People with serious mental illness have higher rates of post-operative complications and longer stays in hospital, according to a review by Australian researchers.

Lead author Kate McBride, Director of the Institute of Academic Surgery at Royal Prince Alfred Hospital and PhD candidate at The University of Sydney, told HealthTimes that mental health is not generally at the forefront of surgeons’ minds.

“Surgery is a bit like a factory sometimes, and it's very clear that we need to just adjust the way the care is delivered for vulnerable groups.”

“From a health system point of view, research has shown that surgeons tend to feel less confident in managing mental illness compared to other comorbidities.”

“And when we talk about stigma, we can break it down into three areas of discrimination, prejudice, and ignorance”, McBride explained.

“And we found that it's ignorance, really, that is the prevailing reason. [Surgeons] just don't know how to manage mental illness compared to other comorbidities. I think there's no real set pathways for how we manage mental illness preoperatively.”

“For example, if somebody had high pressure, they just know automatically to refer them to a cardiologist before surgery, but for some reason with mental health, it's just not managed very well.”

McBride and colleagues reviewed 26 international studies and found that for those with serious mental illnesses, there was a greater risk of post-operative complications, longer stays in hospital, higher inpatient costs, and greater risk of re-admissions within 30 days of discharge, compared to other patients following elective surgery.

“It’s quite complex and there's a lot of multifactorial reasons that we tend to break it up into patient and then health system reasons.”

“On a patient level, people with serious mental illness have more medical comorbidities, so more cardiovascular comorbidities, which relates to some lifestyle factors like more smoking and drug and alcohol abuse.”

“They may find navigating a health system quite difficult, and they have a bit of understandable mistrust of the health system as well”, McBride added.

Research has also previously demonstrated that people with serious mental illness tend to have less access to non-psychiatric care compared to the genera; public, and also tend to present for care later.

“So it's likely that by the time they need surgery, they're probably in a more advanced stage of the illness”, McBride said.

She explained that surgeons tend to take the view that patients don’t want to be asked about their mental health.

“But we did a qualitative study of people with serious mental illness who've had surgery and they were very clear that they want to be asked about their mental health and that they feel uncomfortable to raise it themselves, but they would want surgeons to ask them.”

McBride said her team had also done a survey of surgeons, which revealed they thought that GPs would outline mental health issues in referral letters.

She called for pre-surgery screening tools and better communication between surgical and mental health teams to minimise post-operative issues.

“I think that's a really important change that needs to happen – surgeons need to understand that it's okay to ask people about that and that it would actually help this vulnerable group have more proactive care.”

“We’re just about to start a trial where we screen everybody coming in to have surgery about their mental illness, so this will be just a very simple 10 question checklist.”

“Then those people who are flagged as needing more resources or assistance for their surgical admission will be referred to a mental health nurse or a psychologist, and they'll help guide them through having surgery.”

“We can pick these people up before they have surgery so that they can have their anesthetics managed appropriately”, McBride said.

“Then their community mental health team can be alerted that they're having surgery and we can just adjust the care to be suitable to their needs.”

She said her team’s work is not only focusing on people with mental illness, but is also exploring ways to better support other vulnerable groups, including indigenous patients, CALD groups, and the elderly.