**8. The physical health of people suffering from severe mental illness**

There is a significant amount of information that people who suffer from serious mental illness also are at increased risk of increased morbidity and premature mortality from comorbid medical illness. Viron & Stern (2010) talk of patients suffering from severe mental illness losing over 25 years of potential life with 87% of years of potential life lost being attributable to medical illness. They further comment that the mortality gap, based on data from 1997 to 2000 is 10 to 15 years wider than it was in the early 1990's. Observations at the beginning of the twentieth century noted that physical morbidity and mortality were greater amongst psychiatric patients than in the general population. Other commentators have noted the lack of thorough medical evaluation and inadequate treatment of medical disorders amongst psychiatric patients (Felker B et al 1996) . The issue of co-morbid medical conditions is particularly prominent in patients suffering from schizophrenia. This is not surprising given the social isolation, problems with adequate housing and the lack of organisation of proper meals and poor diet reported for this group of patients (Jablensky et al 2006, Brown et al 1999). High rates of tobacco and other substance use in this group also add to the disease burden (Jeste et al 1996).

Apart from the obvious issues of significant disability related to the illness process itself, there also appear to be a number of medical and health system barriers to recognition and management of medical illness in people with schizophrenia. Such barriers include a reluctance of non-psychiatrists to treat people with serious mental illness, frequent changes of treating doctor, lack of adequate follow up due to patients' itinerancy and lack of motivation and the available time and resources for an appropriate review of medical issues of people who may be uncooperative or have trouble communicating their physical needs (Lambert et al 2003). Higher rates of poverty in those experiencing severe mental illness (d'Amore et al 2001) along with stigma related to the experience of mental illness (Barney et al 2006) may also be further barriers patients with mental illness developing an effective relationship with a General Practitioner. The atypical antipsychotic medications may also lead to an increased prevalence of endocrine disorders such as Type 2 Diabetes (Lambert & Chapman 2004), thus necessitating increased medical vigilance in this regard.

As a way of attempting to improve the co-ordination of the care of medical illness in those patients with serious mental illness, there has been a significant stimulus to develop shared care models between psychiatric specialists and general practitioners. Such models include a Consultation-Liaison model (Gask et al 1997), collaborative case discussions between specialist psychiatrists and groups of General Practitioners (Davies et al 1997) and shared care projects with extensive education for involved General Practitioners (Meadows 1998). There have also been substantive improvements in remuneration for shared care in Australia with the Medicare Plus program encouraging a collaborative care mode.

The General Practice Clinic operated within a mental health service (Symonds & Parker 2007) compensates for a number of the barriers to health engagement discussed above and allows for a high quality of health care with extended clinical review times and health screening significantly above the Australian national average. Other recommendations for improved health care for people suffering from severe mental illness are: improved health screening and health promotion along with systemic models of medical and mental health care integration such as the VHA system in the USA (Viron & Stern 2010). Increased awareness by psychiatrists of the metabolic effects of psychotropic medication along with improved information to carers of people affected by severe mental illness in respect to appropriate medical care (De Hert et al 2010). Better co-ordination of a range of specialist services such as occupational therapists, pharmacists and dieticians in respect to the medical health care of people affected by severe mental illness may also be useful (Heald et al 2010).
