The concept of “wellness” is in the wind these days, and a lot of the impetus for this is directly related to research findings that grew out of a 16-state pilot project sponsored by SAMHSA in 2006. When the results came in, an unsettling outcome was identified: People diagnosed with a mental illness and involved in the public system had a significantly shorter life span than the average American. In fact, up to 25 years shorter.
In Behavioral Healthcare's January issue, Ronald W. Manderscheid, PhD, contributed a comprehensive article on the 10 by 10 goal, a project to increase mental healthcare consumers' life expectancy by 10 years in the next 10 years. We want to bring you up to speed on this effort, and the most interesting way to do this is to chat with our friend Paolo Delvecchio, associate director of consumer affairs at SAMHSA's Center for Mental Health Services.
Paolo has worked for SAMHSA for the past 13 years. His job largely has consisted of promoting consumer participation and fostering recovery in federally funded programs. Over the years, he has been a persistent, diligent, and reliable voice of reasonable advocacy, fueled by a quiet passion and commitment to helping people recover from mental illnesses.
We asked Paolo to start by telling us the single most encouraging aspect of the 10 by 10 goal, and his reply will delight you: “Most of it's reimbursable!” On the downside, we asked Paolo what worried him the most about this tragic early mortality figure, and he responded, “We're going backward.”
“Backward?” we mused. “How can that be?”
“A study conducted in the 1990s revealed a reduction in life span of 15 years. Now, some 15 years later that has increased to up to 25 years,” he told us.
Now we are becoming even more worried. Lori, as part of her recovery, has been taking psychotropic medications for the past 30 years. Paolo, too, is recovering from a mental illness, so both shared a moment of silent concern. We both want those additional 25 years that everyone else is expecting to have.
Paolo went on to tell us that the average life expectancy in the United States recently has been revised upward to an all-time high of 78 years. However, by comparison, the average life expectancy of those diagnosed with a mental illness is in the mid-50s, which was the average life span in the United States in 1920.
Paolo gave us a quick summary of the National Association of State Mental Health Program Directors' (NASMHPD) 2006 analysis of the factors that contribute to this problem:
There has been a significant increase in cardiovascular disease. NASMHPD found that more than 50% of this increase was due to smoking. In fact, people diagnosed with a mental illness smoke twice as many cigarettes as the general population.
While the suicide rate for people with mental illness has increased, it accounts for only a small portion of the 25-year disparity.
There has been a significant increase in obesity and diabetes, partially due to the side effects of medication, especially related to antipsychotics, particularly atypicals.
One of the elements of the 10 by 10 campaign is a wellness pledge that organizations sign as a gesture of support and commitment to being part of the solution. In addition, SAMHSA and Boston University created a Web site (http://www.bu.edu/cpr/resources/wellness-summit/pledge.html) this past December to share creative wellness approaches. The campaign has identified three groups that need education and training:
primary care providers, who need to be better informed about how to work with mental health “consumers” to identify physical health symptoms and problems related to early mortality;
people diagnosed with mental illnesses, who need to know about and take responsibility for managing their physical conditions, and more about how to participate in planning solutions through shared decision making; and
behavioral healthcare staff, who need more information on the indicators of physical problems that lead to early mortality. They need skill development in addressing these issues in ways that promote hopefulness and self-help.
Next month we'll give you some specific “how-tos” that can guide you in developing your own wellness services and programs, and here are some ways you can get started. First, read Dr. Manderscheid's article on the 10 by 10 campaign at http://www.behavioral.net/manderscheid0108. Then, take a close look at what's happening in your behavioral health programs:
Is there any emphasis on wellness?
Is there any emphasis on preventing physical health problems by detecting early signs of problems?
Is body mass index (BMI) a required part of the service user's record?
If physical health information is collected, is it discussed with service users? Do they understand the implications? Have they been given suggestions about how to take responsibility for managing physical health problems?
Also, go to the wellness campaign Web site and read the latest information. See what you can start doing immediately to raise the quality of your service users' physical health.
By sharing our chat with Paolo, hopefully we have raised your level of awareness about the importance of physical health for people who have been diagnosed with mental illnesses. But it would be a waste to close without touching your heart, so in closing Lori shares Anna's story with you, which drives home the point of this article.