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The 10 by 10 goal

January 1, 2008
by Ronald W. Manderscheid, PhD
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By working together we can increase mental healthcare consumers’ life expectancy by 10 years in the next 10 years

Early in the spring of 2006, Craig Colton and I reported findings on premature mortality of public mental healthcare consumers. Our findings were both startling and disturbing: Public mental healthcare consumers die 25 years younger than other Americans. Male consumers are likely to die by age 52; female consumers by age 58. These numbers are comparable to life expectancies in the United States more than 100 years ago, before the era of modern medicine!

Our findings have fostered concern and mobilization across the mental healthcare field. The National Association of State Mental Health Program Directors (NASMHPD) issued a landmark policy paper on actions that state mental health agencies can take to address this crisis. Central to these efforts are basic screening and treatment for high blood pressure, obesity, diabetes, and heart disease, as 60 to 80% of the disparity in life expectancy is due to chronic health conditions.

SAMHSA's Center for Mental Health Services (CMHS) also is addressing this crisis. On September 17 and 18, CMHS's Consumer Affairs Program hosted a Wellness Summit specifically focused on this problem. The heart of the summit was the enunciation of a national call to action: to reduce the life expectancy disparity by 10 years within the next 10 years (“10 by 10”). Participants also made a voluntary pledge to personally foster consumer wellness.

Consumer, family, advocate, provider, researcher, national organization, and federal government participants enthusiastically embraced this vision for change, as well as the 10 by 10 national goal and the pledge. SAMHSA Administrator Dr. Terry Cline sees the disparity in life expectancy as a critical challenge demanding a public health response. CMHS Director Kathryn Power frames it as a major focus of national system transformation efforts.

During the summit participants reported on a diverse range of impressive efforts under way to improve consumers’ health. Particularly noteworthy are the efforts of the National Council for Community Behavioral Healthcare to implement healthy lifestyle initiatives in local community mental health centers, as well as the direct efforts of consumer self-help and peer-support programs across the nation. The summit pointed to the need for a clearinghouse to share information on health promotion interventions achieving successful results. I counted no fewer than 20 such interventions and programs during the summit. Information on these programs needs to be shared broadly.

A strong spirit of collaboration and partnership permeated the summit. All groups are prepared to work closely together to address the crisis. Such unanimity of purpose and action is rare. A consumer noted that the summit gives one cause for hope in the future.

Clearly, major challenges lie ahead. We need to identify and foster primary care partners who will work collaboratively with us to address our consumers’ chronic health problems. As I reported in Behavioral Healthcare's October 2007 issue, efforts are under way to foster a dialogue with our medical colleagues using the framework of the medical home model. There is an urgent need to implement collaborative care that embraces mental health, substance use, and primary care. This collaboration can work only if we also address key financing issues such as Medicaid audit restrictions on payment for mental health and primary care encounters on the same day.

In addition, we need to evolve new approaches to prescription and use of psychotropic medications. The secondary weight-gain effects of some of these medications need to be viewed as health risk factors that are planned for as part of the care process, just as we plan and intervene for other risk factors. Joint consumer-provider planning and shared decision making can facilitate this new approach. Such health promotion regimens are clear examples of preventive interventions for anticipated chronic health problems in the future.

It's important to remember that states have an important role in achieving 10 by 10. They collect and report mortality data to document changes in life expectancy, and they provide information on the relationship between mental health problems and chronic health diseases through vehicles such as the CDC's Behavioral Risk Factor Surveillance System. This work helps achieve closer collaboration between state public health and mental health agencies.

My hat is off to Paolo del Vecchio (CMHS associate director for consumer affairs), Kathryn Power, CMHS, SAMHSA, and NASMHPD for taking leadership in this critical area. We not only can—but we must—achieve 10 by 10!a

Ronald W. Manderscheid, PhD, currently Director of Mental Health and Substance Use Programs at the consulting firm Constella Group, LLC, worked for more than 30 years in the federal government on behavioral health research and policy. He is a member of Behavioral Healthcare's Editorial Board. To contact Dr. Manderscheid, e-mail