Addressing Premature Mortality: Living With Serious Mental Illness

May 29, 2020

Living with a mental illness is all too often accompanied by poverty and social disadvantage, which contribute to shortened life spans and reduced quality of life. However, there approaches for addressing many of the preventable causes of poor health and mortality in this patient population.

This Special Report on premature mortality provides a review of current research as well as clinical and policy innovations to improve the physical health of patients with serious mental illness. Living with a mental illness is all too often accompanied by poverty and social disadvantage, stigma, adverse health behaviors, and poor access to medical care. Taken together, these factors contribute to shortened life spans and reduced quality of life. The articles in this Special Report present approaches for addressing many of the preventable causes of poor health and mortality in this patient population.

Numerous studies from the general medical literature have demonstrated the benefits of exercise in increasing physical fitness, promoting weight loss, optimizing cardiovascular health, and improving mood. As Martino Belvederi Murri, MD, and Panteleimon Ekkekakis, PhD, note, while the literature among individuals with major depression is more limited, there is every reason to expect that exercise would confer similar-if not greater-benefits as those seen in general populations, given the elevated risks. As long as a regimen is appropriate to a patient’s fitness level-150 minutes of moderate activity is a good starting point for most individuals-exercise provides one of the most favorable risk-to-benefit profiles of any treatment that is currently available. The authors highlight the value of focusing on enjoyment as a strategy to engage patients in initiating and adhering to exercise programs.

The social determinates of health have been referred to as the “causes of causes” of preventable mortality. As Lilanthi Balasuriya, MD, Eliza Buelt, MD, and Jack Tsai, PhD highlight in their overview, individuals with serious mental illness who also experience homelessness are at extremely high risk. For these patients, stigma, medical comorbidity, and challenges in meeting basic daily needs can lead to adverse physical health outcomes and early death. Successfully addressing the housing and basic economic needs of this population can provide a foundation for engagement in mental and general medical services.

Finally, these interventions require federal and state policies to support their broader uptake in clinical practice. Emma E. McGinty, PhD, MS, and Gail L. Daumit, MD, MHS highlight how a number of legislative and regulatory interventions beginning with the Affordable Care Act have increased opportunities to facilitate the more widespread adoption of integrated services for individuals with serious mental illness. The majority of these innovations have occurred within Medicaid, the most important funder of services for this population.

We hope that this Special Report provides you with an overview of the impressive and growing array of interventions available to improve the physical health of individuals with serious mental illness. As you read, please think about ways in which you can incorporate these strategies into your practice. By doing so, you can play an important role in helping to improve the duration and quality of your patients’ lives.

Disclosures:

Dr Druss is Professor (Graduate Faculty), Rosalynn Carter Chair in Mental Health, School of Public Health: Health Policy and Management, Emory University, Atlanta, GA. He reports no conflicts of interest concerning the subject matter of this Special Report.

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