Adults with serious mental illness (SMI) die 25 years younger than other Americans. This means that a man with SMI is likely to die by age 53, compared with other men of the same age (who can be expected to live until age 78). I have never encountered a more troubling statistic! Urgent action is needed to address this glaring, unacceptable disparity.
In April, Craig Colton and I reported mortality statistics for persons served through eight state mental health agencies.1 Although the numbers vary slightly from state to state, it is unmistakably clear that the disparity in length of life for both male and female consumers is approximately 25 years, compared with the general population. The situation for people with SMI is actually worse now than in 1986, when the disparity was estimated to be 10 to 15 years.2
Examination of the causes of death show that about 15-20 years of the disparity can be attributed to diseases such as heart and circulatory disorders, diabetes, or other long-term diseases prevalent in elderly Americans. In most instances, these disorders either can be controlled or prevented with quality healthcare that emphasizes early detection, good eating habits, no smoking, exercise, etc. It is well known that persons with SMI often do not take care of their physical health needs for many reasons, including lack of access to care. Five to 10 years of the disparity is attributable to suicide, which can be prevented with access to quality mental healthcare. Further research is needed to explore the role of psychotropic medications in the onset of these disorders.
A major underlying factor in all of these causes is that many mental health consumers have lost hope, frequently because they have not been in a recovery-oriented system that encourages a future life in the community for them. And lacking hope certainly will not help consumers overcome physical health problems—and may make matters worse.
Saving lives and restoring hope are more than ample justification to implement the recent Institute of Medicine report on Improving the Quality of Health Care for Mental and Substance-Use Conditions.3 This report calls for the close coordination and, when appropriate, the integration of mental and primary healthcare. Similarly, Goal 1 of the President's New Freedom Commission on Mental Health recognizes the inseparable relationship between mental and physical health.4
A public health model developed more than 25 years ago provides a conceptual foundation for addressing this large disparity in mortality.5 Aptly called the Wellness Model, this work views illness and wellness as two separate dimensions of health. Illness refers to disease, wellness to one's outlook, social supports, and self-care activities. When combined, these two dimensions frame two strategies for achieving recovery—traditional biopsychosocial interventions and improved self-help and lifestyle changes (figure). Both strategies will be necessary to address this large disparity in mortality and to restore hope to consumers.
Figure. The Wellness Model applied to premature death. Illness and wellness are two independent dimensions. True health and well-being demand that attention be directed to both dimensions. Many mental health consumers are not only ill but also lack wellness (i.e., lack hope). Two separate paths are required to address the two dimensions: one addresses physical health problems, the other wellness problems. “Yes” and “no” represent ends of each continuum (illness and wellness). Most consumers are ill (yes) and not well (no). The Medical Director's Group of the National Association of State Mental Health Program Directors is developing a strategy to work with consumer and family groups, mental health providers, and state health agencies to improve screening and services for physical health problems experienced by consumers with SMI. Clearly, a major segment of this work will involve engaging consumers and their friends and family members in self-help activities and lifestyle changes. This also will facilitate achievement of two primary goals of recovery—increased independence and hope.
As the field begins to engage this tragic issue, we need to set clear and compelling goals (e.g., reducing the disparity by five years within a five-year period). We also need to implement quality- improvement measures to document progress. Mental health consumers in public service settings deserve no less than our very best efforts.
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.