October 8, 2021

expert reaction to excess mortality in people with mental health conditions during the pandemic

A study published in The Lancet Regional Health – Europe looks at all-cause and cause-specific mortality in people with mental disorders and intellectual disabilities, before and during the COVID-19 pandemic.

Dr Ahmed Hankir, Lead for Public Engagement and Education, World Health Organization (WHO) Collaborating Centre on Mental Health, Disability and Human Rights, Institute of Mental Health, University of Nottingham, said:

 “Behind the numbers are human beings who are suffering and struggling terribly. We know that the pandemic has exacerbated inequalities and it is truly tragic that the most vulnerable people in society i.e., those with severe mental illness and disabilities, continue to suffer disproportionately. We must do more for people with these conditions especially those from minority ethnic backgrounds who have even worse outcomes. I agree with the study authors that we need to prioritise vaccination and optimise physical health care and suicide risk reduction, before, during and after peaks of COVID-19 infection in people living with mental health conditions. For us to be able to do this, the government must allocate more resources for the provision of mental healthcare services. We also need to improve the quality of training so health and social care workers are aware of the increased risks of morbidity and mortality in patients with severe mental illness and disabilities so that they can mitigate these risks as best as they can. Health and social care workers must also have the humility to make people with these conditions feel dignified at all times.”

Sarah Shenow, Head of Research at MQ Mental Health research, said:

“This important paper highlights the scandal of premature mortality in people living with severe mental illness. Using comprehensive and sophisticated techniques using the CRIS infrastructure, its findings can be considered robust. 

“The authors found that, during the pandemic, people living with severe mental illness were even more likely to die from COVID-19 than members of the general population. They were also more likely to die from other causes. The groups affected by this increased risk of death include people with schizophrenia, bipolar disorder, major depression, and anxiety disorders, along with those who have learning disability, dementia and personality disorders. In a context where, at the start of the population, people with severe mental illness were already twice as likely to die as the general population and had a life expectancy 15-20 years shorter, this is staggering.  

“Research is urgently needed that investigates why people with severe mental illness are particular vulnerable to physical problems such as COVID-19, and the particular mechanisms that lead to this dual challenge. Research must also take this important knowledge a step further and develop solutions that stops this disturbing trend in its tracks. 

“People with severe mental illness are gone too soon. This paper starkly highlights the urgent need to tackle this.

“MQ Mental Health research will be focusing on this area during their next funding round. MQ’s new programme, Gone Too Soon, will tackle the scandal of premature mortality in people with severe mental illness. Although sometimes due to suicide, as this paper demonstrates, it is largely due to tractable physical illness.”

Dr Adrian James, President of the Royal College of Psychiatrists, said:

“It’s shameful and utterly heartbreaking that the stark inequalities faced by people with a severe mental illness or learning disability have had such tragic consequences during the pandemic.

“There has never been a more important time to address the inequalities that have been seriously exacerbated by COVID-19, including helping vulnerable people get vaccinated. The new Office for Health Improvement and Disparities is aiming to ‘level up the health of our nation’. As a society, we have a moral duty to ensure this means improving the health of people with a severe mental illness or learning disability and reducing inequalities in mental health.”

Dr Livia De Picker, Psychiatrist & Postdoctoral Researcher, University of Antwerp, Belgium, said:

“This study unfortunately confirms our worst fears. Previous research, including from our own group, has convincingly demonstrated that people with mental disorders have a twofold increased risk of death following a COVID-19 infection, but we have also found evidence of possible reduced access to care among patients with severe mental disorders infected with COVID. People with mental disorders already faced barriers to healthcare before the pandemic, and this study provides the first substantive and reliable evidence that this health disparity has even widened during the pandemic. There has been a lot of concern about the mental health problems which will follow the COVID epidemic. This study proves that any discussion about the mental health impact of the pandemic must include substantial attention to the problems and needs of those who already have a mental illness. With World Mental Health day on our doorstep (October 10, 2021), this study should alarm and urge policymakers to increase efforts to improve the health outcomes of people with mental illness, during and after the pandemic.”

Dr Charley Baker, Associate Professor of Mental Health, University of Nottingham, said:

“These results are entirely unsurprising but should be no less shocking for their predictability. There has been systemic government-level under-interest and under-investment in the overall health of people with learning disabilities and people with severe and enduring mental health problems for decades and – despite platitudes used at the time – this was demonstrably magnified during the pandemic. While staff ‘on the ground’ may have done absolute best they could, there are gaping healthcare inequalities in ensuring that some of the most vulnerable people in society are better supported and better prioritised for good quality healthcare access.”

Professor Dame Til Wykes, Head of the School of Mental Health and Psychological Sciences (MHaPS), Institute of Psychiatry, Psychology and Neuroscience, King’s College London, said:

“We know that people with mental health problems die earlier than the general population, and sometimes this is 20 years earlier. They die from physical illnesses like cancer and heart disease and now this large and robust study shows that they are also likely to die from the complications of Covid-19. We do not know enough about the links between physical and mental health although, but we do know that if you develop a mental health problem on top of heart attack then you are more likely to have another one. We need to be working towards eliminating the mortality gap by making it a clear goal for research. Along the way we might also learn more about how to deliver better physical health treatments too.”

‘All-cause and cause-specific mortality in people with mental disorders and intellectual disabilities, before and during the COVID-19 pandemic: cohort study’ by Jayati Das-Munshi et al was published in The Lancet Regional Health – Europe

DOI: https://doi.org/10.1016/j.lanepe.2021.100228

All our previous output on this subject can be seen at this weblink:

www.sciencemediacentre.org/tag/covid-19

Declared interests

Dr Charley Baker: “No COI to declare. This is my view not the view of my employer.”

None others received.