This blog was written by Lia Ali with help from Roman Duncko, Jane Hutton, Faith Matcham and Anna Simpson.

These people are all involved in the IMPARTS project, which is an initiative funded by King’s Health Partners to integrate mental and physical healthcare in research, training and clinical services at Guy’s, St Thomas’s and King’s College Hospitals, as well as South London and Maudsley NHS Foundation Trust.

You can find out more about IMPARTS on the KCL website.

WeNurses Tweet Chat: 28/5/15

@WeNurses @IMPARTSP Let’s not give lip service to holistic care for mind, body & spirit. Let’s make it a reality. #wenurses

— Andrea Shaw (@annedraya) May 28, 2015

On Thursday 28^th May 2015 we conducted an experiment on you. We (the @IMPARTSP team) hosted a twitter chat as guests of @wenurses.  The quote above was made by a participant at the end of an inspiring hour. The topic was ‘Joining the dots: mental & physical health’ and it built on a course that we run at Kings Health Partners, training staff in mental health skills. This is part of the IMPARTS project (Hotopf et al, 2012) which aims to address the issue of whole person care.

This year on the course, we discussed a paper by Elizabeth Reisinger Walker et al. (2015) which looked at mortality in mental disorders. One of their most shocking findings was that people with mental health conditions can lose 10 or more years of their lives compared to the average person in the population. This is sometimes referred to as the ‘stolen years’.

Its vital that we all have the confidence to appraise papers like these, so that we know whether we can trust the shocking headlines that they generate. On our course we helped our students to do this using the CASP critical appraisal checklists.

In this blog, we want to share our experience and give you some of the insights arising from the face to face discussions on the course and the twitter chat. Most of all, we want to hear from you on the impact of findings like this on your lives, your practice and your everyday actions.

Workers in mental health have long suspected that sufferers of mental illness seem to die much earlier than the average person in the population. Causes of death can include heart disease, infections and a multitude of chronic conditions, as well as suicide (Whiteford et al, 2010).

However, although studies of mortality in mental disorder exist, there had not been a comprehensive review of their findings that included statistical analyses of the results in a grouped way. This approach is called a meta-analysis and is a powerful way of gaining insights on a topic from several sources.

Methods

The authors first searched a number of databases, using search terms for mental disorders, specific diagnoses and mortality.

They then used previously defined criteria to find studies of interest. These were:

• English-language cohort studies (A ‘cohort study’ has a longitudinal design in which a group of people are selected and then studied over a period of time to see how the exposure (in this case mental disorder) is related to an outcome (mortality))
• Reported mortality estimates for people with mental disorders
• Studies in which a comparison was made either to the general population or to controls from the same setting as the study.

Data was then abstracted, pooled and statistically analysed using methods designed to look at data from multiple sources (Der Simonian and Laird, 1986) and that also addressed the differences that might exist between studies (heterogeneity).

Results

The main findings were:

1. People with a mental disorder had just over twice the risk of mortality compared to those without a mental disorder. For all-cause mortality, the pooled relative risk of mortality among those with mental disorders (from 148 studies) was 2.22 (95% CI, 2.12 to 2.33)
2. The median years of potential life lost was 10 years (derived from 24 studies)
3. They estimate that 14.3% of deaths in the whole world (or 8 million deaths each year) can be attributed to mental disorders. That’s equivalent to the entire population of a country the size of Switzerland.

Strengths and limitations

These results suggest that mental disorders are amongst the most substantial causes of death in the world. But did we believe these remarkable findings?

On the IMPARTS course we used the CASP guidance to help us make a judgment and determine whether the results of the review are valid. Overall, the results do seem to be valid: a clear question had been set and answered using an established methodology. However, some diagnoses (e.g. dementia) were excluded from the search and it wasn’t entirely clear why. Also, although all the databases we would expect to be searched were included, we couldn’t see any evidence that they had contacted researchers to ask for missed papers. However, they did include analyses designed to look for biases in study selection.

Key strengths of this study include use of robust methodology and a comprehensive approach in terms of reach: 203 studies from 29 countries, spanning 6 continents. This suggests that the findings can be generalised to a number of settings because the data comes from a range of geographical locations and settings (in-patient, community etc.). The only caveat is that it might not be so applicable to people with categories of mental disorder that were excluded e.g. substance misuse and dementia.

Student reaction

The reaction of our students to this paper was profound. Most people were shocked that ‘just’ having a mental illness could mean that a person had so much of their life taken away. We spent time reflecting on people the students had cared for and increased our collective understanding of how mental and physical factors interact.

For example, one nurse recalled a ‘frequent attender’ from early in her career; someone who used illicit drugs and also had depression and multiple physical health needs. This nurse said she wished she had understood more about the mental disorder, as that might have given her the confidence to address that patient’s needs more holistically, even in those brief moments of interaction.

We practiced skills, with role play actors, to build just this kind of confidence, and signposted students to resources that they might use for guidance with their patients (see the list of IMPARTS resources in the links below).

Twitter chat

The Twitter chat brought up themes around confidence and time to engage with mental health issues. The importance that mental health should have in nursing studies curricula was also debated. People needed little convincing that this was an important issue but not everyone had appreciated the scale of the problem.

Students and tweeters came up with many ways in which they are already addressing this health inequality, such as using online resources and setting up large scale buddying or ward twinning projects.

It seems as if people are doing a lot more than paying lip service to whole person care. In fact there is a lot of ‘dot-joining’ going on. Now we want to hear more about it, so please do comment on this blog if you have thoughts or experiences to share. You can also post stuff on the IMPARTS Twitter page or by emailing us directly.

If you need help

If you need help and support now and you live in the UK or the Republic of Ireland, please call the Samaritans on 116 123.

If you live elsewhere, we recommend finding a local Crisis Centre on the IASP website.

We also highly recommend that you visit the Connecting with People: Staying Safe resource.

Links

Primary paper

Reisinger Walker E, McGee RE, Druss BG. (2015) Mortality in Mental Disorders 
and Global Disease Burden Implications: A Systematic Review and Meta-analysis.  JAMA Psychiatry. 2015;72(4):334-341. doi:10.1001/jamapsychiatry.2014.2502. [PubMed abstract]

Other References

Joining The Dots: Mental & Physical Health. #WeNurses tweet chat – Thursday 28th May 2015.

Hotopf M, Rayner L and Valsraj K (2012) Improving ‘Whole Person Care’ – A report on mental health related services offered by King’s Health Partners’ acute trusts.

CASP critical appraisal checklists. Critical Appraisal Skills Programme website, last accessed 22 Jul 2015.

Colton CW, Manderscheid RW. (2006) Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Prev Chronic Dis. 2006;3(2):A42.

Whiteford HA, Degenhardt L, RehmJ, Baxter AJ, Ferrari AJ, Erskine HE, Charlson FJ, Norman RE, Flaxman AD, Johns N, Burstein R, Murray C and Vos T (2013) Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study. Lancet. 2013;382 (9904):1575-1586. [Abstract]

Harris RJ, Bradburn MJ, Deeks JJ, Harbord RM, Altman DG, Sterne JAC. (2008) Meta-analysis: fixed- and random-effects meta-analysis (PDF). Stata J. 2008;8(1): 3-28.

Matcham et al. (2014) Self-help interventions for symptoms of depression, anxiety and psychological distress in patients with physical illnesses: A systematic review and meta-analysis (PDF). Clinical Psychology Review 34 (2014) 141–157.

Rayner et al. (2014) Embedding integrated mental health assessment and management in general hospital settings: feasibility, acceptability and the prevalence of common mental disorder (PDF). General Hospital Psychiatry 2014, 36(3), 318-324.

Resources from the IMPARTS website:

• Self-help materials
• Publications
• Module info
• IMPARTS video
• Newsletters
• Contact duncko@kcl.ac.uk for more information

We are currently producing a set of videos about this work, which will be linked to from this page as soon as they are available.