Greater Needs, Limited Access: With the Recent Ratification of the United Nations Convention on the Rights of Persons with Disabilities by the United Kingdom, Kathryn Senior Reports That Access to Health Care for People with Mental Health Disorders Is One Area That Leaves Room for Improvement

By Senior, Kathryn | Bulletin of the World Health Organization, April 2009 | Go to article overview

Greater Needs, Limited Access: With the Recent Ratification of the United Nations Convention on the Rights of Persons with Disabilities by the United Kingdom, Kathryn Senior Reports That Access to Health Care for People with Mental Health Disorders Is One Area That Leaves Room for Improvement


Senior, Kathryn, Bulletin of the World Health Organization


Eleven years after being diagnosed with schizophrenia, Marita's daughter Mandi experienced severe headaches and began to fall over for no reason. Mandi and her parents described the worsening symptoms to her doctors for more than four years, yet neither a computed tomography (CT) scan nor any other investigation was ever done. "Mandi's symptoms were explained away as a result of her medication, or a progression of her condition, without any evidence that this was the case," recalls Marita.

The general practitioner (GP) who called at Mandi's home after she collapsed one morning prescribed paracetamol and diazepam; and asked Mandi to come to the surgery the following Monday. "On Monday, Mandi's life-support machine was switched off after the brain tumour that filled half her skull had haemorrhaged," says Marita.

After Mandi's death, Marita obtained her medical records and complained formally to the Healthcare Commission in England, which ruled in her favour. "The GPs blamed the psychiatrists and vice versa; no-one would take any responsibility either before Mandi's death or since. None of them ever listened; one psychiatrist spent the entire consultation looking at the floor," says Marita.

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Marita's experience is not unusual. Liz Sayce, chief executive of the Royal Association for Disability and Rehabilitation in the United Kingdom, reports that there is a growing body of evidence from small-scale studies and personal testimony that people with mental health disorders, such as schizophrenia and bipolar disorder, die prematurely and unnecessarily. "This stimulated the United Kingdom's Disability Rights Commission, now part of the Equality and Human Rights Commission, to undertake a larger formal investigation into inequalities in health-care access and their impact on people with mental health disorders and/or learning disabilities," says Sayce. The research involved analysis of eight million primary health care records, consultation with more than 1000 people with mental health problems and/or learning disabilities, their carers, health professionals and representatives of advocacy groups.

The investigation's report, entitled Equal treatment: closing the gap, concluded that people with learning disabilities or mental health disorders in England and Wales were more likely to have significant health risks and major health problems such as obesity, high blood pressure and diabetes. "People with schizophrenia are more likely to have coronary heart disease than other citizens and are more likely to die of it before the age of 55. Yet they are less likely to be screened for cholesterol or to be prescribed statins, the main evidence-based treatment," says Sayce.

Reasons for the inequalities are complex. They include social deprivation--but this factor on its own does not explain the limited access that such people have to primary health care and to specific screening and treatment.

The investigation found that health-care providers viewed disability access almost entirely in terms of physical access to premises and considered many problems were associated with the individual--and not issues that they could remedy. Many patients with mental illness either had difficulty using the appointment system (such as needing to phone for an appointment at a particular time) or could not easily remember and travel to appointments; or they did not trust the service, due to prior experience of not being treated with dignity and respect or distorted perceptions about the way they have been treated, which can be symptomatic of their illness.

"Sometimes patients couldn't understand or cope with the implications of the medical advice they had been given," says Sayce. "But there did not seem to be any strategies in place to support these patients."

Diagnostic overshadowing was identified as another barrier, whereby clinicians attribute symptoms or behaviours of a person to their mental disorder and under-diagnose or miss the co-existing physical illness.

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