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Report: Mentally
ill die younger
(July
2007 Issue)
By Pamela Berard
Adults with serious mental illness who are treated in public systems
have a life expectancy that is about 25 years less than Americans
overall.
In the early 1990s, the gap in life spans was about 10 to 15 years.
The increase is alarming, notes Joseph Parks, M.D., medical director
of psychiatric services for the Missouri Department of Mental Health
and lead author of the recently released report, "Morbidity and
Mortality in People with Serious Mental Illness."
"What other group in America has lost 10 years of life expectancy
in the last decade and a half?" asks Parks, who is also president
of the Medical Directors Council for the National Association of
State Mental Health Program Directors (NASMHPD).
NASMHPD put together the study. The Massachusetts Department of
Mental Health was the first state to conduct and present results
of a study that led to the 16-state Study on Mental Health Performance
Measures, which included Rhode Island and Maine.
Mortality data was volunteered from eight of those states from
the time period of 1997-2000. Among the eight states that submitted
mortality data, it was found that people with serious mental illness
served by the public mental health system had a higher relative
risk of death. While some deaths were caused by suicide or accidents,
the majority - about three in five - died of natural causes or preventable
diseases, including heart disease, cancer, lung disease or complications
from HIV/AIDS.
In Massachusetts, the cardiovascular mortality was 6.6 times higher
in clients of the Department of Mental Health, compared to the general
population, during a three-year period.
Parks says part of what is driving the decline in life expectancy
among those with severe mental illness is the same as what is plaguing
the general population. "People with severe mental illness, even
10 to 15 years ago, were heavier and less active than the general
population," he says. Now, "We've all become heavier and less active.
We see this epidemic of diabetes and obesity in the general population.
And people with mental illness had more of these to begin with.
They are kind of the canary in the coal mine."
He says that the general population has more difficulty navigating
an increasingly complicated health care system, which he calls "a
maladaptive and rapidly failing business model." That problem is
compounded for those with mental illness. "It's not easy to use
your insurance nowadays. And people with severe mental illness have
problems with memory and organization."
A third factor, Parks says, is that some of the newer medications
used to treat mental illness present a greater risk of weight gain
and diabetes than older medications. "That is not to say they don't
have great benefits for people also," he notes.
Parks says that he does not recommend people base their choices
of medication solely on the physical impacts, but, "You've got to
look at the whole picture." He believes mental health professionals
should put more focus on helping those with mental illness stay
physically active, eat lower fat diets and stop smoking.
"The stopping smoking is huge," he says. "Forty-four percent of
the cigarettes that are smoked in this country are smoked by people
with mental illness." He suggests mental health providers ask clients
about their smoking habits or how much sugar soda they consume,
for example, and urge them to stop.
"It's going to take a lot of little interventions," Parks says.
"We're going to have to get into smoking, activity, diet. You can
successful treat somebody's anxiety or depression only to have them
die of a heart attack. What kind of treatment is that? That's like
winning the battle and losing the war."
Parks says just as the Surgeon General has leaned on primary care
to recognize mental health issues, mental health professionals must
also acknowledge physical health issues. "It goes to thinking about
the whole person. Otherwise we don't serve our clients well. Health
is an integral part of mental health."
Parks says that his group just completed a paper on smoking cessation
for psychiatric facilities to go smoke-free and they are working
on a paper on obesity. Last year, the group focused on inpatient
facilities and now at least 41 percent of state psychiatric hospitals
are tobacco free, a number that is increasing. "About one state
hospital every month goes tobacco free on grounds," he adds.
The mortality study may be viewed on the NASMHPD Web site, www.nasmhpd.org.
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