From the Desk of the Medical Director - Dr Pablo Hernandez

"Study Finds Persons Diagnosed with Serious Mental Illnesses (SMI) are Now Dying 25 Years Earlier than the General Population"

How can it be that mental illness can so dramatically cut short the human lifespan? A technical report published in October 2006 by the National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council determined serious mental illness can shorten life by a quarter of a century!

The sixteen-state coordinated study, including Ohio, revealed that 30% to 40% of excess mortality of the mentally ill is accounted for by suicide or injury. However, a staggering 60% of the deaths of persons diagnosed with schizophrenia are due to common medical conditions such as cardiovascular, pulmonary and infectious diseases.

The study also revealed that those with serious mental illness are highly likely to be obese and to abuse tobacco. Statistics support that 75% of persons with diagnoses of mental illness and/or substance abuse smoke tobacco cigarettes. Consider this information in comparison to only 23% of the general population who are tobacco smokers. An interesting sidebar to the study revealed that mental health and AOD clinical staff is approximately one-third more likely to smoke cigarettes than professionals working in other areas.

Every year, the rate of obesity across age, sex, culture, race has set off health alarms throughout the United States. Persons with mental illness are even more likely to be obese. Poverty, unemployment, residence in group care facilities, homelessness, malnutrition, psychotropic medications, and polypharmacy are just a few of the factors. Some psychotropic medications are associated with weight gain, diabetes/hyperglycemia, lipid dysfunction and insulin resistance -all modifiable risk factors- all requiring routine monitoring by a physician.

Difficulties with access to appropriate and timely health care services severely compounds the increased rate of mortality in those with mental illness. Factors such as impaired reality testing, impaired communication skills, mood instability, decreased motivation and paranoia can negatively impact timely access to services. Additional barriers to care include provider’s attitudes when working with the SMI population and coordination of care. The NASMHPD Medical Directors Council study revealed mental health consumers overuse Emergency Departments (ED). With no established primary care, non-compliance to psychiatric monitoring, no access to private insurance or Medicaid/Medicare benefits, the mental health consumer typically turns to the ED for medical assistance. Another contributing factor to choosing the ED is often that the mentally ill neglect/ignore medical conditions until emergent care is required and/or court-mandated.

What I have touched on here in terms of how much more vulnerable the mentally ill are to an early death than persons in the general population only skims the surface of a far deeper problem in our society. Changing the statistics, and therefore lengthening the lifespan of the mentally ill, relies on addressing a multitude of complex, holistic issues and identifying a coordinated approach across all human healthcare systems. Education, increased coordination between psychiatrists and primary care physicians, client and family advocacy and funding are just a few of the necessary stepping stones to add years of quality life to those diagnosed as mentally ill.

Pablo Hernandez, MD
Forensic Medical Director/Medical Director
Netcare Corporation