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New study shows people with mental health problems receive inadequate medical care

Review led by Leicester psychiatrist raises concern over treatment of patients with past mental health issues

Issued on 02 June 2009

New research led by the University of Leicester and published this week in the British Journal of Psychiatry reveals that people with mental health problems are receiving inferior care for their medical needs.

The study by a team of researchers led by Dr Alex Mitchell from the University of Leicester Department of Cancer Studies and Molecular Medicine, warns that medical care delivered across most branches of medicine to those with a mental health or substance abuse diagnosis is of inferior quality to the usual standard of care. This important systematic review showed widespread inequalities of care in those with mental health problems.

Dr Mitchell said: “We wished to investigate whether the quality of medical care received by people with mental health conditions, including substance misuse, differs from the care received by people who have no comparable mental disorder.

“We found that despite similar or actually more frequent medical contacts, there are often disparities in the physical healthcare delivered to those with psychiatric illness with frankly poorer care offered to (or accepted by) those with pre-existing mental health problems.”

The research was based on analysing 31 valid studies (see notes to editors). Dr Mitchell said: “I work in liaison psychiatry and regularly see people who have received what they report as poor treatment by virtue of their mental illness. Often there is a temptation for clinicians to attribute any physical symptom to the psychiatric diagnosis without necessarily assessing the person thoroughly.”

“Perhaps most surprising, our study found that inferior quality medical care did not depend on the presence of current psychiatric symptoms but rather was delivered to anyone with a previous or current mental health diagnosis.”

“If poor quality of care is associated with a mental health diagnosis it could be because poor care is delivered by medical staff or perhaps that reduced care is taken up by those patients themselves. In fact we found in general more care was taken up (the quantity was the same or higher) but its nature was insufficient (poor quality).”

Dr Mitchell, who is also part of the Department of Liaison Psychiatry, Leicester General Hospital, carried out the study with Darren Malone of Lakes District Health Board, New Zealand, and Department of Health Sciences, University of Leicester and Caroline Carney Doebbeling, of the Department of Internal Medicine, Indiana University School of Medicine, Regenstrief Institute, Indianapolis.

Dr Mitchell said that the research raised important questions: “We need to understand if doctors working in medical specialties treat those with mental health problems differently just because of their mental health labels. We also need to know more about whether poor quality of care effects outcomes such as mortality. Mortality has been linked with several mental health problems and inferior care could be one explanation for this.

“The key message of the research is that people with mental health diagnoses should receive comprehensive medical care of at least equal quality to the current standard. Indeed there is a case for believing that those with previous mental health problems might be at high risk of medical complications such as diabetes, cardiovascular and lipid disorders therefore medical care might be appropriately enhanced in this group.”

• There is a campaign from the Royal college of Psychiatrists linked with this paper

http://www.rcpsych.ac.uk/campaigns/fairdeal/whatisfairdeal/linkingphysicalandmh.aspx

and

http://www.rcpsych.ac.uk/pdf/Fair%20Deal%20Manifesto%20-%20Linking%20mental%20and%20physical%20healthx.pdf

The paper is available at: http://bjp.rcpsych.org/cgi/content/abstract/194/6/491

Notes to editors:

Abtract:

We wished to investigate whether the quality of medical care received by people with mental health conditions, including substance misuse, differs from the care received by people who have no comparable mental disorder. We identified 31 valid studies, 27 examined receipt of medical care in those with and without mental illness and 10 examined medical care in those with and without substance use disorder (or dual diagnosis). Nineteen of 27 and 10 of 10, respectively, suggested inferior quality of care in at least one domain. Twelve studies found no appreciable differences in care or failed to detect a difference in at least one key area, several studies showed an increase in healthcare utilisation but without any increase in quality and only three studies found superior care for individuals with mental illness in specific subdomains. Thus despite similar or actually more frequent medical contacts, there are often disparities in the physical healthcare delivered to those with psychiatric illness with frankly poorer care offered to (or accepted by) those with pre-existing mental health problems.

For more information please contact Dr Mitchell on 0116 2256218 or ajm80@le.ac.uk

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