Contrary to what may be a popular belief, a person with serious mental
illness is more likely to die of a heart attack or complications from diabetes
than by suicide.
Misperceptions about the health care needs of people with mental illness
extend even to health care professionals, which may be one of the reasons such
patients are dying prematurely—25 to 30 years earlier than other
Americans, according to federal health statistics. This gap in life expectancy
is an increase from the 10- to 15-year mortality difference in the early 1990s
between individuals with mental illness and others.
To reverse this trend, advocates for people with mental illness recently
called for federal intervention, including improving the tracking of these
individuals' physical and mental health; removing obstacles to their receiving
quality, integrated physical and mental health care; and encouraging primary
care providers to work in close proximity in the same facility with mental
health clinicians to improve provision of that care.
"We have to get past the point of psychiatrists saying 'I don't do
that internal medicine stuff,' and internists saying 'I don't want to take all
of the time that people with mental illness need,'" said Joe Parks,
M.D., medical director of psychiatric services for the Missouri Department of
Parks and other mental health experts briefed congressional staff in June
on the need for federal efforts to reverse the declining life expectancy for
people with serious mental illness. The briefing was organized by the Senate
Mental Health Caucus.
It was Park's 2007 report that identified the lower life expectancy of
people with serious mental illness compared with the general population and
that dispelled the "suicide" stereotype behind the early deaths.
Early deaths, Parks said, were largely due to untreated or undertreated
nonmental chronic health conditions. Among the leading preventable medical
conditions driving the increased morbidity and mortality in this population
were metabolic disorders, cardiovascular disease, and diabetes mellitus.
Park's research also found a high prevalence of modifiable risk factors,
including obesity and smoking. Cigarette use, he noted, is so widespread among
people with serious mental illness that they now smoke about 44 percent of all
cigarettes sold in the United States. "We really need to focus on
smoking because it is a big opportunity" to prevent disease and death,
The prevalence of risk factors among people with serious mental illness is
exacerbated by poor health care access among this population and by the stigma
they face—even from medical professionals, according to a consensus of
Similar health disparities exist even in populations with broad access to
health care, such as veterans, said Barbara Mauer, a health care consultant in
Seattle. Mauer, who has studied the issue, blamed both the negative attitudes
of health care providers toward mental illness and a failure to educate
patients to seek both needed mental and primary health care.
Research studies designed to address disparities between mental health care
and general health care have found health improvements when nurse case
managers coordinate both mental and physical care for each patient, while
educating and giving patients new skills to better manage their own
Analysis of one nurse case manager pilot program found that medical
problems were newly detected by staff in one-third of participating patients
taken to a mental health facility for evaluation and treatment. At the same
time, there was an increase in disease-prevention health care provided to
Another pilot program approached the challenge of split—and therefore
fragmented—mental and general health care from the behavioral health
care side by placing nurse practitioners in mental health clinics. In one such
program in Massachusetts, the nurse practitioners ensured that the mental
health patients also received general health care services.
A Colorado pilot program that is addressing health care providers' negative
attitudes toward mental illness and improving access to care has found some
success. The integrated care program in Summit County combined the staffs of a
community health center and a mental health clinic to create "care
teams" of general and mental health care providers within a facility
that had previously emphasized general health care. The program provided
training for the mental health staff in the common physical health care needs
of people with mental illness and educated the general health care providers
on signs that patients may also need mental health and substance abuse
Among the biggest impacts of the program was the improved communication it
encouraged between two traditionally separate organizations, to the extent
that both were comfortable referring patients and seeking additional
information from the other side of the program.
"It's important to share our knowledge and share our
ignorance," said Helen Royal, a nurse in the program.
Advocates at the congressional briefing said the federal government can
encourage such pilot programs by including funds for them in their established
Also, the Community Mental Health Services Improvement Act (S 2182 and HR
5176) would create a new grant program through the Substance Abuse and Mental
Health Services Administration (SAMHSA) to fund the co-location of primary
care services within mental health organizations. The legislation, which would
provide $50 million in grants for the first year of a five-year program, was
included in draft legislation to reauthorize SAMHSA, but that legislation has
stalled for the year.
Supporters are optimistic that the grant program will be revived in
Congress next year, along with efforts to require insurers to cover smoking
cessation and obesity treatment programs.
The text of S 2182 and HR 5176 can be accessed at<http://thomas.loc.gov>
by searching on the bill numbers. ▪