Having a Severe Mental Illness Means Dying Young

People diagnosed with serious mental illness — schizophrenia, bipolar disorder, or severe depression — die 20 years early, on average, because of a combination of lousy medical care, smoking, lack of exercise, complications of medication, suicide, and accidents. They are the most discriminated-against and neglected group in the U.S., which has become probably the worst place in the developed world to be mentally ill.

MENTAL ILLNESS

In many previous blog posts I have bemoaned the shameful state of psychiatric care and housing for people with severe mental illness. My conclusion was that the United States has become the worst place, and now the worst time ever, to have a severe mental illness. Hundreds of thousands of the severely ill languish inappropriately in prisons. Additional hundreds of thousands are homeless on the street.

But it gets worse. Having a severe mental illness also means that you will probably die very young. I have asked Dr. Peter Weiden to explain why, and to suggest what we should do about it. He is a professor of psychiatry at the University of Illinois College of Medicine and has spent his professional career working on improving outcomes and reducing side effects and complications for people with serious mental illness.

Thanks so much, Peter, for this glum but much-needed assessment. Until recently I assumed that the reduced life expectancy in the severely ill was attributable to the “big four” factors of lousy medical care, heavy smoking, sedentary lifestyle, and antipsychotic use. To my great surprise a large and well-conducted study recently found the lowest mortality in the severely ill who had received low to moderate doses as compared with those who had taken no medicine or high doses. This is just one study, and it can be interpreted in different ways, but it does suggest that antipsychotics are less the culprit in early death than I had imagined.

This possibility should focus our attention even more on lousy medical care and smoking. Clearly we mustn’t just improve the totally inadequate psychiatric care and housing currently provided for the severely ill. We must also follow Dr. Weiden’s suggestion that medical care be an essential part of the package, along with smoking cessation and exercise.

Will anything change? The (non)treatment of severe mental illness in the U.S. is our national shame. This is a voiceless constituency in the U.S. that very few people seem to care about. It is different in much of Europe, where enlightened policies and adequate funding for the severely ill lead to decent lives in the community and better health care.

There is always an outcry from the media and our politicians when there is poor health care for the military, children, women or ethnic minorities. Everyone went crazy when one person died of Ebola. We should be deeply ashamed of ourselves for neglecting the severely ill, creating a system that imprisons them, renders them homeless, and allows them to die so young. We need a Charles Dickens to illustrate their plight, and a new Pinel to free them of their chains. Two centuries ago the Age of Enlightenment banished the idea that mental illness was caused by witchcraft or possession. As Harry Stack Sullivan put it, people with schizophrenia were more simply human than otherwise. It’s long past time that we remembered this and acted accordingly.