An overlooked health inequality

When we talk about the health inequalities experienced by people with severe mental illness (SMI), the focus is usually on issues such as cardiovascular disease, diabetes and smoking. Far less attention is given to eye health. Yet many people living with conditions such as schizophrenia and bipolar disorder may be experiencing sight loss that is undetected, undiagnosed and untreated.

This matters because people with SMI already face some of the widest health inequalities in society, dying on average around 15 years earlier than the general population due largely to preventable physical health conditions. Evidence now suggests that visual impairment should be considered part of this inequality. A large Northern Ireland study involving almost 800,000 people found significantly higher rates of blindness among people with severe mental illness than those without.

Barriers to Eye Care

Many eye conditions, including glaucoma, diabetic retinopathy and cataracts, develop gradually and can often be treated successfully if detected early. However, people with SMI can face additional barriers to accessing eye care, including anxiety, cognitive difficulties, poverty, social exclusion and poor coordination between mental and physical health services. Diagnostic overshadowing can also mean physical health concerns are overlooked because attention is focused on mental health needs.

The Scale of the Problem

Research among psychiatric in-patients found that 65% had impaired visual acuity, most had not visited an optician for at least five years, and many who had been prescribed glasses had lost them and not replaced them. This raises an important question: how many people with severe mental illness are living with avoidable sight loss that has never been identified?

Why Sight Loss Matters

The consequences can be significant. Poor vision is linked to social isolation, reduced independence, poorer mental wellbeing, falls, injuries and greater demand on health and care services. For someone already managing a severe mental illness, untreated sight loss can create another major barrier to recovery and quality of life.

Practical Solutions Within Reach

The good news is that solutions are within reach. Eye health could become a routine part of annual SMI physical health checks, with simple questions about vision, encouragement to attend regular sight tests, and clear referral pathways where concerns are identified. Greater collaboration between mental health services, primary care and community optometry could also help improve access for those who struggle to engage with routine healthcare.

Making Eye Health a Priority

If we are serious about reducing health inequalities, eye health can no longer remain on the margins. Every missed sight test or untreated eye condition represents a missed opportunity to improve someone’s independence, wellbeing and recovery. Bringing eye health into mainstream conversations about severe mental illness is a simple but important step towards more equitable healthcare.

Our Recommendations

Our recommendations aim to improve eye health outcomes for people with severe mental illness (SMI) by strengthening detection, diagnosis, treatment, and follow-up. This includes adding eye health to annual NHS health checks, improving professional training and referral pathways, increasing support to help people attend appointments, and ensuring eye health is included in medication reviews, health inequality monitoring, and NHS frameworks.

Author: Eamonn Dunne

About the author:

Eamonn Dunne is Policy & Campaigns Manager at Thomas Pocklington Trust, a national sight loss charity committed to creating a more inclusive society for blind and partially sighted people.

References

  1. NHS England. Improving the physical health of people living with severe mental illness.
  2. UK Government. Severe mental illness and physical health inequalities briefing.
  3. Ulster University. Severe Mental Illness and Ophthalmic Health: A Linked Administrative Data Study.
  4. ADR UK. Tackling the health inequalities of people living with severe mental illness.
  5. Vieweg et al. Visual acuity and reported eye problems among psychiatric in-patients. Psychiatric Bulletin.
  6. Research on vision impairment, wellbeing and health outcomes.
  7. BMJ Open. Research on improving physical healthcare for people with severe mental illness.