Only 35 percent of people with severe mental illnesses get timely follow-up treatment after being released from psychiatric hospitalization, even though a reform meant to improve treatment of such illnesses took effect more than three years ago.
Ideally, such a person should receive an appointment at his or her local mental health clinic within two weeks, to preserve continuity of treatment. But of the 74,000 patients who have been hospitalized in a psychiatric ward for at least two weeks, only 35 percent receive such a timely appointment, according to data compiled by the Israel National Institute for Health Policy Research that was presented at a conference last week.
Many of these patients also aren’t receiving proper care of their physical ailments.
The study found that only 58 percent of patients with severe mental illnesses have basic data like height and weight in their medical files, compared to 90 percent of the general population. Of those whose weight is recorded, 38 percent are overweight, compared to 23 percent of the general population.
In addition, 14.4 percent have diabetes, compared to 9.6 percent of the general population. But the study found that their treatment for that disease didn’t fall short of the treatment given the general population.
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Maintaining the physical health of patients with severe mental illnesses poses special challenges, because they must visit doctors or clinics at their own initiative, wait patiently for their turn, communicate with the medical staff and implement the doctors’ recommendations when they get home — all actions that are liable to be difficult for them. And the health system has long been criticized for its shortcomings in treating physical diseases among the mentally ill, even when patients are hospitalized.
The result is that such patients have an increased mortality rate, especially when they have chronic illnesses.
A 2012 report by the Health Ministry found that patients who had been hospitalized in psychiatric hospitals were at higher risk of dying from a wide variety of causes. These included suicide (16.3 times the risk among the general population), murder (3.6 times) and traffic accidents (2.6 times), but also respiratory diseases (2.4 times), diabetes (2.1 times) and heart disease (1.6 times).
“We know the life expectancy of patients with severe psychiatric illnesses is about 20 years shorter than that of the general population, and that’s grave in itself,” said Dr. Tzvi Fischel, chairman of the Israel Psychiatric Association. “We in the association have taken on the issue of extending our patients’ life expectancy as a key issue to deal with, in cooperation with family doctors.”
“We need to act in a more complex, creative way than we do with the general population,” he continued. “Our idea is to create a treatment team comprised of the psychiatrist who is treating him and the family doctor and build a plan to monitor the patient’s physical illnesses as well, in hopes that this will lead to closing the gap between illness and mortality rates for psychiatric patients and those of the general population.”