Dr Smith-Merry is Associate Professor in the Sydney School of Health Sciences within the Faculty of Medicine and Health at the University of Sydney. Jen is Director of the Centre for Disability Research and Policy (CDRP), a multi-disciplinary centre whose mission is to make life better for people with disability in Australia by translating research to policy and practice.
Jen is chief investigator on multiple grants which evaluate or develop policy and services in disability and mental health. She works closely with people with lived experience of disability and has a strong interest lived experience-informed policy and service design.
Title: Unintentional Drug-related Deaths for people with mental illness in NSW Australia, 2012-2016
Author(s): Jennifer Smith-Merry, Kenji Fujita, Tim Chen
Introduction: People with serious mental illness are a vulnerable and stigmatized group who generally receive poorer healthcare and have worse health outcomes including greater premature mortality. Drug-related deaths are a significant cause of death in people with serious mental illness but drug and alcohol strategies are often disconnected from our thinking about the health and wellbeing of people with mental illness. The aims of this study were to understand drug-related premature death in people with mental illness, investigate trends and rate of changes in unintentional drug-related deaths, describe types of medicines involved, and identify populations at risk. In this paper we explain the data and then outline the policy and practice related solutions needed to address this situation.
Methods: Unintentional drug-related deaths for people with mental illness between 2012 and 2016 were identified in the National Coronial Information System. Data regarding age, gender, marital status, year of death, substances contributing to death was extracted from the retrieved cases. Descriptive statistics were computed for the results of the present study based on counts and proportions where relevant.
Results: A total of 495 unintentional drug-related deaths were identified (1.6 deaths/100,000 population), showing an upward trend (p<0.01). Males (Rate ratio, RR: 1.8, 95% confidence intervals, CI: 1.5-2.2), people aged 35-44 (RR: 1.7, CI: 1.3-2.2) were more likely to die from unintentional drug-related deaths compared with the reference (female and people aged 25-34 respectively). The median number of drugs involved per death was 5.0 while the most frequent number of drugs involved (i.e. mode) was 1 (97/495 cases, 20%). The most common substance involved amongst 495 cases was diazepam in both gender (males: 135/319, 42%, female: 76/176, 43%). Alcohol and heroin were predominantly involved in deaths amongst male (both p<0.05). During the study period, amphetamine showed the highest increase (3.2-fold), followed by codeine (2.5-fold), quetiapine (2.5-fold) and morphine (2.2-fold).
Discussion: This study identified differences between gender, age group and marital status in trends and rates of unintentional drug-related deaths for people with mental illness. Differences in demographic characteristics imply that a multifaceted and structured approach is required to inform intervention and prevention strategies. Physical health promotion for people with mental illness must include a consideration of drug and alcohol use. The results in this study point towards the importance of renewed efforts around prescribing awareness and medication monitoring practices, as well as medicines-related education for people with mental illness. The number of overall deaths (n=398, 80%) involving polypharmacy or interactions between illicit, over the counter and prescribed medications also necessitates a strategy that brings together cohesive prescribing, mental health and drug and alcohol strategies as part of our overall consideration of the health of people with mental illness.