Psychiatrists and Consumers Need to Talk More About Health, Survey Finds

Having a severe mental illness shortens life expectancy by 25 years, according to recent research. Deaths among people with schizophrenia are largely the result of preventable medical conditions, such as diabetes and cardiovascular and respiratory diseases. However, findings from a recent survey indicate that mental health professionals are not doing enough to promote healthy lifestyles among their patients with schizophrenia.

The survey of 250 adults with schizophrenia and 250 practicing psychiatrists suggests that communication between these groups about health is less than optimal. In fact, although most of the consumers (82%) felt that treatment to promote their overall health—not just their mental health—was important to their recovery, about half had no expectation that their psychiatrist should focus on anything but their mental health. Among psychiatrists, although nearly all respondents (91%) felt that they were responsible for taking care of medical conditions that resulted from the psychiatric care they provided to patients, more than a quarter (27%) did not hold themselves responsible for ensuring that patients receive appropriate care for all their health problems.

The online survey had three goals: to examine the extent to which overall health is addressed in mental health settings, to examine the dialogue between consumers and providers about treatment and potential adverse effects, and to explore the degree to which people with schizophrenia are aware of routine healthy living practices. The average age of the consumer respondents was 38. More than half (56%) were women, 76% were Caucasian, and 52% reported paid or unpaid employment. Most (88%) had some kind of health insurance, and 90% were currently taking medications to treat their schizophrenia.

Nearly three-quarters of the consumers (74%) reported having at least one of 11 medical conditions listed in the survey, with high cholesterol (36%) and high blood pressure (34%) being the most common. Twenty-three percent reported having diabetes. However, in response to a survey item about whether their psychiatrist had asked them about these health conditions, only 40% reported being asked about cholesterol, 42% about diabetes and blood sugar levels, and 49% about blood pressure. When psychiatrists were asked whether they routinely discussed these health conditions with patients, their responses showed some disparities: 82% reported routinely asking about cholesterol, 88% about diabetes and blood sugar levels, and 75% about blood pressure. Nearly 90% of psychiatrists reported routine discussions with patients about "tips to live a healthier lifestyle," but 63% of consumers reported having such discussions with their psychiatrist.

"We should all be alarmed and outraged that the lives of people with schizophrenia are being cut short by 25 years," said David Shern, Ph.D., president and chief executive officer of Mental Health America, which commissioned the survey. "This survey tells us that mental health providers and people with schizophrenia must communicate more about issues like diet, exercise, and medication side effects if we're to turn the tide of this public health crisis and extend the lives of the millions of Americans with schizophrenia."

The survey was conducted in late 2007 by International Communications Research, a leading independent research company. The group of consumers, all of whom had been given a diagnosis of schizophrenia by a medical professional, was provided by a research panel that maintains a nationwide pool of respondents and checks the quality and validity of the sample. The sample of psychiatrists has previously been verified through a series of studies as being representative of the national population of physicians, including psychiatrists. Three-quarters of the psychiatrists surveyed treated a minimum of 11 patients with schizophrenia per month, and 55% of them saw 21 or more such patients per month. The full results of the survey are available at www.nmha.org/go/surveys.