Doubly disadvantaged – why some people are dying too soon



Dr Jayati Das Munshi is an Academy Clinician Scientist Fellowship award holder at the Institute of Psychiatry, Psychology & Neuroscience, Kings College London. She uses big data to understand inequalities in health and dying.

People with severe mental illnesses such as schizophrenia die between 15 and 20 years younger than the rest of the population. I’m sure you’d agree that’s a big gap and you might assume they are more likely to be at risk from accidents or suicide. 

In fact, the same illnesses that will kill you and me – heart attacks, strokes and cancer – will be the cause of death for those with mental illness. It will just kill them far younger.

The causes for this are complex, but they may include inequalities in healthcare provision. For example, clinicians may be less proactive in looking after the physical health of people with severe mental illness. Even worse, they may be mis-attributing a physical symptom, such as pain or dizziness, to mental illness when it could be a warning sign of something else.

We also know that people living with both severe mental illnesses and physical health conditions find it challenging to navigate health systems which are often split into ‘mental health’ and ‘physical health’. This group may be more likely to smoke, have high blood pressure, gain weight and develop diabetes.

In 2014, I received a Clinician Scientist Fellowship from the Health Foundation and the Academy of Medical Sciences to support my research in this area. My work involves analysing the health records of more than a million patients to find out exactly what’s behind this issue, and why those from ethnic minorities are doubly disadvantaged, with the care and treatment they receive likely to be even worse. I'm supplementing my analyses of healthcare records with interviews with service users and their carers.

What sets this research apart is this large number of records, which gives us enough data be able to focus on ethnic minorities. I’m investigating whether certain groups are more likely to encounter barriers to care, if they are more likely to suffer from particular physical illnesses or less likely to receive treatment.

Conditions like type 2 diabetes mellitus are two or three times more common in people with severe mental illnesses. We have now also established that they are even more prevalent in South Asian, black Caribbean and black African ethnic minority groups living with severe mental illnesses. In one of our studies using representative data from London, we found that 64% of people with severe mental illnesses who identified as being Bangladeshi suffered from type 2 diabetes mellitus over the age of 55, compared to 17% of white British people living with severe mental illnesses. 

Findings like these have major implications for the provision of healthcare to people with severe mental illnesses in ethnically diverse areas.

I’m motivated by trying to tackle the inequalities which people with severe mental illnesses experience, and in particular what this means for ethnically diverse populations. We need to understand why parts of society have such different healthcare experiences and why health inequality is a fact hidden in plain sight.

The Academy is currently developing a project to engage people on the topic of death and dying. For more information visit this page.

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