Huge life expectancy gap and physical health inequalities in young people with psychosis addressed in declaration from Tokyo conference
Sydney Austrailia - To address the life expectancy gap and physical health inequalities experienced by young people with psychosis, global experts are announcing the Healthy Active Lives (HeAL) declaration at this year’s International Early Psychosis Conference in Tokyo, Japan. The international initiative is led by Dr David Shiers, retired GP and Advisor to the National Audit of Schizophrenia, UK and Dr Jackie Curtis, University of New South Wales, and South Eastern Sydney Local Health District (SESLHD) Sydney, NSW, Australia.
Compared to people of the same age who have not experienced psychosis, young people with psychosis face serious health inequalities resulting in a shortened lifespan of 15-20 years; a two- to threefold increased risk of cardiovascular disease makes this the leading cause of a potentially preventable early death (ahead of suicide); a two to three times increased risk of developing type 2 diabetes over their lifetime; a 3 to 4 times increased likelihood of being a smoker (with around 60% smoking at the time of diagnosis of psychosis); increased weight gain, low self esteem and reduced quality of life.
• Huge life expectancy gap and physical health inequalities in young people with psychosis addressed in declaration from Tokyo conference, also published in Lancet Psychiatry
• Small study shows potential of exercise and diet programme in improving the physical health of young people with psychosis
• Study underlines poor physical health of people treated for first episode psychosis and importance of using the safest interventions possible
Despite this, these physical health risk factors are often not detected, or adequately treated, even when they are apparent to the health provider. The Healthy Active Lives (HeAL) initiative, that aims to ‘Keep the Body in Mind’ in young people with psychosis, arose from the work of an international working group set up at a previous International Psychosis Conference in Amsterdam in 2010.
Dr Curtis says: “Our aims include actively confronting the perception that poor physical health is inevitable in people with psychosis, by encouraging professional attitudes that engender hope and optimism that young people experiencing psychosis can achieve healthy active lives.”
Dr Shiers says: “We want to ensure that positive physical health outcomes, such as smoking cessation, regular physical activity, a healthy diet and prevention of weight gain are as equally valued as mental health outcomes in achieving recovery.”
Part of the initiative is to reduce the complications of treatments for psychosis, for example by offering lower dose medication regimens, avoiding multiple drug prescriptions, and considering switching to antipsychotics with a lower risk of metabolic consequences such as weight gain.
HeAL has set 5-year targets to improve physical health in young people with psychosis, including that 90% of people experiencing a first episode of psychosis (FEP) have, within one month of starting treatment, a documented assessment including their risks of future obesity, diabetes and cardiovascular disease. Other aims include that three quarters of patients with FEP gain no more than 7% of their pre-illness weight, and maintain blood pressure, blood sugar and lipids within a normal range within two years of beginning antipsychotic treatment. To achieve these aims HeAL aims, within two years of the onset of psychosis, to offer 90% of patients with psychosis health promotion advice, reduce smoking prevalence to below 30%, and ensure more than half of patients engage in at least 150 minutes per week of moderate intensity physical exercise.
Dr Curtis concludes: “Achieving HeAL’s aspirations will require a commitment for change in the way we work together with young people who experience psychosis and their families and supporters, to empower them to enjoy healthy active lives as an essential part of the process of recovery.”