Mental health policy and practice across Europe: an overview

Tackling social exclusion 37
networks, compounding race or other discriminations, repeated rejection
and consequent restriction of hope and expectation.
(Sayce 2001: 122)
In this chapter we describe just four examples. A fifth example, on the situation
faced by asylum seekers and refugees, is discussed in Chapter 15.
An equal chance of life itself?
Around the world, people with some types of mental health problem or learning
disability are more likely to die prematurely even when compared with smokers.
One factor in this disparity appears to be a pattern of unequal access to health
promotion, prevention and treatment for both psychiatric and, particularly,
somatic illnesses. Or, more formally, they are excluded from consuming (accessing)
services that are available to others. Yet there is no significant attention
to health improvement for these at-risk groups comparable, say, to smoking
prevention/cessation programmes.
An international review (Harris and Barraclough 1998) of empirical evidence
on the ‘excess mortality’ associated with learning disability and mental health
problems found that – for natural causes (excluding suicide) – there is a significantly
raised risk of premature mortality for groups including:
• People with ‘mental retardation’ (learning disability): the mortality rate from
natural causes is 7.8 times higher than expected. By comparison, the mortality
rate from natural causes among smokers is only 2.5 times higher than
expected.
• People with schizophrenia – 1.4 times higher than the expected mortality
rate (it is higher in some countries; for instance, it is 2.5 times in Britain)
(Department of Health 1991).
• Other psychotic disorders – 2.4 times higher.
The type of diseases accounting for premature death include infectious,
circulatory, endocrine, respiratory, coronary heart disease (CHD), digestive and
genito-urinary illnesses. One study estimated that, for schizophrenia, these figures
translate, on average, into lives shortened by ten years for men and nine
years for women (Allebeck 1989). Another study looked into the reasons behind
a higher mortality rate due to ischaemic heart disease in Western Australian
psychiatric patients between 1980–98 (Lawrence et al. 2003). The conclusions
were diverse but included lower revascularization procedure rates in the psychiatric
population, particularly in those with psychoses. In Western Australia
these revascularization processes tend to be elective procedures through private
health insurance, with reduced access for those accessing the service through
Medicare (the Australian public health insurance scheme). Only 13 per cent of
people with psychosis had any private insurance compared with 32 per cent in
the general population. Other factors that explained the higher mortality rates
in the psychiatric population included more risky behaviours such as smoking,
for which rates were 43 per cent in the psychiatric service user population compared
with 24 per cent in the non-psychiatric population, with rates even