Mental health and physical health are inextricably linked and people with mental illnesses are more likely to develop physical illness and tend to die earlier than the general population.

International studies report a reduced life expectancy in psychiatric patients by 20 years in males and 15 years in females (Laursen 2011; Wahlbeck et al. 2011). Research from Western Australia found that the gap in life expectancy for people with psychiatric disorders registered with West Australian mental health services increased between 1985 and 2005, from 13.5 to 15.9 years for males and 10.4 to 12.0 years for females. The majority of excess mortality was attributed to physical health conditions, such as cardiovascular disease, respiratory disease, and cancer (Lawrence et al. 2013).

Evidence suggests that people with mental illness are more likely to develop physical illness due to a combination of lifestyle, socioeconomic and system-level factors such as social stigma, lack of health service integration, and a lack of clarity about who is responsible for physical health monitoring in people with mental illness. Medication side effects (for example, weight gain and hyperlipidaemia—elevated levels of lipids in the blood) may also be a significant contributor for some individuals (Firth et al. 2019; Liu et al. 2017). See Mental health for more information about mental illness.

Measuring physical health of people with mental illness

Part of the challenge in reporting on the physical health of people experiencing mental illness is a lack of information. However, while there is no national data set on prevalence of physical illness in mentally ill people, information is available from a number of other data sources. Together these sources provide insight into the chronic conditions and substance use in people with mental illness.

A number of initiatives and programs that monitor the physical heath of Australians with mental illness have the potential to provide insight into this important issue, but they are not consistent across jurisdictions and different health settings. In 2017, the Australian Government committed to regular national monitoring and reporting (Department of Health 2017); funding for an updated National Nutrition and Physical Activity Study and a National Health Measures Study was also announced in 2019. It is expected that data from these studies will better inform future physical health information activities.

Measuring patient experience is an important component of the care for people with mental illness not only to guide service improvement, but also because quality of care is linked with clinical outcomes. Because of the bidirectional relationship between physical and mental health, New South Wales has investigated several aspects of physical health care including healthy eating and diet, smoking, alcohol and drug use, sexual health, exercise and physical activity, and possible side effects of some medications. According to its 2018–19 Your Experience of Service survey, more than half of mental health consumers recall being provided with information on exercise, diet, medication side effects, smoking, and alcohol and drug use. People were less likely, though, to recall receiving information on sexual health (NSW Ministry of Health 2019). See Patient experience of health care.

How common is physical illness among people with mental illness?

There is no national data set that directly monitors the prevalence of physical illness in mentally ill people but some information is available from other data sources.

For example, the 2017–18 National Health Survey (ABS 2018) estimated that there was a strong overlap between physical health and mental health problems. People who reported having a mental illness were much more likely to report having a chronic medical condition, and vice versa. Females with a mental and/or behavioural condition were more likely to have a physical health comorbidity than males. The most common chronic conditions reported included back problems, arthritis, and asthma (Table 1). See Chronic conditions and multimorbidity for more information.

Table 1: Chronic conditions of persons with and without mental illness in 2017–18

Selected chronic condition

Persons with mental illness(a) (%)

Persons without mental illness (%)

Arthritis(b)

23.3

13

Asthma

18.2

9.5

Back problems(c)

27.7

13.5

Cancer (malignant neoplasms)

2.6

1.6

Chronic obstructive pulmonary disease(d)

5.2

1.8

Diabetes mellitus(e)

6.7

4.4

Heart, stroke and vascular disease(f)

7.1

4.2

Kidney disease

1.9

0.8

Osteoporosis

6.3

3.2

  1. Includes alcohol and drug problems, mood (affective) disorders, anxiety-related disorders, organic mental disorders and other mental and behavioural conditions.
  2. Includes rheumatoid arthritis, osteoarthritis, other and type unknown.
  3. Includes sciatica, disc disorders, back pain/problems not elsewhere classified and curvature of the spine.
  4. Includes bronchitis and emphysema.
  5. Includes Type 1 and Type 2 diabetes, and type unknown. Estimates also include persons who reported they had diabetes but that it was not current at the time of interview.
  6. Includes angina, heart attack, other ischaemic heart diseases, stroke, other cerebrovascular diseases, oedema, heart failure, and diseases of the arteries, arterioles and capillaries. Estimates include persons who reported they had angina, heart attack, other ischaemic heart diseases, stroke or other cerebrovascular diseases but that these conditions were not current at the time of interview.

Source: ABS 2018.

The second national survey of People Living with Psychotic Illness (Morgan et al. 2011) also provides estimates on the physical health of Australians living with psychosis. Chronic back, neck or other pain were the most common chronic physical conditions (32% compared with 28% for the general population) identified among people with psychosis in 2010. Other common conditions included asthma (30% compared with 20% for the general population) and heart or circulatory conditions (27% compared with 16%).

One-quarter (24%) of people with psychosis were at high risk of cardiovascular disease. About half (45%) of people with psychotic illness were obese and almost two-fifths (38%) reported gaining weight as a medication side effect. Physical activity levels were far lower in people with psychosis, with 96% classified as either sedentary or undertaking low levels of exercise in the previous week compared with 72% for the general population (Morgan et al. 2011).      

Substance use and mental illness

There is a strong association between the use of alcohol, tobacco and illicit drugs and mental illness. Use of these substances can not only trigger or worsen mental health issues, but is strongly associated with physical health conditions including cancer, cirrhosis, and cardiovascular disease (Crocq 2003).

According to the 2019 National Drug Strategy and Household Survey (AIHW 2020), people who had been diagnosed or treated for a mental health condition in the previous 12 months were estimated to be about 1.2 times as likely to drink alcohol at levels that exceeded the lifetime risk and single occasion risk (at least monthly) guidelines than people who had not been diagnosed or treated for a mental illness (Table 2). According to the People living with psychotic illness 2010 report, the lifetime rate of alcohol use or dependence in people with psychosis was double the rate of the general population (51% compared with 25%) (Morgan et al. 2011).

Table 2. Proportion of people aged 18 years and over who use alcohol, tobacco and illicit drugs by mental health status in 2019

Mental illness(a)

Alcohol use

Any illicit drug use

Daily smoking

Single occasion risk (at least monthly) (%)

Lifetime risk (%)

Diagnosed or treated for a mental health condition

30.9

21.3

26.2

20.2

Not diagnosed or treated for a mental health condition

25.3

17.1

15.2

9.9

(a) Includes depression, anxiety disorder, schizophrenia, bipolar disorder, an eating disorder and other form of psychosis.

Source: AIHW 2020.

Use of Illicit drugs is also common among people with mental illness. In 2019, compared to people with no mental illness, people with mental health condition were 1.7 times as likely to have used any illicit drug in the previous 12 months and about 2 times as likely to have used meth/amphetamine and pharmaceuticals for non-medical purposes (AIHW 2020). The lifetime rate of any substance use or dependence in people with psychosis, at 51%, was 6 times the population figure of 9% (Morgan et al. 2011). See Illicit drug use.

A similar pattern to that for consumers of alcohol and users of illicit drugs is apparent for daily smokers. People who reported a mental health condition were twice as likely to smoke daily as those who had not been diagnosed with, or treated for, a mental health condition (20% compared with 9.9%) (Table 2) (AIHW 2020). Two-thirds (66%) of people with psychosis smoke, smoking on average 21 cigarettes per day. Almost one-third (31%) of people had tried to quit in the last year, but just over one-quarter (27%) had never tried (Morgan et al. 2011).

Another source of information on physical health and substance use in people with mental illness is Victoria’s Mental Health Services annual report, where new indicators on the incidence of tobacco and diabetes have been added as part of Victoria’s 10-Year Mental Health Plan. According to the 2018–19 report, 10% of registered Victorian mental health clients were diagnosed with type 2 diabetes and 37% of admitted clients were tobacco users (DHHS 2019).

Treatment and management

To improve the management of physical health conditions in adults with severe mental disorders, and support the reduction of individual health behaviours constituting risk factors for these illnesses in order to decrease morbidity and premature mortality, the World Health Organization (WHO) has developed guidelines discussing pharmacological and non-pharmacological interventions related to tobacco cessation, weight management, substance use disorders, cardiovascular disease and risk, diabetes mellitus, HIV/AIDS, and other infectious diseases (tuberculosis, hepatitis B/C). In summary, WHO recommends that lifestyle changes such as following a healthier diet, increasing physical activity and quitting smoking together with psychosocial support have an important role in reducing physical illness in people with severe mental illness (WHO 2018). See Mental health services for more information.

Future directions

Improving the physical health of Australians with mental illness and ensuring that their life expectancy and quality of life is the same as among the general population is a priority for policymakers and clinicians. A number of common themes are evident in national and state mental health commission reports on this issue, including:

  • the need for holistic person-centred physical and mental health care using a collaborative and coordinated approach
  • addressing the side effects of antipsychotic medication
  • education (Mental Health Commission of NSW 2016).

Where do I go for more information?

For more information on the physical health of people with mental illness, see:

References

ABS 2018. National Health Survey: first results, 2017–18. ABS cat. no. 4364.0.55.001. Canberra: ABS.

AIHW (Australian Institute of Health and Welfare) 2020. National Drug Strategy Household Survey 2019. Drug Statistics series no. 32. Cat. no. PHE 270. Canberra: AIHW.

Crocq MA 2003. Alcohol, nicotine, caffeine, and mental disorders. Dialogues in Clinical Neuroscience 5(2):175–185.

Department of Health 2017. The Fifth National Mental Health and Suicide Prevention Plan. Canberra: Australian Government.

DHHS (Department of Health and Human Services Victoria) 2019. Victoria's mental health services annual report 2018–19. Melbourne: DHHS.

Firth J, Siddiqi N, Koyanagi A, Siskind D, Rosenbaum S, Galletly C et al. 2019. The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness. The Lancet Psychiatry 6(8):675–712.

Laursen TM 2011. Life expectancy among persons with schizophrenia or bipolar affective disorder. Schizophrenia Research 131:101–4.

Lawrence D, Hancock K & Kisely S 2013. The gap in life expectancy from preventable physical illness in psychiatric patients in Western Australia: retrospective analysis of population based registers. British Medical Journal 346:f2539.

Liu NH, Daumit GL, Dua T, Aquila R, Charlson F, Cuijpers P et al. 2017. Excess mortality in persons with severe mental disorders: a multilevel intervention framework and priorities for clinical practice, policy and research agendas. World Psychiatry 16(1):30–40.

Mental Health Commission of NSW 2016. Physical health and mental wellbeing: evidence guide. Sydney: Mental Health Commission of NSW.

Morgan VA, Waterreus A, Jablensky AV, Mackinnon A, McGrath J, Carr V et al. 2011. People living with psychotic illness 2010: report on the second Australian national survey. Canberra: Australian Government.

NSW (New South Wales) Ministry of Health 2019. Your experience of service: what consumers say about NSW Mental Health Services 2018–2019. Sydney: NSW Government.

Wahlbeck K, Westman J, Nordentoft M, Gissler M, Laursen TM 2011. Outcomes of Nordic mental health systems: life expectancy of patients with mental disorders. The British Journal of Psychiatry 199:453–8.

WHO (World Health Organization) 2018. WHO guidelines: Management of physical health conditions in adults with severe mental disorders. Geneva: WHO.