The life expectancy of patients with a serious psychiatric disorder is, on average, 13 to 30 years shorter than the rest of the population.
This is partly because the organization of healthcare fails to address the limitations and specific risks faced by these patients, discovered Fenneke van Hasselt.
Van Hasselt will be awarded a PhD on 25 October by the University of Groningen for research she carried out at her employer GGZ Westelijk Noord-Brabant
(mental healthcare organization for western North Brabant province).
The shorter life expectancy is mainly due to the fact that people with severe mental illness are at greater risk of physical diseases, such as cardiovascular disease and diabetes, due to the side effects of medication, an unhealthy diet or lack of exercise, for example. At the same time, symptoms which would indicate this are insufficiently recognized and treated, notes Ms Van Hasselt. ‘Sometimes this already runs aground at the first stage because the patient fails to see a General Practitioner (GP) about their symptoms.’
People with severe mental illness often live at home and have their own GP. Alongside this, they will be under the care of a psychiatric team. ‘A proportion of these patients report that they never visit a GP, but when asked whether they have any particular health problems they often have at least three issues they should see a GP about. But even those patients who do manage to visit a GP often find that they are unable to clearly describe their complaint, for example because they experience physical symptoms in a different way’, explains Fenneke van Hasselt.
So there are health issues, but the necessary care is not always provided. To discover why this is so, Van Hasselt talked not only to various healthcare providers but also, more specifically, to patients and their families. What surprised her in particular was how well the patients could explain what the obstacles for them are. ‘It helps them, for example, if they don’t have to wait too long for the results of a test. In this way you deal with the issue that people with severe mental illness have a tendency to magnify uncertainties. They can end up losing a whole day because of a single doctor’s appointment, simply because they get so worked up about it. It is important to realize this when you are sitting on the other side of the table.’
All those involved, however, considered the biggest problem to be that the coordination between the various care providers still often falls short, Fenneke van Hasselt discovered. ‘Something may be started at the GGZ but the GP knows nothing about it, or vice versa. Or they both fail to set up a procedure because they each expect that the other will do it.’ All the parties also need to be fully informed about the medications prescribed for the patient. ‘This would seem to be common sense, but is far from the case at present. A great deal could be achieved with just simple measures like these.’
The patients, family, GPs and GGZ staff have a clear view of the division of tasks between the mental health practitioners and GPs, Van Hasselt observed. ‘The GP should maintain a general overview while the GGZ should be responsible for gauging whether a patient is capable of arranging for their own healthcare needs. Some patients are perfectly capable of deciding whether or not they should see their GP with a particular complaint, while others would definitely benefit from visiting their GP on a regular basis accompanied by someone from the GGZ.’
Fenneke van Hasselt also suggests a policy change in her study – arranging a health assessment. This would be based on an interview with the patient about their current complaints, medications, and lifestyle. This information could be combined with information from the GP and the pharmacy, so that a list can be drawn up of the health issues which require medical evaluation. ‘This would enable you to identify major diseases in ambulant psychiatric patients and draw up a treatment plan for them’, says Fenneke van Hasselt.
Fenneke van Hasselt (Heerenveen, 1984) studied medicine at Erasmus University Rotterdam. She carried out her PhD research at the GGZ Westelijk Noord-Brabant. The title of her thesis is Improving the physical health of people with severe mental illness: The need for tailor made care and uniform evaluation of interventions. She will be awarded a PhD in mathematics and natural sciences by the University of Groningen. Her supervisors were Anton Loonen, professor of Pharmacotherapy in Psychiatric Patients, and Maarten Postma, professor of Pharmacoeconomics. Fenneke van Hasselt works as a trainee medical specialist in psychiatry at GGZ Westelijk Noord-Brabant. [JH1]
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