Physical health status affects the ongoing mental health and wellbeing of people with mental illness (Kisley & Goldberg 1997). Furthermore, mental illness has been shown to profoundly affect physical health status. A large study from Western Australia (Coghlan et al 2001b), revealed that death rates from all main causes were higher for people with mental illness and the overall death rate was 2.5 time higher than the general population of Western Australia.
People who have experienced mental illness can have compromised physical health for a number of reasons. They are less likely to receive appropriate health care compared with those without mental illness, and it is an indictment of our mental health care system that people who have been involved with mental health services have often had their physical health needs overlooked. Furthermore, behavioural factors such as smoking, harmful alcohol and other drug use, obesity, poor diet, inadequate living situations (such as homelessness), and poor self-care as a consequence of illness symptoms, can make people with mental illness vulnerable to physical health problems.
In contrast, being in good physical health, sleeping well, eating well, exercising, and avoiding harmful alcohol and other drug use are important for maintaining wellbeing. In the consultations, many consumers mentioned the importance of "getting the basics right" to prevent relapse, by which they meant the fundamental sources of wellbeing in terms of sleep, nutrition, physical fitness, and access to physical health care. These are things that are fundamental to the wellbeing of all people, but assume greater significance for people who are more vulnerable to mental health problems because they have previously experienced an episode of mental illness. Notably, good sleep patterns are very important for wellbeing, and disruption to sleep is often one of the first signs of relapse (Birchwood et al 2000).
I know I've got to go back and get the basics right. I've got to sort out sleeping first, and make sure I eat, get back into some walking. It's so easy to let things slip, but it's so important for me. I have to stay on top of these things. —Consumer
A growing body of research shows that exercise is protective of mental health, particularly in relation to alleviating depression (Hutchinson, Skrinar & Cross 1999; Tkachuk & Martin 1999). Many of the consumers in the consultations mentioned the unique benefit of exercise for staying well and of the need to increase their level of exercise when they noticed early warning signs. Exercise can benefit in at least two ways: by increasing the production of neurotransmitters that improve mood and as a form of distraction.
I need to make sure that I have my walk every day: if I stop doing that I start to become unwell. —Consumer
The role of nutrition in relapse is not well understood, but good nutrition is likely to be protective. For example, there is strong evidence that improving nutrition in socially disadvantaged children has positive physical and mental health consequences . Moreover, poor nutrition is a risk factor for many physical health problems, which in turn, can exacerbate mental health problems.
Ensuring access to physical health care is also imperative. Many of the more disadvantaged people with mental illness, particularly those who are homeless, do not have access to general health care and routine health checkups, and this can be detrimental to their physical and mental wellbeing. Dental care is also often lacking and this can be a factor that contributes to social exclusion.
The impact of physical health on mental health requires considerably greater recognition than it currently receives. Of special significance is obstetric care for women, as pregnancy can increase vulnerability to a range of risk factors, and the postpartum period has clearly been identified as a time of increased risk for relapse of schizophrenia and bipolar illness (Altshuler et al 1996, Leibenluft 1996). People who have previously experienced mental illness need their potentially increased vulnerability to physical health problems and procedures identified and sensitively responded to so that physical health issues do not precipitate mental health problems, and vice versa.
I have to have an operation on my knee soon and I know that the anaesthetic will make me unwell again. The last time I had an anaesthetic I was in the psych ward for months. I know that will happen again, but no-one will listen. No-one is interested on the effects for my mental self. I guess their take is that if I get psychotic after the operation then that's not their problem and the psych services will deal with it if it happens. They don't care, it's not their problem, but I know what's going to happen and I don't want the operation and to go through it all and so much. I just want someone to realise what is going to happen and to stop it now. —Consumer