‘Diagnostic overshadowing’ identified as barrier to physical-disease care
The Rethink Mental Illness analysis drew on NHS data for England, comparing mortality among adults under 75 referred to specialist secondary mental health services with the wider adult population. The charity concluded that this group dies 15 to 20 years earlier than peers without such referrals, and that for several of the conditions examined, the gap in premature deaths is the starkest recorded to date.
For working-age adults living with severe mental illness, deaths from cardiovascular disease and cancer each exceeded 24,000 in the 2022-2024 reporting period — the highest since records began, according to the charity. Cancer, cardiovascular disease, liver disease and respiratory disease together accounted for 56.5 percent of deaths among 18- to 74-year-olds with severe mental illness in England during the period. Cancer and cardiovascular disease each contributed just under 19 percent of all deaths; respiratory disease 11 percent and liver disease 8 percent. Suicide comprised 7 percent.
Beyond cardiovascular disease and cancer, the analysis found that adults with severe mental illness were 6.3 times as likely to die from liver disease and 6 times as likely from respiratory illness before 75. They were also 14.6 times as likely to die by suicide compared with adults who had not been referred to specialist mental health services.
The report identifies several drivers of the excess mortality. Alongside poverty, poor housing, higher smoking rates, weight gain attributed to psychiatric medication, physical inactivity and fragmented care, the authors single out “diagnostic overshadowing” — the tendency for physical symptoms in patients with mental illness to be misattributed to psychiatric causes, leaving underlying conditions underinvestigated and undertreated.
Mark Winstanley, the chief executive of Rethink Mental Illness, called the disparity a scandal. “It is a scandal that people living with severe mental health problems are so much more likely than the rest of the population to die from often preventable physical health conditions,” he said. “Given that many are in frequent contact with health services throughout their lives, it is clear that opportunities to identify and treat physical health problems are being missed.”
“These early deaths are not inevitable,” Winstanley added. “The new cross-government mental health strategy … must prioritise physical health checks, improve access to mental-health informed interventions and bolster peer support, if it wants to reduce these terrible health inequalities.”
Prof Subodh Dave, the president of the Royal College of Psychiatrists, said the gap was unacceptable. “Having a severe mental illness shouldn’t be an early death sentence. This stark inequality is unacceptable. People with severe mental illness deserve the same opportunity to live long, healthy lives as everyone else. We know that evidence-based solutions to close this gap exist – from smoking cessation to routine physical health checks. But what is lacking is concerted action to prevent these premature deaths.”
A spokesperson for the Department of Health and Social Care said the government recognised the inequalities and was taking action. “People living with severe mental illness face stark health inequalities, and too many continue to experience poorer physical health outcomes,” the spokesperson said. The spokesperson said the government was “developing a new modern service framework to look at what action is needed to help people live healthier and longer lives through high-quality care, opening 100 new community mental health centres, and our mental health strategy will go further, outlining how we plan to build a more integrated system that responds earlier and reduces waiting times for support.”
The findings arrive before the government’s independent review of mental health, autism and ADHD, which is expected to be published this week and anticipated to recommend a more holistic approach to supporting patients with these conditions.