The inequality is not new, but the size of it keeps being restated in ways that should be harder to ignore. Adults in England with serious mental illness — defined here as people referred to specialist secondary mental health services — are 4.8 times more likely to die before the age of 75 than the general population. Rethink Mental Illness calculated that from published NHS data covering 2022 to 2024, and the breakdown is the story: 6.3 times as likely to die of liver disease, 6 times as likely of respiratory illness, 3.8 times as likely of cardiovascular disease, 2.3 times as likely of cancer. They are also 14.6 times as likely to die by suicide.
For working-age adults with a mental illness, deaths from cardiovascular disease and cancer are at their highest since records began — more than 24,000 deaths from each in the 2022–2024 period. Those four conditions plus liver disease accounted for 56.5 percent of deaths among 18- to 74-year-olds with severe mental health problems in England. Suicide accounted for 7 percent.
The paradox of frequent contact
The most striking finding is not the ratio; it is the fact that most of these people were not strangers to the health service. Rethink’s chief executive, Mark Winstanley, points out that many are in frequent contact with services throughout their lives, and that the opportunities to identify and treat physical health problems are therefore being missed rather than merely unavailable.
The report’s own explanation names the mechanism: diagnostic overshadowing. Physical symptoms get attributed to the psychiatric diagnosis, so they are not investigated or treated with the same urgency they would be in another patient. That is layered on top of the familiar material drivers — poverty, poor housing, smoking rates, weight gain from medication, inactivity, fragmented care spread across services that do not talk to each other.
Two systems of care sit next to each other for the same person, and the handoff between them is where the twenty years go. A psychiatrist manages the mental illness; the physical complaints that come up in that room get read as symptoms of it. Smoking cessation, routine physical health checks and “mental-health informed” interventions exist and are known to work, as the president of the Royal College of Psychiatrists, Prof Subodh Dave, notes — what is missing is concerted action to deliver them to this group.
What the data can and cannot carry
The figures come from a charity’s calculations on NHS statistics rather than from a study designed to test a hypothesis, so the causal story is stated in the report rather than established by it. The ratios are adjusted comparisons of mortality rates by referral status; they tell you who dies early and of what, not precisely why. “Diagnostic overshadowing” is offered as a leading explanation, and it is consistent with the pattern — the excess is concentrated in conditions that are treatable when caught — but it is an inference from the numbers, not a measurement of clinical behavior.
There is also a definitional narrowness worth naming. The population is people referred to secondary mental health services, which is a marker of severity and of contact with the system, not a measure of all mental illness. People whose conditions are managed in primary care or not at all are outside the frame. So the 4.8 figure describes the most visible subset of a much larger group, and the direction of the gap in less visible populations is not something this data can answer.
Why it lands now
The findings were released ahead of the government’s independent review of mental health, autism and ADHD, which is expected to recommend a more holistic approach to supporting patients. The Department of Health and Social Care response points to a new service framework, 100 new community mental health centres and a mental health strategy that responds earlier and reduces waiting times.
There is a bureaucratic logic to it. The NHS is organized so that mental health care is a specialty and physical health care is everything else, with the general practitioner as the nominal router between them. For people who are frequently inside the psychiatric system, the router is exactly the component most likely to fail — and the Guardian reported last week that access is being tightened further rather than widened, with a plan to limit NHS diagnoses of ADHD drawing accusations of rationing.
The honest way to read the report is as an indictment of integration rather than of intent. The treatments exist, the contacts with services already happen, and the deaths are described by Rethink as not inevitable. What has not been built is a system in which the person being treated for a mental illness is also routinely examined as a body.