Mental Health in Scotland: Improving the Physical Health and Well Being of those Experiencing Mental Illness

Health Improvement - Key Policies and Evidence

Smoking Cessation

Around 25% (2005/6) of adults in Scotland smoke however, the prevalence is significantly higher among those with a mental illness.

Studies (in UK) have shown that 74% of people with schizophrenia spectrum and 70% of people with affective psychosis are smokers - a rate almost three times that of the general population. While people with mental illness are subject to the same smoking related diseases as everyone else, they are less likely however to be offered smoking cessation services and when they do, they may face additional challenges.

A study by ASH Scotland (2004) ⁵¹ sets out why these challenges exist. A further study in 2005 maps services specifically offering support for smoking cessation to people with mental illness. ⁵² References for these studies and key policies and guidance for the NHS and partners, ⁵³ are provided in Annex E.

The Scottish Government consultation, in early 2009, on achieving smoke-free mental health services was born out of a need to help to inform the Scottish Government's future action on reducing exposure to second-hand smoke in psychiatric hospitals and psychiatric units, and this in turn will contribute to tackling broader health inequalities.

Reducing or stopping smoking is likely to make the greatest impact on reducing morbidity and mortality. It is important that discriminatory beliefs do not prevent access to safe behavioral and pharmacological approaches to smoking cessation.

Weight Management and healthy eating

Most adults in Scotland are already overweight and the prediction is that by 2050 60% of men and 50% of women could be clinically obese.

It is now estimated that one in three deaths from cancer and one in three deaths from coronary heart disease ( CHD) are attributable to poor diet. Type 2 diabetes is 13 times more likely to occur in obese women than other women.

While data on BMI linked to mental health status are not known for Scotland, there is a general acceptance that the rates are higher both at the underweight and overweight/obese ends of the scale. Given the increasingly strong evidence that even a small weight loss (of 10% of body weight) can reduce risks and improve health, there is a need to encourage all steps toward change ⁵⁴.

Physical activity

Two thirds of adults in Scotland are relatively inactive, leading to twice the risk of dying from CHD compared to active people (independent of all other risk factors).

Physical activity also has a range of well evidenced benefits for mental wellbeing including improved physical self perception and self esteem, improved mood and reduced state and trait anxiety. Moderate activity also reduces physiological reactions to stress and can improve both the quality and quantity of sleep. ⁵⁵

Evidence now shows that short bouts of activity (for example 10 minutes of brisk walking three times a day) are as effective as a single 30 minute session and activity need not be vigorous to confer benefits.

Given the reduction in risk of CHD, diabetes and some cancers together with the improvement in wellbeing, increasing short bouts of moderate physical activity has much to offer.

Inequalities in Health

Equally Well: The Report of the Ministerial Task Force on Health Inequalities (June 2008) ⁵⁶ sets out the Scottish Government's commitment to reducing health inequalities in Scotland.

The report challenges public services to develop a more anticipatory and proactive approach to working with those whose health is at greatest risk and acknowledges that people with mental illness are at significantly increased risk of poor health outcomes.

While the report acknowledges the provision of universal health services including health promotion can be a gateway, it calls on local delivery agents to tailor and target services to ensure engagement and support for specific populations.

This general approach to health improvement (more proactive and tailored to those at greatest risk) now offers a significant opportunity to invest in health promotion services for people with mental ill health thereby increasing the likelihood of successful referral and engagement as part of the planned health checks.

Health Improvement Initiatives for People with Mental Health Problems

Although the evidence base for successful health improvement interventions for people with mental health problems is in its infancy, there is considerable expertise among allied health professionals, clinical and health psychologists, health improvement practitioners and others engaged in general health promotion, which could be tapped into to improve effectiveness.

As part of the response to perceived needs Health Scotland is:

(i) Undertaking a review of evidence based approaches to tailored and targeted interventions for smoking cessation support, weight management and physical activity tailored for people with mental health problems;

(ii) Undertaking to provide a suite of user and carer led health information for smoking cessation, weight management and physical activity again tailored for people with mental health problems; and

(iii) Working with NHS Education for Scotland to identify how this evidence and patient information support for consultations can be used to help build capacity and capability amongst the wider workforce in the delivery of health checks and the support provided as a consequence.