You’ve got a choice. You can either buy cigarettes, or get food to see you through the week. For most people it’s a no-brainer. Of course you’d buy food. But if you’re suffering from schizophrenia, living on the disability support pension and facing other psycho-social challenges, then the choice isn’t so clear.
“Some of my patients will choose cigarettes over food,” my clinical specialist nurse told me. “They also drink huge amounts of coffee. I’ve even seen people eating dried coffee from the tin.”
So what’s going on here? I’m schizophrenic, and aside from dealing with the symptoms of the illness, there’s another statistic which I’m struggling to come to grips with. People with schizophrenia tend to live between 14 and 20 years less than the general community.
Every year, 9,000 Australians with a serious mental illness will die prematurely. We face higher incidence of diabetes and cardiovascular disease, very high levels of unemployment, and many of us are in temporary housing. It’s not a good mix.
I’m also 43. The average life expectancy for a non-indigenous Australian male is around 80 years, a bit longer for women. I smoke, and weigh more than I should. According to the statistics, I’ve got about another 17 years left in me. That’s quite sobering.
Professor Amanda Baker, a senior researcher at the National Health and Medical Research Council (NHMRC) specialising in schizophrenia, told me there are a number of reasons why people with schizophrenia have reduced life expectancies. The big ones are poor lifestyle, unemployment and social isolation. She said that around 85% of people with schizophrenia smoke, compared with approximately 20% of the general population.
One of the main reasons people smoke, she said, is that the medications used to treat the illness are often sedative and dulling, and so people use tobacco and caffeine heavily because they’re stimulants.
The medications also have other side effects. For reasons that aren’t entirely clear, the anti-psychotics used to treat schizophrenia have a negative effect on metabolism. When I was first put on Olanzapine, a potent anti-psychotic, I put on about 25 kilos in a matter of months. I’ve moved onto a different medication since then, but it’s also weight unfriendly, and despite doing moderate exercise, I’ve never been able to shake the weight I gained.
According to Baker, until recently there wasn’t a lot of attention paid to the physical health aspects of serious mental illness. Clinicians didn’t discourage patients from smoking because there was a pervasive attitude that you “don’t upset the schizophrenics.”
Not so long ago it was also OK to smoke in psychiatric institutions. Public facilities have clamped down on that, but smoking is still common in private hospitals.
Is there anything that can be done?
“People with schizophrenia are generally more dependent, and have less coping skills than the general population, and that makes it very hard for them to give up or make lifestyle changes,” Baker said.
So the initiative needs to come from both patients and their care team. While psychiatrists in the past were only focused on medication and the mind, these days, said Baker, they are being encouraged to have a wider view of their patient’s health, both physical and mental.
What needs to happen is a greater focus by clinicians on the overall wellbeing of their patients. Baker said this is finally occurring.
“Psychiatrists are being encouraged to look after the physical, as well as mental health of their patients, and that means addressing smoking, as well as diet and exercise,” she said.
That’s a good start, but for the meantime, people with serious mental illnesses like schizophrenia will continue to die young. And that is a major downside of being sick.
I"m 43 and schizophrenic. According to the statistics, I"ll be dead in 17 years | Joshua Gliddon
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