Efforts to reduce early mortality among the mentally ill moving slowly
Friday, February 26th, 2010
By: Maiken Scott
mscott@whyy.org
People with serious mental illnesses tend to die about twenty five years earlier than other Americans, mostly from treatable diseases. After a 2006 report documented this gap, government agencies and mental health advocates vowed to close it. What's happened since then?
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The "Ten by Ten" campaign set out to reduce early mortality among the mentally ill by 10 years over the next 10 years. With the federal Substance Abuse and Mental Health Services Administration (SAMSA) as a sponsor, providers and advocates proudly joined. University of Pennsylvania researcher Mark Salzer remembers the early enthusiasm:
Salzer: When the initial report came out, the 10 by 10 campaign had a lot of traction, lot of people signed up and said they were going to do something ….
MS: AND?
Salzer: I have seen very little…
Almost three years have gone by since the pledge, but Mental health advocates say the numbers have stayed the same. Life expectancy for Americans is around 77, for people with severe mental illness, it's in the fifties. Philadelphia mental health advocate Joseph Rogers occasionally cracks a joke about this:
Rogers: I'm 58 years old, so I always say, my clock is already past the time, I guess…
But Rogers knows he is one of the luckier ones, living a healthy, productive life despite his mental illness. The connection between mental and physical health problems is well known. Heart disease and diabetes plague this group. Many lead sedentary lifestyles, are overweight, smoking rates are sky high. Psychotropic medications often have severe side effects, including obesity. And, says Rogers – there is a major issue with access to care:
Rogers: Mental illness creates poverty, and when you're living in poverty in this country, your health care is not great, and you end up not getting issues like diabetes and other things taken care of.
Paolo del Vecchio of SAMHSA says his agency is still committed to the 10 by 10 goal, and is spending 14 million dollars a year on an integrated care program:
del Vecchio: What that particular program is looking at – how can primary healthcare be delivered within mental health care settings.
Researcher Mark Salzer says some simple steps could have a major impact without a lot of expense. For example, psychiatrists could encourage their patients to be physically active, to quit smoking.
And community mental health providers could tackle the issue as well:
Salzer: Each of these agencies could have a physical health czar who is responsible for you know, getting the word out about smoking, and weight loss and physical activity and be the liaison to these centers.
Joseph Rogers says it would help if mental and physical health care were delivered by one system:
Rogers: We need to really change the focus of mental health care to really bring it into the mainstream of healthcare, so that people with mental illness are getting good, holistic healthcare.
Mark Salzer isn't confident that changes will come any time soon:
Salzer: We don't do a good job communicating innovative programs to one another, what we do is we, in the behavioral health field, we provide the services that someone will pay for. There really isn't a lot of money for innovation there is no incentive for the agencies, and I don't think people are always interested in innovation and learning from other people. It takes creativity and it takes energy and motivation to do it.
Creative energy, says Joseph Rogers, is in short supply right now: As government budgets tighten, mental health providers struggle just to keep basic services alive.
Fascinating that subsequent to Maiken Scott's coverage SAMHSA introduced a 10 by 10 website and it also established a new starting date by changing the name of the campaign from the "10 x 10 Campaign" which was introduced in 2007 (see below) to the "10 x 10 Wellness Campaign" and used a new launch date, "SAMHSA 10 x 10 Wellness Campaign, launched in 2010 ….".
"In response to this public health crisis, in September of 2007, CMHS/SAMHSA convened a National Wellness Summit where the agency launched the '10 by 10 Campaign' to reduce early mortality by 10 years over the next 10-year time period." (Source: SAMHSA Portfolio of Programs and Activities, http://www.samhsa.gov/About/SPPA/SPPA2009.pdf , pages 159 to 160.)
This is right on, we need more insightful comments like this.
–Efforts to reduce early mortality among the mentally ill moving slowly
–People with serious mental illnesses tend to die about twenty five years earlier than other Americans, mostly from treatable diseases.
Both statements are misleading. The first one more so.
We keep very few public records on people dealing with mental illnesses privately, our medical records like all medical records are protected. We are about 20% of Americans, and hazarding a guess, I would say as a demographic we differ little from most other broad demographics. "The" mentally ill is an offensive representation, caricature, like "the" Jews and "the" Blacks before it. Why it continues puzzles me.
Narrowing the description to people with serious mental illnesses alters the claim some, but we keep no clear record of private care that I am aware of.
Almost all claims about mental illnesses are gleaned from public programs. I am 72, I have never participated in a public program, and am well past Joe Rogers' age. Anecdotally I can argue my dependence upon private health care is probably an influence.
The history of public mental health programs is negative, the access of people in public mental health programs to physical health care is more negative. Despite the fact that all psychiatrists are first MDs, physical health care in public mental health programs falls well behind.
Harold A. Maio, retired Mental Health Editor
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It takes a great deal of courage to report on any systemic issue facing those who look to our nation's mental health system. It is much easier to ignore a despairing reality and report on promising discoveries, paradigms and treatments without considering the present. This was promised to be the era of evidence based practices, person centered care, community integration, cultural competency, safer and more effective medications, empowerment, vastly superior outcomes, best practices, integrated care and so much more yet it has truly been the era of mortality and morbidity.
Under the rubric of "System Transformation" mental health clients were to regularly achieve Wellness & Recovery. Sadly, too many will not live long enough to experience either.