Premature mortality rates during the pandemic were far higher amongst people with severe mental illness – and Black and Asian people were worst affected, a new report has found
"We already know that people living with a severe mental illness have a life expectancy 15-20 years shorter than the rest of the population. This data provides yet more evidence of this deep injustice, as well as its undeniable links to poverty and racism." Andy Bell, chief executive, Centre for Mental Health
Newly-published data from the Office for Health Improvement and Disparities (OHID) shows that people with a severe mental illness (SMI) in England were five times more likely to die prematurely during the pandemic.
According to the statistics, 42,815 people with an SMI, such as schizophrenia or bipolar disorder, died before the age of 75 during the first year of the pandemic – nearly 8,000 more than the average from previous years of 35,025.
The OHID report also found that Black and Asian adults with SMI experienced the largest increase in premature mortality during the pandemic. The greatest increase in premature mortality was among people living in deprived areas, the report says: “People with SMI living in the most deprived areas of England had the highest premature mortality rates before the pandemic, the highest premature mortality rates during the pandemic, and the greatest increase in premature mortality during the pandemic.”
During the first year of the pandemic, the premature mortality rate for people with SMI increased by 16%, the report found, compared to the annual average before the pandemic (2017 to 2019). This was a similar rate of increase to those without SMI (15%). However, the report says, the “ongoing underlying higher rate of premature mortality in people with SMI meant the impact in those with SMI was greater”.
There were also sex-based differences. The report found that “men with SMI had a higher premature mortality rate than women with SMI during the pandemic”. However, it adds: “Women with SMI had a higher excess premature mortality compared to their peers without SMI.”
The increase in premature mortality for people with SMI during the pandemic was “particularly high in London,” the report says. “This may reflect the regional impact of COVID-19 early in the pandemic and high levels of deprivation and proportions of people from black and Asian ethnic groups in London.”
The report’s authors note: “The stark difference in premature mortality between people with and without SMI pre-pandemic, and the sharp rise in premature mortality in people with SMI during the COVID-19 pandemic, highlights the vulnerability of people with SMI to premature death.”
The Centre for Mental Health, a charity, said that urgent action was needed. Chief executive Andy Bell said: “Today’s new data lays bare the unacceptable physical health inequalities faced by people living with a severe mental illness. We already know that people living with a severe mental illness have a life expectancy 15-20 years shorter than the rest of the population. This data provides yet more evidence of this deep injustice, as well as its undeniable links to poverty and racism.
“The government must act now. Its planned Major Conditions Strategy could set a target to close the life expectancy gap within a decade, and put in place the necessary actions to protect the health of people living with a mental illness.
“The NHS has taken some important steps to address this injustice since the 2019 Long Term Plan, including offering smoking cessation services to people in hospitals and ensuring that more people with a severe mental illness are getting a full annual health check. But we cannot stop there. We need concerted action to ensure people with a mental illness have fair access to vaccination programmes, cancer screening, stop smoking services in the community, dentistry, money advice and opportunities for physical activity.”
The report’s authors conclude by saying that their findings “highlight the vulnerability of people with SMI to infectious disease pandemics.” They add: “Similar vulnerability to premature mortality may occur in response to other extreme events and times of societal change. This analysis highlights the need for recognition of the vulnerability of this group by health and social care professionals and others in contact with people with SMI.” The findings, they add, should inform the actions of policy makers and public health specialists to mitigate the impact of future pandemics.
The findings of the OHID report are troubling. It is already well-documented that people with severe mental illness are more likely to die prematurely than mentally well people. But it’s concerning to know that their rates of premature mortality increased more steeply during the pandemic than those of the general population, and that the effect was most marked in ethnic minorities and people living in deprived areas. We support calls to ensure that people with severe mental illness have equal access to services, and to make sure that policy-makers address the vulnerabilities of this particular group in future pandemic planning.