Dramatic Association Between Mental Illness & Early Death

By Hugh C. McBride

According to the National Association of State Mental Health Program Directors (NASMHPD), people in the United States who have severe mental illnesses die 25 years earlier than do members of the general population. 

In the years since NASMHPD revealed this information in the Oct. 2006 publication of Morbidity and Mortality in People with Serious Mental Illness, experts have identified a number of factors that may be contributing to the disparity but have yet to make much headway in closing the quarter-century life expectancy gap. 

“Mental health has been late to the dance in terms of looking at the connections between mental health and physical health,” NASMHPD Executive Director Dr. Bob Glover told Time magazine reporter Kate Torgovnik for her Dec. 3 article. “It may be moot what you’re doing for mental-health needs if people are dying so early from physical causes.” 

Potential Causes 

Most experts don’t believe that the mental illness itself is the cause of the dramatically lowered life expectancy. Instead, they point their finger at two primary culprits:

1. The prevalence of the mentally ill to engage in unhealthy behaviors (such as smoking, failing to eat well and exercise properly, and abusing alcohol and other drugs). 

2. The failure of the health care system to adequately identify and treat individuals whose conditions may prevent them from taking more active roles in their own medical care. 

The NASMHPD report (which was based upon an analysis of data collected from 18 state mental health agencies) found that although suicide and injury contribute to early death among the mentally ill, the two leading causes of death within this demographic are the same as in the general population: cardiovascular disease and cancer. 

Preventable Conditions 

In recent decades, considerable time and money has been expended in the effort to educate the public about the heath risks associated with tobacco. And though the message appears to be getting through within the general population (adult smoking rates in the United States have been on the decline for decades), the problem remains prevalent among mentally ill individuals. 

An Oct. 7 article in the Australian and New Zealand Journal of Public Health reported that smoking rates among the mentally ill are four times as high in the general population, and that mentally ill smokers consume 50 percent more cigarettes than do smokers within the general population. 

“Smoking compounds many of the health problems already experienced by people with mental illnesses,” the study’s author, Kristen Saxone-Moeller from the University of Melbourne, said in an Oct. 8 article on the ScienceDaily website. “Combined with drug therapies that often make them overweight, they are at even greater risk of diabetes, heart attacks and strokes if they smoke.” 

In the Time article, Glover notes that some mentally ill individuals may have actually been conditioned to smoke by the very people who were charged with their care. 

“I used to run state hospitals, and we’d use cigarettes as reinforcement – ‘You did good; you get a cigarette,’” Glover said. “When people didn’t do well, we took away their tobacco privileges. We were part of the problem.” 

A Vulnerable Population 

Though hospitals have abandoned the practice of promoting smoking, the medical industry continues to contribute to the physical health problems experienced by mentally ill patients. For example, the NASMHPD report notes that newer generations of antipsychotic medications tend to have less-than-positive effects on patients’ physical health. 

“With time and experience the second generation antipsychotic medications have become more highly associated with weight gain, diabetes, dyslipidemia [abnormal levels of blood lipids], insulin resistance, and the metabolic syndrome,” the authors wrote. 

At least these patients have the benefit of interacting with health care providers. With elevated rates of poverty and homelessness among the mentally ill population, many have little or no access to even the most rudimentary health care services. 

“The public health system is underfunded, and it’s gotten worse over the years,” Andrew Leuchter of the UCLA School of Medicine said in a May 3, 2008 USA Today article. “[When mentally ill patients try to get medical help] I hear of great difficulty getting appointments even for simple problems like high blood pressure.” 

Fixing the Problem 

In addition to documenting the extent of the problem, the authors of NASMHPD’s Morbidity and Mortality also called for a number of changes to the ways in which mentally ill individuals interact with the health care system. The following are the four primary recommendations as listed in the report’s “What Should be Done” section: 

1. Prioritization of the public health problem of morbidity and mortality and designation of the population with SMI as a priority health disparities population. 

2. Tracking and monitoring of morbidity and mortality in populations served by our public mental health systems (surveillance). 

3. Implementation of established standards of care for prevention, screening, assessment, and treatment. 

4. Improved access and integration with physical health care services. 

In sections of the report that address specific changes to be made on the national, state, and provider/clinician levels, the authors call for measures that include better funding, continued education and awareness initiatives, and improvements to the manner in which health and wellness information is conveyed to mentally ill patients. 

For Joseph Parks, the director of psychiatric services for the Missouri Department of Mental Health, these and other efforts can’t come to fruition soon enough. “Many struggle for decades to overcome mental illness,” Parks told USA Today writer Marilyn Elias, “and after all that struggle, it’s particularly cruel to think that you would die young.”

 


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