It's not just suicide: the hidden causes behind the early deaths of people with mental illness
New NHS data shows people with severe mental illness are dying 15 to 20 years earlier than everyone else. Most of these deaths are from preventable physical illness.
When we talk about early death in mental illness, suicide is usually the first thing people think of. It matters enormously, and the risk is real. The Rethink Mental Illness analysis reported this week found that people with serious mental ill health are 14.6 times as likely to die by suicide as those who were not referred. But suicide accounted for 7% of these early deaths, while cancer, cardiovascular, liver and respiratory disease together accounted for more than half (56.5%).
This is the part of the story that gets far less attention, and the one where better care could save the most lives.
What the research found
Rethink analysed NHS data and found that people with severe mental health problems die 15-20 years earlier than the wider adult population, largely due to preventable physical conditions. The analysis defined serious mental ill health as being referred to specialist secondary mental health services. Overall, this group is 4.8 times more likely to die before the age of 75.
The excess risk differs by condition. For adults under 75, it is 6.3 times higher for liver disease, 6 times higher for respiratory illness, 3.8 times higher for cardiovascular disease and 2.3 times higher for cancer.
Why is this happening?
There isn't a single cause. The report points to poverty, poor housing, higher rates of smoking, weight gain from medication, physical inactivity and fragmented care. Bhnet
It also highlights diagnostic overshadowing, which is where physical symptoms are wrongly attributed to mental illness, so potential illnesses are not always properly investigated and treated. Chest pain, fatigue, weight loss or breathlessness can be dismissed as anxiety, low mood or "part of your condition". Sometimes they are. Sometimes they aren't, and the delay costs lives.
Why this matters to us as a psychiatric service
Psychiatry can't treat the mind in isolation. The same illness that affects mood or thinking can make it harder to book appointments, attend screening, describe symptoms or be believed. Some of the medicines we prescribe, including some antipsychotics and mood stabilisers, can affect weight, blood sugar and cholesterol. That is a good reason to monitor carefully and talk openly about it, and it is not a reason to avoid effective treatment.
A few principles we think should be standard:
Physical health is part of every mental health review. Weight, blood pressure, bloods, smoking and alcohol, sleep and activity all belong in the conversation.
Medication decisions consider the whole person. Benefits and side effects should be discussed together, and metabolic monitoring should actually happen.
New physical symptoms get investigated. A psychiatric diagnosis should never close the door on a physical work-up.
Care should be joined up. Clear communication between psychiatry, GPs and other services stops people falling through the gaps.
Beyond severe mental illness
The Rethink figures concern people under specialist secondary care, but diagnostic overshadowing isn't limited to them. People with ADHD, autism, OCD and other conditions, especially women and adults who have been underdiagnosed for years, often describe having real physical symptoms explained away. The lesson applies widely: listen carefully, and don't assume every symptom is psychiatric.
What now?
The findings come just before the government's independent review of mental health, autism and ADHD, which is expected to be published this week and to recommend a more holistic approach to supporting patients with these conditions. We hope it leads to real change in how physical and mental healthcare work together, particularly in rural areas like Cornwall where distance and limited services already make access harder.
If you are living with a mental health condition, you deserve the same standard of physical healthcare as everyone else. Ask for a health check, mention new symptoms even if you think they're "just your mental health", and ask your prescriber about monitoring for any medication you take. If you're a carer or family member, you can raise these questions too.
If you're struggling right now, Samaritans are available free on 116 123, day or night. If you'd like help finding the right support, we're happy to point you in the right direction.
Source: Rethink Mental Illness analysis of NHS data, as reported by the Guardian.
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