The main author of the current study, Professor Wahlbeck, suggested a number of possibilities for the decreased life expectancy within this population:^
“These include an unhealthy lifestyle, inadequate access to good-quality physical healthcare, and a culture of not taking physical disease into consideration when treating psychiatric patients. In addition, people with mental illness are more often poor, unemployed, single and marginalized - all known risk factors for poor health and premature mortality.”
Addressing health disparities, such as differences in mortality by population group, is an important goal for public health.^ Individuals with mental health conditions are a particular group affected by health disparities. Another expert in the field, Professor Graham Thornicroft, commented, “If such a disparity in mortality rates affected a less stigmatized section of the population, then we would witness an outcry.”^
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| Image from ArtTherapy |
An unbelievable example of such a case involved a 56-year-old Californian man who had been hospitalized a number of times for serious mental health conditions.^ A friend came by to check on him, because he said he was not feeling well. His friend found him unresponsive and called for help. He was pronounced dead by emergency responders. A number of people thought the death was caused by an accidental drug overdose or suicide due to his past history. However, an examination found that he died of complications from emphysema - a preventable lung condition. Possible heart complications, associated with the emphysema, may explain the sudden death. He had been a heavy smoker for over 25 years. Although he had frequently been admitted to the hospital and had contact with health professionals, he died 20 years early as a result of tobacco use. Hospital records indicate that he tried quitting at least 10 times, but he never received any assistance.^ In this case, his physical condition was overlooked and left untreated. If it had been recognized, he could have received treatment that may have prevented his premature death.
Preventing similar instances from occurring will require considerable effort. In order to garner the support needed, increased attention to the physical health of individuals with mental health conditions is a first step. However, this only addresses part of the problem, because many people with serious mental health conditions do not have regular contact with health professionals. As the lead author above suggests, other determinants, such as employment and stigma are additional avenues for intervention. Interventions that go beyond health care delivery are needed. Otherwise, we may not reach some of the most marginalized individuals - reducing our ability to address the persistent health disparities affecting this group.
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Robin McGee is a first year doctoral student in the Behavioral Sciences and Health Education department at the Rollins School of Public Health. She has been interested in mental health promotion ever since a summer internship experience with Mind, a mental health charity in the UK.
Interesting post.
ReplyDeleteDo the authors mention whether there is any research to see if there is a compounding effect of mental illness on top of the increases exposures to known risk factors among those with mental illness?
This is very interesting and well written! Often people with mental disorders are viewed only as their disorder. This article brings about a very important issue that more than just mental disorders need to be treated. There is a horrible stigma surrounding mental disorders, which prevents them from being viewed like any other disease that needs to be managed and treated.
ReplyDeleteYour use of a case study was excellent. The case study really helped to illustrate how a person with a mental disorder was overlooked physically by the medical professionals he had access to.
A couple of questions I had:
What do you mean by "employment and stigma can be other avenues of intervention"? Do you mean that efforts to employ individuals with mental disorders can make it more likely that they have consistent access to physical health care? A sentence or two to clarify what you mean might be a nice thing to include in your blog.
Also, for the "most marginalized individuals," how can these individuals be reached if they cannot manage their disorder well enough to be employed (maybe because they can't afford it or have no support system to help them), so that they aren't reachable by avenues such as employment, hospital visits, etc.?
Otherwise, well done. Your use of quotes also contributed well to the points you made.
-Kylie
Thanks for the comments and questions Lance and Kylie.
ReplyDeleteIn this article, the authors did not mention any research on whether there is a compounding effect. This is a very good question though. I think more research is needed to better understand the complex relationship between mental and physical health.
I agree that a few more clarifying sentences would be helpful - trying to be succinct requires much more precise language! I think that access to health care is a very important first step. What I was trying to say about employment and stigma, is that improved medical care is only part of the solution (again a very important part). So, in addition to finding ways to improve access and quality of care, improving employment and reducing stigma may also contribute to reductions in mortality for this population. A number of other domains (e.g. education) would be relevant, as well.
For example, let’s say someone who is employed begins having psychotic symptoms. For various reasons, the person delays seeking assistance, maybe due to stigma. His performance at work declines considerably, and he loses his job. Stigma and discrimination may also play a role in job loss. The added stress of job loss and associated economic troubles may exacerbate symptoms. Also, as you point out, access to health care declines, so interventions for both physical and mental health may not be available. The person then falls into a cycle where his health limits from him being able to work and not working impacts his health. Improving the chances for earlier intervention through reductions in stigma (and others) and trying to maintain this person in employment may have prevented his deterioration.
With that said, this example relies on early intervention - before someone falls into the ‘most marginalized group’ - so it does not really reach the people who are already in this group. Instead, it prevents them from entering the group (best case scenario!). The challenge of reaching people already in the marginalized group is considerable - requiring much more thought and effort. Ethically, though, we need to be aware that some interventions we offer may increase health disparities due to disproportional access. Addressing some of the more ‘distal’ factors may reduce this problem.
I enjoyed the post! I particularly like you last paragraph with suggestions on how to move forward. I think it might be helpful to clarify the statement about distal factors. I also would love to know more about specific programs/interventions/approaches that seem to be working.
ReplyDeleteAlso - the use of ^ is very smart to link people with specific sources, but also having them listed at the bottom might be helpful.
Thank you!
Gaya
Emory MPH 2010- BSHE, student of Ariela
I wonder if part of the lack of focus on physical health and related risk behaviors (specifically something like smoking) is that physicians might think of something like smoking as stress reduction (and thus improving mental health). Thoughts?
ReplyDeleteMental health is such an interesting public health topic because although it is deeply personal and individual and isolating, it is also very public -- so many homeless individuals we see on the streets are mentally ill.
Also, I like how you walked the line between population and personal in your post by couching an individual's story in the midst of the research. It's stories like this that help make the case for the action you advocate, even in the face of all the numbers presented.