The agenda of the Equally Well campaign is to enhance monitoring of the physical health of the mentally ill people through measuring care accessibility and their experiences in the healthcare services. The mentally ill Australians experience various barriers when accessing healthcare services compared to those with psychological health problems. According to Roberts et al. (2018), although the Equally Well campaign has greatly tried to address some of these factors, more work should be done to address numerous determinants of health and change the societal perception about people living with mental illnesses.
Barriers to quality care among people with mental health problems can be divided into system-level factors, provider factors, and patient-related issues (Lawrence & Kisely, 2010). Systemic factors contributing to inequality in care access among the mentally ill people include geographic issues, resource and managerial and resource separation of mental and physical healthcare facilities, unavailability of clarity on who is responsible for the mentally ill people’s health, lack of integration between psychiatry and medicine, inadequate community care and fragmentation of care among providers. The provider-related factors include limited care access among this population, including stigmatization, resource and time challenges, and the potential to treat physical complaints as psychosomatic symptoms. Patient-related issues involve cognitive impairment, social isolation, limited support from family, minimal pain sensitivity, difficulties in expressing health needs, and fear.
Australians with psychological health problems have more difficulty receiving the crucial care services they need. People with mental conditions are 10% more unlikely to access healthcare services compared to those without mental health issues (Lawrence & Kisely, 2010). Affordability is the greatest barrier to care access. Due to limited ability to negotiate for the care cost, this group is likely to pay more for care services. There is a disparity in the respect demonstrated by the nursing staff toward patients living with psychological conditions. The fear of the disrespect acts as a barrier to seeking care services among patients with psychological health conditions. Compared to the general population, Australians with mental problems face extra problems when negotiating with the healthcare system, affecting their access to health services.
Kilbourne et al. (2018) reveal stigmatization of people with mental health conditions as common in the health sector. Nobody likes being stigmatized, and people would always avoid going to places where others may feel uncomfortable while in their midst. This is what happens with most patients with mental health conditions, especially those who have experienced the medical staff’s stigmatization in their previous hospital visits. Healthcare professionals tend to see them being disruptive or difficult as individual characteristics rather than a symptom of mental illness and therefore perceive such patients to be difficult. Patients with mental illnesses are not given full attention during care, encouraging hopelessness and low expectation from the care services, which affects an individual’s willingness to disclose symptoms of a certain health problem.
People with mental illness are unlikely to have an existing good relationship with a regular care professional at a local community facility. Psychological problems impair the patients’ cognitive ability to recognize symptoms of a particular physical health problem, limiting their motivation to seek health advice. People with problems like agitation and anxiety may have some challenges dealing with busy care professionals, as one is supposed to wait for their appointments during care, which sometimes may be challenging for such patients who may decide to leave before the appointment as a way to cope with their condition, however, healthcare professionals may translate it as being uncooperative, and disrespecting, leading to the poor patient-physician relationship, therefore lack of motivation to establish long term contact and friendship.
Studies demonstrate that healthcare professionals are poor at determining and treating physical health symptoms in people with psychological health diseases (Brämberg et al., 2018). This happens because physical health complaints may happen as part of a psychiatric condition, and some care professionals would neglect the physical assessment of mentally ill patients, assuming the complained about symptom is psychological. Moreover, mental health illness may render psychiatric patients unlikely to communicate their physical needs, therefore making it hard to receive the deserving quality care.
Until the Equally Well campaign is able to address these barriers causing barriers among the mentally ill when accessing care services, the campaign is not enough. The campaign needs to get into the root of these barriers to identify the underlying factors behind each determiner of health and find a permanent solution to the causes. Some of the issues causing limiting the access of care among the population members are complex, and to have them fully resolved, the campaign should focus on such factors separately, for instance, systemic, provider-related, and patient-related barriers to developing suitable interventions for each.
Factors for Poor Physical Health
According to Firth et al. (2019), psychological health and physical health are significantly related; for instance, those with severe mental problems are vulnerable to experiencing a broad range of chronic physical health problems. Co-existing physical and mental problems may reduce the quality of life and result in prolonged sickness with worse health outcomes. People living with mental health problems experience a wide range of physical symptoms that come from both the problem itself and the effect of treatment. Psychological disorders can alter sleep cycles and hormonal balances, while various psychiatric drugs have side effects, including weight gains and irregular heart rhythms that are key risk factors for different chronic physical diseases, therefore exposing this population to serious physical health problems. Moreover, the way individuals experience mental illnesses can increase their risk of developing poor physical health. Mental diseases affect the cognitive and social function and reduce energy levels, which negatively affects health behaviors. The mentally ill are less motivated to take care of their own health and likely to adopt unhealthy sleeping and eating habit, abuse substances, or smoke as a way of responding to symptoms of their mental conditions, therefore leading to poor health outcomes.
According to Daniel et al. (2018), individuals living with mental health problems experience higher poverty and unemployment rates, social isolation, and lack of stable housing. These social determiners of health increase their vulnerability to developing chronic physical problems. For instance, poor people cannot afford healthier food alternatives and often go for the cheaper, unhealthy food options, which expose them to nutritional deficiencies. Additionally, it can be hard to engage in physical activity when living in unsafe housing or neighborhoods due to a lack of income to afford safe housing.
Psychological and physical diseases share various symptoms, including decreased energy levels and food cravings, increasing consumption of food, reducing physical activity, and resulting in weight gains. Such factors enhance the vulnerability of developing chronic physical problems. Excessive eating with reduced physical activity leads to obesity, which is a critical risk factor for many chronic diseases, including cardiovascular, diabetes, cancer, and stroke. Mentally ill people are likely to develop some physical problems, including heart disease, diabetes, and respiratory problems. Firth et al. (2019) reveal that symptoms of most mental illnesses like anxiety and depression are key risk factors for most chronic diseases.
Compared to the general population, individuals with mental disorders, including schizophrenia, are likely to have lifestyle risk factors for mortality and cardiovascular diseases (Daniel et al., 2018). This population is more likely to smoke compared to the general public. Tobacco cost renders most of the mentally ill poorer economically, worsening their physical health outcomes. Depressed people tend to smoke more than the general population, therefore exposing them to different tobacco-related complications, including cancer. Because of an unhealthy lifestyle, people with mental health conditions are likely to have increased intake of fat-rich diets and lower fiber intake compared to the general population.
Psychotropic medication is linked with numerous side effects and physical complications. Antipsychotic medication can particularly induce neurologic effects, such as tardive dyskinesia, endocrinologic effects like galactorrhea, and cardiovascular effects such as lengthening of the QT interval side effects. Although new antipsychotic agents are not toxic, they can worsen physical health outcomes (Daniel et al., 2018). Using such medication increases the vulnerability of mentally ill people for poor physical health status compared to those not taking such medications.
Although the Equally Well recognizes the role of social determinants of health on equal health outcomes for all, the campaign cannot guarantee fair care access to all without extra commitment to solve various underlying social disparities and promote healthy living environments on societal dimensions. Prioritizing factors like employment, education, and safe housing among the mentally ill population can be key to equal health outcomes among populations. The Equally Well campaigns need to be grounded on addressing the identified problems using evidence-based interventions; without that, achieving a recognizable positive change would be difficult.
Nutrition, Exercise-Based Interventions, and Pharmacological Treatments
People living with mental conditions have poor nutrition than those without such conditions, which may contribute to dyslipidemia, obesity, and impaired glucose regulation, increasing the risk for heart diseases. Studies demonstrate that nutrition interventions improve weight management among people living with a mental condition reduce blood glucose levels and waist circumference (Ilyas et al., 2017). Physical exercise among individuals with psychological health diseases like schizophrenia improves their physical fitness, which is associated with a decrease in psychiatric symptoms. However, reduced motivation to participate in physical activity programs makes it hard for mentally ill people to participate in physical activity programs.
Providing people living with mental conditions with lifestyle guidance is key to empowering them to address various challenges associated with the illness to increase their adherence to the right diet and physical activity. The Equally Well campaign should invest in physical exercise interventions, coaching, and educational sessions to enhance the uptake of people living with psychological problems in such programs. Studies suggest that advice on the physical activity programs is not solely enough to encourage more participation, and a more assertive approach is required. Pharmaceutical treatments are necessary to reduce psychological health symptoms among people with mental illnesses. Mental illness symptoms result from chemical imbalances in the brain. The pharmaceutical medication regulates these chemical imbalances and reduces the symptoms or relieves the pain completely.
Conclusively, the Equally Well initiative is critical to improving people’s well-being and physical health with psychological health conditions in Australia. However, the initiative needs to increase its effort to address numerous health determinants that limit care access and result in general health disparity. The initiative should increase its commitment to change the societal perception about the mentally ill and encourage equal treatment in the care setting by addressing provider and associated systemic factors.
Brämberg, E. B., Torgerson, J., Kjellström, A. N., Welin, P., & Rusner, M. (2018). Access to primary and specialized somatic health care for persons with severe mental illness: a qualitative study of perceived barriers and facilitators in Swedish health care. BMC family practice, 19(1), 1-11.
Daniel, H., Bornstein, S. S., & Kane, G. C. (2018). Addressing social determinants to improve patient care and promote health equity: an American College of Physicians position paper. Annals of internal medicine, 168(8), 577-578.
Firth, J., Siddiqi, N., Koyanagi, A., Siskind, D., Rosenbaum, S., Galletly, C., … & Stubbs, B. (2019). The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness. The Lancet Psychiatry, 6(8), 675-712.
Ilyas, A., Chesney, E., & Patel, R. (2017). Improving life expectancy in people with serious mental illness: should we place more emphasis on primary prevention?. The British journal of psychiatry, 211(4), 194-197.
Kilbourne, A. M., Beck, K., Spaeth‐Rublee, B., Ramanuj, P., O’Brien, R. W., Tomoyasu, N., & Pincus, H. A. (2018). Measuring and improving the quality of mental health care: a global perspective. World psychiatry, 17(1), 30-38.
Lawrence, D., & Kisely, S. (2010). Inequalities in healthcare provision for people with severe mental illness. Journal of psychopharmacology, 24(4_suppl), 61-68.
Roberts, R., Lockett, H., Bagnall, C., Maylea, C., & Hopwood, M. (2018). Improving the physical health of people living with mental illness in Australia and New Zealand. Australian Journal of Rural Health, 26(5), 354-362.