the remaining population
• Diabetes is more common in people with schizophrenia (six per cent) and manic depression (four per cent) compared to the remaining population (two per cent)

In addition, the research also found some inequalities in preventative health care. For example:

• Women with schizophrenia were less likely to have had a cervical smear test in the previous five years (63 per cent) compared to the remaining population (73 per cent), although this did not apply to those with manic depressive disorder
• 86 per cent of patients with schizophrenia and ischaemic heart disease had a blood pressure reading recorded compared with 92 per cent of the remaining population with ischaemic heart disease
• 67.7 per cent of patients with schizophrenia and ischaemic heart disease had a recent cholesterol test, compared to 79.9 per cent of the remaining population
• Only 48 per cent of stroke patients with schizophrenia had a cholesterol test in the last 15 months, compared with 63 per cent of the remaining population
• 63 per cent of stroke patients with schizophrenia were on aspirin (either prescribed or over-the-counter) in the last 15 months compared with 68 per cent of general stroke patients

The researchers said: “Equitable access to health care is about patients receiving the level of care appropriate to their level of need rather than a 'one size, fits all' approach. For example, patients with higher levels of need and greater risk of adverse outcomes may need more energetic screening and management. We have found no evidence of this.”

The report also revealed some encouraging trends. More of those with severe mental illness had been recorded as receiving smoking advice and more had been prescribed smoking cessation medication compared to smokers without any mental health problems. More of those with severe mental illness (60 per cent of those with schizophrenia) had also had their blood pressure recorded in the past year compared to the remaining population (44 per cent) and those with schizophrenia were more likely to have a normal blood pressure reading (82 per cent versus 77 per cent).