Death by Diagnosis
Dhruv Khullar, MD in an article in the New York Times of June 7, 2018 described the serious health disparities that Americans living with serious mental illness face. According to Dr. Khullar people living with serious mental illness die 15-30 years earlier than those without a serious mental health condition. That is an enormous reduction in life expectancy when we consider the general statistics that people live longer. It’s a myth that people living with serious mental illness are more likely to die from suicide, overdoses and accidents. In fact, they are more likely to die from diseases like cancer, heart disease, stroke, diabetes and respiratory problems. They are less likely to enter into doctors’ offices and hospitals and when there the treatment options may be limited and the problems they are presenting may be attributed to their mental health problem. Their ability to follow a diet or health regime, take medication, maintain appointments or remember to take prescribed medications may be effected by symptoms related to their mental health condition. If we add the realities of high rates of homelessness, poverty and social isolation experienced by people with serious mental health problems to higher rates they experience of obesity, physical inactivity, poor nutrition and tobacco use we can begin to identify how their health problems are accelerated.
Brendan Reilly, MD in a recent article in The New England Journal of Medicine commented on his late brother’s journey through the health care system where is spinal cord damage and resulting quadriplegia was ascribed to his mental health condition. For physicians, family members and people living with serious mental illness the most serious aspects of the person’s mental health problems may be where treatment is focused and other diseases and conditions may be neglected.
How can the gap be narrowed between life expectancy for people living with severe mental illness and those without those problems? Can healthcare professionals learn to make accommodations through changes in treatment delivery or supports offered to individuals with severe mental health problems when they are experiencing health issues? And, can we help people living with severe mental illness maintain their physical health and wellness through specialized prevention programs geared to their needs. To accomplish change the role of the primary care physician or internist as a valuable member of the professional team needs to be reconsidered.
Key words: health disparities and mental illness, serious mental illness, disease and mental illness, life expectancy and mental illness