Premature Mortality Among People With Severe Mental Illness (SMI)

Volume 8 Issue 4 April, 2018

Mental illness (MI) accounts for one third of all years lived with disability throughout the world, and despite its tragic position as the leading cause of global disease burden, MI is underappreciated for its impact on overall population health. For instance, over three decades of research into the morbidity and mortality of individuals with severe mental illness (SMI) has consistently revealed mortality rates two to three times higher and a life expectancy of 25-30 years shorter compared to the general population. While public descriptors of people with MI have included “in need of help”,“unpredictable”,“violent” and “dangerous”, mention of shortened life span or risk of dying is absent. These omissions imply a poorly informed public; SMI is now clearly known to be associated with premature mortality and in this sense should be considered potentially fatal.

Contrary to popular belief, the main causes of premature death are not drug overdose or suicide, but rather, preventable illnesses such as cardiovascular disease, diabetes, tuberculosis and HIV/AIDS. Incidence of other preventable conditions, such as obesity and respiratory disease, is also much higher among patients with SMI. This is aptly expressed by a mental health care professional as “We talk about people with MI and people with diabetes, and smokers and the obese, and so on and so on. We’re talking about the same people – just with different labels.”

Such findings bring significant questions: what is the cause of this disparity in mortality/morbidity? What can health care professionals do to help reduce this gap? We know SMI being complex disorders with multifactorial etiology, the factors responsible for premature mortality are multimodal.

A recent report by the Early Onset Illness and Mortality Working Group outlines several factors that may contribute to poor physical health of people with SMI. Some factors, such as those related to the mental illness itself and socioeconomic status. Other contributing factors include behavior and lifestyle and poor preventative medical care, both of which are more easily modifiable with the assistance of medical care practitioners. Undoubtedly the cause of premature mortality also includes factors like, poor access to care, stigma preventing the seeking of care, reduced insurance reimbursement for mental illnesses, insufficient workforce of mental health clinicians, inadequate funding for research on mental illnesses, and more.

Despite the “right to health” having become law in 126 countries worldwide, this huge loss of life among people with mental illness needs to be recognized as a human rights disgrace. Key Actions that can be taken to improve both the physical and mental health of people with SMI as proposed by WHO are;

1) Create protocols for both the physical and mental health needs of patients with severe mental disorders in the following areas: prevention, identification, assessment and treatment., 2) Improve access to general health services through the integration of physical and mental health services, 3) Work to overcome the stigma often associated MI and end discrimination that sufferers often endure.

Through education and advocacy, mental health care professionals can improve standards of care to include more comprehensive, integrated, and robust care for mental illness and other medical conditions with a focus on prevention, treatment, resilience, and recovery.

To conclude, individuals with SMI are potentially vulnerable along biological, psychological, and social dimensions, and they may have complex and multiple comorbid medical conditions and diseases, fragile social circumstances, and other co-occurring conditions that contribute to premature mortality. We need to recognize that this work is a far-reaching public health challenge that will require highly coordinated, integrated, multicomponent responses at local and national levels.