How the St Vincent's declaration can help mental health clinicians HeAL the physical burden of disease in severe mental illness — ASN Events
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How the St Vincent's declaration can help mental health clinicians HeAL the physical burden of disease in severe mental illness (#308)

Jackie Curtis 1 2 , Philip Ward 2 , David Shiers 3 4 , Katherine Samaras 5 6
  1. Early Psychosis Program, Eastern Suburbs Mental Health Program, Bondi, NSW, Australia
  2. School of Psychiatry, University of New South Wales, Kensington, NSW, Australia
  3. National Audit of Schizophrenia, London, United Kingdom
  4. Guideline Development Group, NICE Guidance for adults with psychosis and schizophrenia, London, United Kingdom
  5. Diabetes and Metabolism Division, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
  6. Department of Endocrinology, St Vincent’s Hospital, Darlinghurst, NSW, Australia

The St Vincent's Declaration on diabetes care helped establish benchmarks of what we now take for granted as the standards of care in diabetes. The principles contained within the Declaration can be transported and applied equally well to another group who not only also experience high rates of diabetes, but suffer from a 20-year short fall in life expectancy, those with severe mental illnesses (SMI), such as schizophrenia and bipolar disorder. SMI is characterised by a disproportionate disease burden. Premature death is most frequently related to cardiovascular disease, to which diabetes and obesity are frequent accompaniments. The determinants of poor physical health in this patient group include poor nutrition, sedentariness, smoking, poorly treated or untreated diabetes and cardiovascular risk factors, reduced access to health care and lesser health care delivery at point of contact with medical services.

As part of an international consortium focusing on improving physical health in youth with mental illness (iphYs), the Healthy Active Lives (HeAL) Declaration highlights disparities in health care of people with SMI and advocates for standards of physical health care that are equal to the rest of the community. The St Vincent's Declaration was pivotal as a pre-existing model or template for determining appropriate care.

The HeAL Declaration will be discussed and highlights the five year target: that any young person developing psychosis should expect their risks for future physical health complications to be equivalent to their peers who have not experienced psychosis. In any regard, equivalent to a diagnosis of type 1 diabetes in a similarly aged young person.

Key principles include: primary health promotion for physical activity and healthy eating; measuring and maintaining satisfactory cardiometabolic measures and safe prescribing of antipsychotic medications.      

Partnerships and collaboration between psychiatry and diabetes health care professionals with their skill sets in complex disease management will help address and lessen the physical disease burden experienced by people with SMI.

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