Figure 1 illustrates the elevated rates of mood disorders in Ontarians with diabetes, heart disease, cancer, arthritis and asthma. People with serious mental illnesses face a greater risk of developing a range of chronic physical conditions compared to the general population, impacting almost every biological system in the body. Higher rates of diabetes, heart disease and respiratory conditions in people with serious mental illnesses have been well-established by the research; the links to cancer are still emerging and preliminary findings vary depending on type of cancer.
Diabetes rates are significantly elevated among people with mental illnesses.
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Antipsychotic medications have been shown to significantly impact weight gain; obesity rates are up to 3. Conversely, people with diabetes have nearly twice the rate of diagnosed mental illnesses as those without diabetes. The biological impact of high blood sugar levels is also associated with the development of depression in people with diabetes. Left untreated, co-existing diabetes, poor mental health and mental illnesses can hinder self-care practices and increase blood sugar levels, contributing to worsening mental and physical health.
People with serious mental illnesses often experience high blood pressure and elevated levels of stress hormones and adrenaline which increase the heart rate.
Antipsychotic medication has also been linked with the development of an abnormal heart rhythm. These physical changes interfere with cardiovascular function and significantly elevate the risk of developing heart disease among people with mental illnesses. In Canada, women with depression are 80 percent more likely to experience heart disease than women without depression. Similarly, people with mental illnesses have up to a three times greater likelihood of having a stroke. Conversely, there are significantly elevated rates of depression among people with heart disease. It is three times more likely that a person with heart disease will experience depression when compared to people who do not have heart problems.
Co-existing heart disease and mental illness contribute to worse health status and higher health care utilization rates. Figure 1. Source: T. People with serious mental illnesses have a significantly increased likelihood of developing a range of chronic respiratory conditions including chronic obstructive pulmonary disease COPD , chronic bronchitis and asthma. People with mental illnesses have high smoking rates, due in part to historical acceptability of smoking in psychiatric institutions, the impact of nicotine on symptom control, and the positive social aspects of smoking.
Social factors such as poverty, unstable housing, unemployment and social exclusion may also impact upon both smoking rates and the development of respiratory conditions, but there has been little research on this topic among people with serious mental illnesses. People living with chronic respiratory diseases experience significantly elevated rates of anxiety and depression. People who experience asthma attacks similarly have a greater likelihood of experiencing anxiety and panic disorders. In addition, some asthma medications have been demonstrated to alter mood.
The research linking mental illness and cancer has yielded mixed results. Recent research has found significantly higher rates of cancer among people with schizophrenia than expected. Many studies have found decreased rates of respiratory cancers among people with serious mental illnesses; it has been suggested that this lower risk may be linked with past institutionalization which may have protected people from environmental risks.
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People living with cancers face a higher risk of developing depression, due in part to high levels of stress, emotional upset, and changes in body image. For example, older women with breast cancer and a diagnosis of depression were significantly less likely to receive optimal treatment. Research has consistently found a lower rate of arthritis in people with serious mental illnesses than the general population.
It has been previously suggested that schizophrenia may reduce the risk of developing arthritis due to genetics, the anti-inflammatory side effects of antipsychotic medications, and more sedentary lifestyles linked to institutionalization and illness. However, it has been argued that rates of arthritis may in fact be underreported in people with serious mental illnesses due to a reduced likelihood of reporting pain. By comparison, people with arthritis are at significantly elevated risk of developing mood and anxiety disorders.
People with serious mental illnesses face many barriers to accessing primary health care. These barriers are complex and range from the impact of poverty on the ability to afford transportation for medical appointments to systemic barriers related to the way that primary health care is currently provided in Ontario. For example, people with mental illnesses who live in precarious housing may not have an OHIP card due to the lack of a permanent address or a safe place to store identification.
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Some physicians may also be reluctant to take on new patients with complex needs or psychiatric diagnoses, due to short appointment times or lack of support from mental health specialists. The stigma associated with mental illness also continues to be a barrier to the diagnosis and treatment of chronic physical conditions in people with mental illnesses. Stigma acts as a barrier in multiple ways.
It can directly prevent people from accessing health care services, and negative past experiences can prevent people from seeking health care out of fear of discrimination. Furthermore, stigma can lead to a misdiagnosis of physical ailments as psychologically based. People with serious mental illnesses who have access to primary health care are less likely to receive preventive health checks. They also have decreased access to specialist care and lower rates of surgical treatments following diagnosis of a chronic physical condition.
The mental health of people with chronic physical conditions is also frequently overlooked. Diagnostic overshadowing can mask psychiatric complaints, particularly for the development of mild to moderate mental illnesses. Short appointment times are often not sufficient to discuss mental or emotional health for people with complex chronic health needs.
There are several initiatives in Ontario that can help to reduce barriers to health care. The Chronic Disease Prevention and Management Framework being implemented in Ontario has the potential to address the importance of emotional and mental health care for people living with a chronic physical condition.
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Collaborative mental health care initiatives such as shared care approaches are linking family physicians with mental health specialists and psychiatrists to provide support to primary health care providers serving people with mental illnesses and poor mental health. Some community mental health agencies have established primary health care programs to ensure their clients with serious mental illnesses are receiving preventive health care and assistance in managing co-existing chronic physical conditions. However, these initiatives currently lack sufficient infrastructure, incentives and momentum.
Seclusion and restraint also play a role in many interactions with law enforcement, where some estimate about half of those killed by police officers has a mental illness. MHA calls for the ultimate abolition of seclusion and restraint and encourages providers, teachers, law enforcement, and consumers to work together to plan alternatives and create cultures that do not use seclusion and restraint. People living with mental health conditions have the right to live and fully participate in their communities of choice.
From denying someone an apartment to kicking kids out of schools, discrimination against people living with mental health conditions often occurs in areas like housing, employment, and education. Community inclusion means not only addressing discriminatory practices that exist but also providing necessary supports that allow people to live and find meaningful roles in their communities.
In order to best serve the people they aim to help, services should be driven by wants and experiences of consumers to include things like peer support and self-help tools that fight isolation and promote recovery. To learn more about community inclusion, check out Community Inclusion After Olmstead. MHA calls for the following policy change:. People living with mental health conditions have the right to receive the services they want, how and where they want them, with full explanation of insurance benefits, treatment options, and side effects.
Insurance plans should provide a full explanation of services covered and implement mental health parity, which means providing coverage for mental health related services comparable to those offered for physical health services. This includes making sure people have choices in both services and providers with access to necessary and effective treatment options.
Informed consent and culturally and linguistically competent services empower people to make the best decisions for their health and well-being. To learn more about services issues, check out our Services Issues page. People living with mental health conditions have the right to privacy and to manage who can see their healthcare information. This includes controlling who sees their health information and the ability to access and supplement their mental health records.
Health plans and providers should provide information about privacy and confidentiality protocols. For example, many mental health professionals are required to report child abuse; therefore, an individual should know prior to engaging in treatment that any disclosure of child abuse may potentially result in a report to respective authorities. Information about privacy and information sharing should be given when a person joins a health plan or begins treatment with a new clinician and should be available on an ongoing basis, with the ability to withdraw, narrow, or otherwise modify terms of consent for what is to be shared.
To learn more about privacy, check out Standards for Management of and Access to Consumer Information. Mental Health Rights Breadcrumb Home. Mental Health Rights People living with mental health conditions are people. Liberty and Autonomy People living with mental health conditions have the right to make decisions about their lives, including their treatment. MHA urges states to create and enforce laws which permit persons with mental illnesses to designate in writing, while competent, what treatment they should receive should their decisional capacity be impaired at a later date.
There are a growing number of effective treatments for mental health conditions, including psychotropic medications. However, all medications pose some risks and many pose quite serious risks to the health of the persons who take them, particularly when medications are taken for extended periods to treat chronic illnesses.
For this reason and because of its commitment to the autonomy and dignity of persons with mental health conditions, MHA strongly agrees that all persons, even persons lawfully convicted and serving a sentence of imprisonment, have a right to refuse medication and that medication may not be imposed involuntarily unless rigorous standards and procedures are met. Coercion occurs during many so-called "voluntary" admissions. Z inermon v.
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Persons facing involuntary commitment are routinely offered the option of becoming voluntary patients. However, in many treatment facilities, a person who has been voluntarily admitted is not free to leave when she or he chooses. Rather, it is common for mental health laws to permit the facility to detain a person for up to one week after she indicates a desire to leave. MHA urges states to eliminate this form of admission and admit persons to mental health facilities in the same manner as persons are admitted to medical treatment facilities for non-psychiatric illnesses.
Seclusion and Restraint People living with mental health conditions have the right to be free from all abuses, including the practices of seclusion and restraint. Engaging consumers in this activity should take place immediately upon admission or at the next clinically appropriate time because a disproportionately large number of seclusion and restraint events take place in the first few days after a person is admitted to a psychiatric facility.
These trainings should take place when staff are first hired and continually at regular intervals. Only staff persons who have received this training should be involved in seclusion or restraint of consumers.
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To reduce and ultimately eliminate the use of seclusion and restraints, the federal government and the states should drastically improve the mechanisms currently available to monitor these activities and the harm caused by them to mental health consumers. As one step to improve monitoring of the use and abuse of seclusion and restraints, MHA calls on the states to publish on their websites data on the use of seclusion and restraints including the number of hours spent in restraint for each public facility and private facility contracting with the state as well as data on any injuries or deaths associated with the use of seclusion and restraint and diversion to correctional facilities.
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