Media reports of suicides of high-profile individuals make it easy to believe that suicide is a leading killer of people with serious mental illness. It’s not even close, falling behind largely preventable conditions such as heart disease (10 times higher than suicide), cancer, diabetes, and other chronic diseases.

Although these diseases can affect anyone, they make for a particularly lethal combination among people with serious mental illness. In fact, people with serious mental illness die 10 to 25 years earlier than the general population.

It’s not difficult to understand why. Even in the wealthiest countries, people living with serious mental illness face everyday challenges that complicate their ability to adopt healthy choices and seek needed care. The same is true in low- and middle-income countries, but with added barriers. In those countries, 90 percent of people with serious mental illnesses are outside the formal health care system because they are confined to their homes or in social or penal institutions.

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We can do something about these disparities, and a growing set of global evidence is showing the way. That is the main message of new care guidelines released this week by the World Health Organization and of Healthier Longer Lives, an international conference on serious mental illness taking place in New York City.

Several things have been proven to help people with serious mental illness live healthier, longer lives.

One requires changing perceptions among health care workers and caregivers that people with serious mental illness are “beyond help.” All too often, people living with serious mental illness face stigma at routine health examinations, are passed over for health-related advice, and go without necessary and timely treatment for physical problems like high blood sugar, high blood pressure, and being overweight. As a result, entirely preventable diseases aren’t being diagnosed and treated.

People with serious mental illness, for example, are two times more likely than the general population to use tobacco and often die younger due to preventable tobacco-related health conditions. The new global guidelines make clear that the smoking-cessation interventions recommended for the general population should also be offered to people with serious mental illness.

The new WHO guidelines demonstrate that everyone who provides health services to individuals with serious mental illness can make a difference in their health. That begins with primary health care providers, some of whom are so overwhelmed by addressing the myriad challenges of people with serious mental illness that they refer them to specially trained providers. The primary health care system should be any community’s first and main point of contact with the health system and, when that system works well, it should address the vast majority of individuals’ health needs — both mental and physical — across their lifetimes.

On a broader scale, we need to redesign the current health care model and integrate the provision of primary and psychiatric clinical care with another vital element: the community.

People with serious mental illness need a supportive, long-term community for meaningful behavior change. A primary care doctor can prescribe medicines to someone living with serious mental illness who also has obesity and diabetes, but if that person doesn’t exercise or have support from peers to eat better, the medicines won’t have their intended effects.

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One of us (R.A.) works with Fountain House, which is based in New York City. With 340 “clubhouses” in 32 countries, it offers a model for how community support can strengthen clinical care. Fountain House creates places of inclusion that welcome, encourage, and engage those living with serious mental illness as active participants in their own recovery. To address preventable illnesses such as diabetes and high blood pressure, it offers fitness and nutrition programs and health education to lose weight, eat healthier, reduce stress, stop smoking, and stay sober.

This model seems to work. A study by researchers from New York University, funded in part by Fountain House, found that Fountain House participants have lower hospital re-admission rates compared to those not benefiting from community support, as well as 21 percent lower total cost of care.

In the U.S. and around the world, community-based care has the potential to make a big impact, especially when you consider the economic burden of mental illness: The global economy is estimated to lose $16 trillion between 2010 and 2030 due to mental disorders.

Many resources are already available — and now new guidelines for health care providers — to reverse the devastating trend of premature death among people with mental illness and make their lives healthier and longer. Let’s start now.

Shekhar Saxena, M.D., is a visiting professor in the Department of Global Health and Population at the Harvard T.H. Chan School of Public Health and was previously the director of the World Health Organization’s Department of Mental Health and Substance Abuse. Ralph Aquila, M.D., a practicing psychiatrist, is the medical director of Fountain House. He is a consultant for several pharmaceutical companies.

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  • Everyone has a mental illness in this world. Fix that.
    On that note, there is something terribly wrong with everyone. It varies as to what it is and how much they are able to live “normally” without it being noticed, but everyone has at least one major mental illness. Some deeply seeded deformity of the thinking process. Everyone.

  • The issue of people diagnosed with major mental health problems dying 20-25 years prematurely has engaged many of us who have experience especially in the public mental health systems. One factor that hasn’t received enough attention is the high incidence of alcohol/drug abuse and addiction. As a former state mental health commissioner and director of alcohol and drug treatment services as well, I learned that we could match public health death records with enrollment records for public mental health and addictions services. What I learned was that people who had at least one enrollment in both systems died at the average of 45 years old. Of course, this is only one study but it certainly suggests that paying more attention to people with dual disorders is worth more study and attention. I am now chair of the board of a 12 step program, Dual Diagnosis Anonymous of Oregon which provides peer supports for people and offers some practical alternatives to ignoring the issue. It is well-received in this state and meetings have started in the past 2 years in the United Kingdom as well as many other states. We have a lot of work to do and more to learn.

    • Ms Nikkel,
      Comparing any research to what goes on here in the US is a real mistake. the UK has a public health service, and ‘Socialized Medicine.” In the UK people don’t go for years without medical or psychiatric care, like in the US. Here in the US, this Dual Diagnosis is well documented, but there was no profit in researching or treating it.
      The ACA was supposed to address these issues, but it was undermined by the insurance, pharma and medical provider industries. Here in the US it was just more profitable, to stigmatize, ignore or discriminate against these people.

      I am so sick of industry trolls getting on here and selling whatever it is they are peddling this week.

  • Mr. Debacher,
    I shall be brief then, I do go on sometimes. Low dose Lithium sounds great, people living in areas with naturally occurring Lithium, in their drinking water tend to be happier. Of course we need a lot more than that to cure our ills. Personally I find that Lithium in hot springs makes me feel really good. Like everything else, things are a lot more complex than they appear.

    I think that getting rid of Neo liberalism would go a long way towards lessening mental illness, general distress, and corruption in our pharma industry, and the commoditization of health.

  • The US does not follow any of the WHO guidelines. There are few if any regulations, attempts to track outcomes or even standards of science based prescribing methods. In spite of what is being advertised here, there has been no improvement in the treatment of these individuals in 50 years. Clinicians are even recycling old treatment, drugs and things like electro- shock, and peddling it for a new audience.
    A young man with Schizophrenia was shot 17 times by the police, yet the only so called Advocacy Group was funded by pharma and one of the providers who contributed to his death. The hospital where he was denied treatment, donated money to the advocacy group, and the behavioral health clinic, that failed him. The same behavioral health clinic, refused to protect both their clients, and their employees, which contributed to his death. The circle of corruption denial and deception, was helped along by local news outlets, and a corrupt state government. The facts have been kept from the public, as the number of incidents, suicides, addictions are rising. The public is unaware that their tax dollars are given to religious non profits, to provide behavioral healthcare. Religious non profits are outside the law, they have no reporting requirements, no accountability. In many states these religious non profits are the only providers. They appear cheaper, because there is no accountability. There is no one tracking how many of their clients end up dead, in jail, drive into despair and poverty, or even suicides. All of these adverse outcomes are dismissed. When the news headlines show another tragedy, shooting or child abuse story, the complacent public does not even ask why or how anymore. These articles are written to mislead. The people with assets, support systems and money are entitled to a different form of care. Low income people who are not discussed here, are forced to forced to go to random non profits, that get tax payers funds to deliver care that is far beyond sub par. The term non profit, has given these organizations a level of secrecy, and misinformed the public. They are misled to believe these non profits are less expensive or have some kind of ethical concerns. The opposite is true, in Fact the religious designation, absolves them of any accountability or even the use of evidence based care. They can apply prayer, faith, and pseudo science, while their CEOs and Directors rake in massive salaries. These salaries are extracted directly from the money that was supposed to provide care. These topic are almost never covered in any healthcare discussion. The public is once again being Gas Lighted. We can look at the horrors of History to see what religious mental healthcare looked like. It was a chamber of horrors, torture is a better description. We are repeating History. There is no accountability at all, pharma insiders made sure the outcomes would not be tracked.

    The only discussion in mass media, now is an endorsement for pharma. Most Americans don’t know that mental health care for most Americans is not like it is presented on TV. It is people with serious issues rotting in prison, or so demeaned by the process they have no hope for the future. Many are forced into joining churches, where they are exploited and lied to. The religious non profits believe that prayers cure Bi Polar Disorder or Depression. There is no scientific evidence that they do, but that was misreported also, by mass media.
    No one tells the real stories. The families living in fear or destroyed by this scourge. The generational nature of these disorders, is ignored by the providers. No one explored how Pharma with the help of psychologists expanded their market to include anyone in distress. Anyone looking at this objectively would see a criminal conspiracy, which WHO already has.

    • “…Pharma with the help of psychologists expanded their market to include anyone in distress.” Did you mean to say “psychiatrists”? As a psychologist who worked 18 years in a large state psychiatric hospital, I am quite familiar with the US mental health care mess, but please provide a link to where I can read about the “criminal conspiracy” that WHO has seen.

    • Mr. DeBacher,
      In many places in the US, Psychiatrists are no longer required to dispense psychiatric medications. Social Workers, Nurses and Physicians Assistants can prescribe. Plenty of Psychiatrists are involved too, they sign Gag Orders and remain silent about the horrors they are participating in. A lot of the factual information is proprietary too, owned by Pharma or other interests.

      WHO can only look at the data available, and see trends through the statistics. The numbers they refer to here, point to the premature deaths. As far as I know, no one is tracking why. There is a strong correlation with factors like, income, family and support system. That means the people with serious M.H. issues, that have money or a family with money will live longer and do better.
      Pharma and industry insiders made it nearly impossible to track much more than the death rates. For example, local behavioral health providers, are often religions non profits. These organizations have no reporting requirements, not much accountability, their non profit status insulates them. When one of their employees prescribes a medication, often without even medical oversight, and the patient ends up in the ER, no one tracks the medication or combination that put them there. Pharma is well aware that tracking any of this, is not profitable, if a particular brand name kept popping up it would look bad. The same with dead mentally ill, who die of exposure, no one asks what if any treatment they got.
      Who could only look at reported numbers like the deaths. Their investigators did not go to individual hospitals or treatment providers. They did not go and spend a couple of weeks with an American family, that is dealing with a family member, or members afflicted with mental illness. No one in the industry, ever followed a family over 20 years. No one ever looked at the roll of marketing and pharma on prescribing rates, outcomes or even some level of accountability.
      Years ago, I started asking, why are some of these people repeatedly ending up in the ER. Week after week, the same medication, the same clinic prescribing. At the same time I knew families dealing with these issues, over the years there was always another medication, another experiment, another incident. This goes on over decades. Mentally ill in our community interacting with the police, sometime ending in a high profile police shooting. Every winter a few die of exposure, overdoses or violence.
      Nothing has improved in 50 years. Most of the practitioners have no idea the person they medicated last week was in the ER, or dead. They don’t bother to find out if say the person with Bi Polar Disorder, has a family that lives in fear, of the next incident. No one bothered to track or research the effect on families, and other interactions. Pharma certainly did not provide any funding for that kind of research. In Fact they funded only research, that could put them in a good light.
      Our media has perpetuated a kind of discrimination that completely denies the humanity of anyone even suspected of a mental illness. Plenty of popular sites like this one, along with pharma supporting TV Shows, pharma funded advocacy groups, and even support groups online, that are directed by pharma and marking concerns, have led us to a point where WHO is pointing out serious flaws. No American group is capable of looking at any of this objectively, they are all beholden to Pharma.
      I have interacted on every level and my paycheck does not depend on what I write here. Unlike so many of these providers, Psychiatrists, Psychologists, Social Workers whose careers depend on their silence, I actually talk to a lot of these people, and have had to interact with them daily. The really terrifying thing are the younger ones, put on medication at an early age, not because of a real mental illness, but because of trauma, poverty or what I call, Disregulated parents. It is really clear that a lot of this early trauma leads to mental issues. Instead of researching any of that, these children are simply medicated. There is not much research there either, it is done randomly, with only the guidance of pharma marketing. These kinds will have problems the rest of their lives, their development stunted without a thought.
      The Failure to even collect data, on any of this points to a conspiracy, one of greed, obscene profits, and a lot of media misdirection. Perhaps you should start reading you local paper, and see how they sensationalize the “crimes” attributed to the mentally ill. They even turned these into marketing for pharma, not an objective look at the system. Just look at the marketing on this site.
      Mental Health care in this country is a horror show. It has not improved much since the 1950s. In Fact rates are climbing, along with the suicide rates. They always try to mislead the public with studies done overseas, and pseudo science. None of the marketing has improved the lives of anyone. The marketing always leaves out the facts. We have a system that rewards bad behavior, requiring clinicians to pile in the diagnosis to maximize billing. No one researched the effects over time. Most of the advocacy focuses on paying the providers, or having access to medication. It is a given that people with these disorders tend to die, and there is no expectation of real improvement.
      Like I stated previously they expanded all of the descriptions, not because it improved diagnosis and treatment, but to increase billing and medication opportunities. There is not the slightest expectation of an outcome anymore. All we can do is look at the death rates, which have been normalized in our media.
      WHO merely pointed out the problems, they did not correlate it to the lack of objective research or the pervasive pharma and industry marketing. No media is covering this objectively. Instead they run articles about resilience. In my community, even after a horrific death, they ran anecdotal stories, where they interview a person who thinks they were helped. Years ago i did surveys on this population. I realized the surveys were not designed to objectively measure anything. What they were measuring, and presenting as fact based data, was qualitative data, that only reflected the Hawthorne Effect. Since then that model has been adopted by the VA and the hospital and medical provider industry.

      Wakey Wakey, you worked in the Industry. Upton Sinclair stated, “It is difficult to get a man to understand something, when his salary depends on his not understanding it.” Professionals, content marketers and corporate propagandists tend to jump in here, and defend the industries that profit from this Hellscape. It is a conspiracy of greed.

    • I will go and find links to the relevant WHO information and digest it on my own. A commenter on several sites, I have observed that the longer a comment, the less likely it is to be read seriously. After all, at a live research paper presentation, even comments by “experts” are expected to be succinct. I have tried to seriously read your comments, but am only partly clear on your goals. Though I have had occasions to correct psychiatrists about their prescriptions and their discharge recommendations, I cannot accept that they are financial slaves to Big Pharma.

      My own crusade is to get this nation on low-dose lithium, the most effective, safest, cheapest, and most available way to combat neurodegenerative conditions. Big Pharma can’t make money off the third element, so they focus on what they can develop for big profits. A few in the psychiatric community have said publicly that they think low-dose lithium is an excellent option, but the neurology community is resistant. (My own two neurologists are fine about my being on it, but are not routinely prescribing it themselves.) Based on my own experience, I again suggest that you post shorter comments, list your goals clearly and succinctly, and provide links to studies where relevant.

  • All too often, people living with serious mental illness face stigma at routine health examinations–??

    They face prejudice and discrimination. Please do not call it “stigma”.

    Harold A Maio

  • First you will have to stop giving them psych meds. They are the biggest drivers of early death. Ever wonder why diabetes, etc. is so rampant in the mentally ill? Because a large amount of psych meds cause them, particularly antipsychotics. New evidence is showing antidepressants alone account for a shortening of life close to 20 years. How about someone spends some time really researching the long term consequences of them and practicing real informed consent?

    • Terrie,
      The research has not been done for a reason. The current medications are profitable. The media continues the discrimination, in order to obscure the facts, and peddle more pharma. The pharma industry lobbies against research, accountability and facts. They are making plenty of money selling off label pharmaceuticals, for disorders that are not improved with these drugs. They marketed anti psychotics for PTSD, sleep, and situational depression, to people over 65, that research already showed could die from these drugs. At the same time mental health providers are revisiting old drugs, like Lithium that were proven to be toxic. The Facts are terrifying!
      A physician recently did a “Clinical Trial on Lithium for children, it was unscientific and put these children and their families through heck. He did not even track the blood levels in the children. He lied to desperate parents, and one of the subjects begged his mother for death. The mass media did not cover it. Stories like this get suppressed, because they might generate questions about the role of pharma, the research process, and inform the public.
      Kaiser Health News offers a more objective view of these topics, this site is more industry friendly.

  • Providers and patients will have to think carefully to target efforts on this issue. I’ve been both a provider, at a state psychiatric hospital, and a patient with bipolar type 2. I ran support groups for depression and manic-depression in the community. Many of the patients in the state hospital were certainly having serious physical health issues, had limited ways to get treatment after discharge, and likely would have shortened lives. But I and most of my support group attendees had enough opportunity to access both physical and mental health care in the community, so at least some of us have led long lives. I would not want patients reading this article to assume they would die much sooner than average. I’m 76, and in spite of recently acquiring several serious health issues, I’m better physically and mentally than I was five years ago.

    It will help to have universal health care insurance properly restored, and to better integrate physical and mental health care in the community. Tracking patients with the most serious mental health issues in the community remains a challenge, but some model approaches have shown success. It can be hard to clone or disseminate such programs, and regrettably, an innovative program may itself die of senescence because its creators are replaced by those who lose understanding of the original model and methods.

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