HELPS Context

The promotion of healthy living conditions and the prevention of physical comorbidity are preconditions for maintaining the dignity and the human rights of residents of mental health care Institutions. However, there is significant empirical evidence that the physical health status of people with severe mental illness is often disregarded by mental health care Institutions. Studies from several countries have shown that the physical health condition of patients with severe mental illness (SMI) is, on average, relatively poor and that their risk of premature death due to physical illness is considerably increased. Compared with the general population patients with schizophrenia were characterised by a higher prevalence of obesity, cardiovascular and respiratory diseases, diabetes, several types of cancer and poor oral health status.

Adverse effects of psychotropic medication, a lack of physical health monitoring, and an unhealthy lifestyle of mentally ill patients, e.g. smoking and illegal drug use, poor diet, lack of physical exercise and alcohol abuse, are regarded by several authors as the potential causes of high somatic morbidity and mortality. Many studies have shown that people with mental illness have a high prevalence of heavy smoking, illicit drug use, alcohol abuse, poor diet, insufficient levels of dental care and physical activity. On the other hand there is increasing evidence that modern psychotropic drugs increase the risk of obesity, diabetes and cardiovascular diseases.

Thus far, only few efforts have been made to prevent physical comorbidity in people with severe mental disorder. While most of the existing health lifestyle intervention programmes were focused on smoking cessation, only few approaches exist for the improvement of nutrition behaviour and physical exercise. Moreover, in their majority existing programmes are focused on the change of individual behaviour without regarding the role of (un)healthy living conditions. According to the concept of empowerment programmes on health promotion must enable people to increase the control over their health related living conditions and over their quality of life. Consequently, a general strategy on health promotion for residents of mental health care Institutions must take into account behavioural as well as environmental and iatrogenic health risks. Moreover, a European health promotion programme must consider the variation of physical health problems, health relevant behaviour, health related attitudes, health relevant living conditions and resource level in mental health care Institutions across Europe. Thus, a strategy is needed which enables people in mental health care Institutions to routinely identify the most relevant health problems among residents, to explore the main causes for these health problems, to choose appropriate intervention programmes and to systematically evaluate their effects.