When a person suffers from mental illness, do their physical problems tend to be undertreated? Unfortunately, the answer is often yes. This situation is especially serious, given that people with mental illness tend to have more physical illness than those without mental illness. A number of studies confirm this phenomenon. (See, among others, Goldman et al. 1999: “Les patients atteints de maladie mentale présentent 30% plus de risque de maladie respiratoire que la population générale”.)

In a study of over 4,000 psychiatric patients, nearly 50 percent of subjects also suffered from a physical illness. This disproportionate number of physical illnesses in patients with a mental illness constitutes a major problem—one that must be addressed by healthcare providers.

There are many reasons why patients with mental illnesses have high rates of physical illness, compared with the general population. Some of these reasons are caused by communication problems. Certain people with schizophrenia may find it difficult to describe their illness and sometimes (due to a reduced pain threshold, reported in certain studies, or to perceptual problems) may even neglect to mention they are in pain or describe their physical symptoms.

Even if a patient adequately describes an illness, it is not always certain that the healthcare provider will give it all the attention it deserves. Medical staff must always be on the lookout for colleagues who downplay, or improperly treat, physical illness in patients with mental illness.

No medical practitioner is likely to tell a psychiatric patient that her mental illness disqualifies her from receiving aggressive treatment for breast cancer. However, several studies examining the difference in care between psychiatric patients and those in the general population have indicated that patients with mental illness sometimes receive inferior care. (Study by Druss et al., 2000: “Les patients recevant des soins pour des maladies cardiovasculaires avaient moins de chance de recevoir un traitement agressif lorsqu’ils avaient un diagnostic concomitant de maladie mentale.”)

It is important to note, though, that risk factors such as smoking, alcoholism, risky sexual behaviour, illegal drug consumption, and obesity disproportionately affect the psychiatric population. For example, there is a high smoking rate among people with schizophrenia (88 percent) and among people with bipolar disorder (70 percent).

Knowing these problems exist should encourage healthcare providers in a psychiatric milieu to implement prevention measures wherever possible. However, this is often a challenge. For example, health professionals often find it difficult to obtain free and informed consent from patients, and many patients have problems adhering to programs.


Increasing numbers of health establishments have opened psychiatric care “wellness”, “health action”, or “holistic care” clinics, designed to treat obesity, diabetes, pre-diabetes, cholesterol-related, and blood pressure problems in people suffering from these physical illnesses and mental illness. These preventative measures are also designed to motivate patients suffering from mental illness, help them modify their lifestyle, and lessen the risk of heart and cardiovascular disease.

When it comes to the physical health of people with, and without, mental illness, one point is clear. There should not be any hierarchy in dispensing healthcare, unless it involves pinpointing patients who are in most urgent need. All healthcare providers must understand that patients with mental illness have the same rights as anyone else to quality physical care. By ensuring that patients with mental illness are in the best possible physical health, we also increase their chances of recovering from mental illness. Recovery is a long process, and people with mental illness must be as physically healthy as possible if they are to surmount their challenges and enjoy a full and satisfying life.

Willine R. Rozefort MD, M.Sc. CCFP FCFP
Chief, Department of General Medicine
Douglas Mental Health University Institute