It is the 21st century and yet those in Ontario with serious mental illness and diabetes are receiving inadequate medical care compared to those with only diabetes. This was the finding from a study just published online ahead of the print journal by researchers at the Centre for Addiction and Mental Health (CAMH) in Toronto and the Institute for Clinical Evaluative Science (ICES) and others.
Dr. Paul Kurdyak and colleagues looked at all cases of diabetes treated in Ontario between April 1, 2011 and March 31, 2013. They identified 1,131,375 individuals with diabetes, among whom 25,628 (2.3%) had schizophrenia and compared the quality of care they received along with emergency room visits and hospitalizations.
Canadian Diabetes Association 2013 Clinical Practice Guidelines recommends that people with diabetes have at least 4 Hb1AC blood tests, one cholesterol test, and one retinal (eye) exam.
Those with schizophrenia received fewer cholesterol checks than those without ((72.4% vs. 80.3%), and fewer eye exams (56.8% vs. 67.4%). Fewer people in both groups received the Hb1AC blood test but those with schizophrenia received even fewer tests and the difference was statistically significant (35.8% vs. 37.7% ).
And these deficiencies came about even though people with schizophrenia had 30% more visits to their primary care doctors than those with diabetes only. And those with schizophrenia made more visits to the emergency room for diabetes complications, more visits for all illnesses other than trauma and more frequent hospitalizations.
As a result, the lives of these individuals are 15 to 20 years shorter than individuals without a serious mental illness.
Sadly, this is not a situation that is unique to Ontario. Numerous studies in various jurisdictions have shown a similar trend. In Sweden, a 2013 study found that he average life expectancy of men and women with schizophrenia is 15 years and 12 years shorter respectively than for those who do not suffer from the disease.
This, despite the fact that people with schizophrenia had contact with the health service over twice as often as people without the condition, but they were no more likely to be diagnosed with cardiovascular disease or cancer.
One study suggested that the reason for this shortened life expectancy is that physical illnesses are diagnosed late and treated insufficiently. That same point was made in Britain where studies suggest "that poor health monitoring by the NHS, and the dismissive attitude of some health professionals towards people with severe mental illness" results in shortened life spans.
Resolving this dichotomy in care, according to Dr Kurdyak who headed up the Ontario study, requires that "We really need to develop more innovative and integrated ways to address both mental and physical illness in a large population that is burdened by both types of conditions."
And while doctors themselves may be responsible for this poor care, Ontario has created a dichotomy between physical health and mental health. At a recent meeting of the Public Accounts Committee discussing the Auditor General's criticism of mental health services for Children, Conservative health critic, Jeff Yurek, asked a rather pointed question.
He stated that if he had a child who broke his leg, he could take him to the emergency and have it set the same day. If his child had a mental health problem and was suicidal, his son would have to wait 18 months for service in Ottawa. Nancy Matthews, the Deputy Minister agreed that "wait times are an incredibly important issue" and the government has been working hard on improving this since 2011.
Clearly, not enough is being done but it needs to be done sooner rather than later.
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