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August 24, 2014
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Cynthia Scott is your average health-conscious 56-year-old. She watches
what she eats, drinks lots of water and takes a multivitamin every morning.
She goes for frequent walks and visits her doctor regularly for checkups,
including cholesterol and diabetes screenings.
Scott also has schizoaffective bipolar disorder,
a mental illness she keeps in
check with a low dose of Zyprexa. If you were to ask Scott, she would say
she is a healthy person overall. So she was shocked when the National
Association of State Mental Health Program Directors (NASMHPD)
published a study two years ago (2006) called
Morbidity and Mortality in People with Serious Mental Illness.
The report analyzed data from 16 states and found that, on average,
people with severe mental illness
die 25 years earlier than the general population. "Hearing that made
me so sad," says Scott. (See the Year in Health, from A to Z.)
The findings were a bombshell for the rest of the
mental-health community. "The study jarred the field," says Dr. Bob Glover,
the executive director of NASMHPD. After the 2006 report came out, many
mental-health agencies in the U.S. made it an immediate priority to figure
out why their patients die sooner and how to improve their longevity. Says
Glover: "Mental health has been late
to the dance in terms of looking at the connections between mental health
and physical health. It may be moot what you're doing for mental-health
needs if people are dying so early from physical causes."
Indeed, the causes of physical illness and death
among psychiatric patients are much the same as those in other groups -
cigarette smoking, obesity, diabetes - and are treatable. The problem is
that people with serious mental illness tend to be low on the socioeconomic
totem pole and often don't get the best available health care.
Frequently, their own doctors pay little heed to their patients' physical
health. "Medical doctors think, 'Well, they're crazy,' so they don't take
their concerns seriously," says Wendy Brennan, executive director of the
National Alliance on Mental Illness (NAMI)
in New York City. "Their very real
physical symptoms are often dismissed."
One of the most common contributors
to early death among mentally ill patients, for instance, is smoking. While
about 22% of the general population smokes,
more than 75% of people with
severe mental illness are tobacco-dependent.
According to Glover, a study conducted by NASMHPD after the publication of
its mortality study found that 44%
of all cigarettes in the United States are consumed by people with
psychiatric histories. "I used to run state hospitals, and we'd use
cigarettes as reinforcement - 'You did good; you get a cigarette,'" he
says. "When people didn't do well, we took away their tobacco privileges. We
were part of the problem." The agency is now working to make state mental
hospitals smoke-free by 2011.
Obesity is another big risk factor.
People with depression or bipolar disorder are about twice as likely to be
obese as the general population; in people with schizophrenia, that
likelihood is three times greater. This is in part because so many
psychotropic medications cause weight gain. At many state hospitals, says
Glover, "you'd see a woman be admitted at 120 lb. Three to six months later,
she'd weigh 200."
Obesity-related illnesses, like
diabetes, are so prevalent among the mentally ill that health officials call
them an epidemic within an epidemic. For example, about 13% of schizophrenic
adults in their 50s have received a diabetes diagnosis, compared with 8% of
the general population of the same age.
In October, the NASMHPD released another report, with recommendations for
treating the particular problem of obesity, including giving those with
severe mental illness better access to dietary consultations and promoting
the prescription of low-weight-gain antipsychotics. The agency is currently
working on creating a tool kit for federal health-care providers to better
inform them on the issue.
At NAMI–New York City, after reading the
2006 mortality report, health workers held focus groups to assess their
patients' health concerns. There were many - foremost among them, the simple
desire to feel deserving of good health. "The most shocking thing was that
people really wanted to be healthy but there was a disconnect," says program
associate Katie Linn, who ran the focus groups. "A lot of it came down to
they didn't feel like
they were worthy of taking care of themselves."
Based on the participants' responses,
NAMI created a program called Six Weeks to Wellness, a weekly class
that teaches everything from proper nutrition to controlling anxiety through
yoga and meditation. "It's been wildly popular," says Linn. "It helps to
say, 'Your health is important to us.' They've never heard that before."
NASMHPD, the next logical step is to educate the doctors who care for the
mentally ill. This month, the agency will release guidelines for
standardizing the medical tests, assessments and care given to mental-health
patients in the public system. The recommendations include taking regular
measurements of patients' height and weight, checking their glucose levels
and carefully evaluating their medication history. Psychiatrists, likewise,
are not exempt.
According to Mental Heath
America, based in Virginia, a recent survey of people with schizophrenia
revealed that they rarely discussed physical health with their
psychiatrists. So the organization is working on an initiative with the
American Psychological Association to better educate mental-health
specialists about the physical concerns facing patients with serious mental
As for Cynthia Scott, over the past two
years she has taken her health consciousness to a whole new level, regularly
attending NAMI's yoga workshops in New York City. "I'm big on taking care of
myself," she says.
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