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.
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.
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.