Management of physical health conditions in adults with severe mental disorders

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Eduardo Garcia-Toledano

World Rare Disorders Foundation & Childhood Cancer Foundation, Spain

: J Spine Neurosurg

Abstract

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The global burden of disease due to mental disorders continues to rise, especially in Low- and Middle-Income Countries (LMIC). In addition to cause a large proportion of morbidity, mental disorders, especially Severe Mental Disorders (SMD) are linked with poorer health outcomes and increased mortality. SMD are defined as a group of conditions that include moderate to severe depression, bipolar disorder and schizophrenia and other psychotic disorders. People with SMD have two to three times higher average mortality compared to the general population, which translates to a 10-20-year reduction in life expectancy. While people with SMD do have higher rates of death due to unnatural causes (accidents, homicide or suicide) than the general population, most deaths amongst people with SMD are attributable to physical health conditions, both non-communicable and communicable. Furthermore, people with SMD are more likely to engage in lifestyle behaviors that constitute risk factors for Non-Communicable Diseases (NCDs) such as tobacco consumption, physical inactivity and consuming unhealthy diets. Most studies reporting the excess mortality in people with SMD are from high income countries. The situation may be much worse in LMIC where the resources are inadequate, the institutions are not well managed and access to quality mental health care and physical care is limited. Equitable access to comprehensive health services remains out of reach for most people with SMD. Unfortunately, people with SMD often lack access to health services or receive poor quality care, including promotion and prevention, screening, and treatment. It is crucial to address the disparities in health care access and provision for people with SMD. Following the principle of non-discrimination and universal health coverage as elaborated in Target 3.4 of the United Nations Sustainable Development Goals by 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote of mental health and well-being, people with SMD should be offered at least the same level of treatment for physical health conditions and their risk factors as the general population. The WHO Comprehensive Mental Health Action Plan (2013-2020) outlines a vision where people living with mental disorders can exercise the full range of human rights and to access high quality, culturally-appropriate health and social care in a timely way to promote recovery. In service of this vision and as part of WHO’s mental health Gap Action Program (mhGAP), these guidelines on the management of physical health conditions in adults with severe mental disorders will provide up-to-date, evidence-based recommendations to support the scale-up of care for physical health conditions and their risk factors affecting people living with SMD globally. Accordingly, the objective of these guidelines is to improve the management of physical health conditions in adults with SMD and support the reduction of individual health behaviors constituting risk factors for these illnesses, with the aim of decreasing morbidity and premature mortality amongst people with SMD. Existing WHO guidelines for the general population are relevant to the physical health conditions that increase the morbidity and mortality for people with SMD, for example, the Package of Essential Non-communicable (PEN) disease interventions for primary health care in low-resource.

Biography

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Eduardo García-Toledano is currently working as a Vice President and General Counsel of Global Health, Madrid, Spain. He is heading up the group responsible for the foundation's external liaison with all stakeholders working to support the availability of treatments for childhood cancer and rare diseases on behalf of the company. He has worked on programs for the Spanish Government Ministry of Health, social services and equality. His career has been focused on patient care and case management for patients with chronic and rare diseases, working with laboratories and orphan drugs helping people who need help and are suffering from rare and chronic diseases.

E-mail: toledanoeg@gmail.com