NHS 'bias' against mentally ill linked to high death rate

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An inquiry into the high death rate among people with mental health problems treated on the NHS is to investigate claims that they are subject to institutionalised discrimination.

An inquiry into the high death rate among people with mental health problems treated on the NHS is to investigate claims that they are subject to institutionalised discrimination.

Research by the Disability Rights Commission suggests that they are four times more likely to die from a treatable illness than other patients and 58 times more likely to die before the age of 50.

The inquiry will look at why people with learning disabilities and mental health problems such as schizophrenia and manic depression as well as conditions such as Down syndrome and autism receive worse care from the NHS.

Preliminary studies show people with schizophrenia die on average nine years before the rest of the population. Fewer than one in five women with a learning disability has cervical screening.

The inquiry will focus on primary care - access to GPs, health-screening services and health improvement initiatives - before moving on to examine the hospital service. Spokeswoman Sue Pratt said there were clear examples of differential treatment between patient groups in the new GP contract, introduced in April.

"The contract includes a target for GPs to give people with mental problems a health check once a year. But there is no corresponding target for people with learning disabilities," she said.

Many patients found that when they attended a GP's surgery for treatment, they were ignored while the doctor talked to the carer. "There is incredibly low cancer screening among these patients," Ms Pratt said. "We want to find out if that is because the information about screening is presented in a way that makes it difficult for them to understand."

The inquiry will examine whether doctors are diagnosing problems too late because of an assumption that they are linked with the mental problem or learning disability. This is known as "diagnostic overshadowing".

"GPs see the disability first. Patients say they have a cabinet full of prescriptions for their mental problems but when they say they have heart palpitations, they are dismissed," Ms Pratt said.

In 2001, a 36-year-old man with learning disabilities died of organ failure two weeks after being discharged into the care of his wife from Darlington Memorial Hospital in Co Durham. John Atkins had a heart condition but neither he nor his wife, Helen, who also had learning disabilities, had understood how serious it was.

The County Durham and Darlington Acute Services NHS Trust found that staff had "overestimated the couple's ability to judge their own situation".

Sheila Holins, professor of the psychiatry of learning disability at St George's Hospital in London, said "institutionalised discrimination" was in part to blame for the high death rate. "There is a lack of awareness of how much ordinary services need to be adapted to make sure people with learning disabilities get equal access and equal care," Prof Holins said.

The Royal College of GPs welcomed the inquiry. Mayur Lakhani, chairman of the Royal College, said: "We are committed to promoting excellent care for all patients whatever their needs."

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