Patients afflicted with mental illness also may have their communication efforts thwarted, in part, by their mental condition. "Mentally ill patients may be less able than others to communicate proactively with the physicians," Li and his colleagues wrote. "Accordingly, they may be less able to assert their preferences for more aggressive surgical treatment when they do wish to go that route. Taken together, these factors could place patients with coexisting mental illnesses at a disadvantage when their doctors are deciding what type of treatment to recommend."
Such conditions, as Li notes in the study, have an impact on healthcare systems, related to longer length of stays, worse post-operative outcomes and more frequent 30-day readmissions, as well as higher risk of short and long term mortality, all issues that healthcare reform is trying to address. Among the mental health diagnoses includes schizophrenia, other psychosis, major depression, bipolar disorder, substance abuse and post-traumatic stress disorder.
As the aging population continues to grow, the number of older people with psychiatric and substance abuse disorders is projected to double in the next decade. Mental illness is prevalent among the Medicare population. About 26% of Americans aged 65 or older have a major psychiatric condition such as depression or anxiety and more than 1.7 million have an active substance abuse disorder.
Li notes that other studies have shown that mentally patients with coronary heart disease may also face barriers in receiving diagnostic catherization and revascularization procedures.
"Physicians in general practice have to pay increased attention to mental health issues," says Li.