Friday November 9, 2018

Healthier, Longer Lives

Isn’t that what we all want? To be healthy, and if healthy, enjoy long lives? So why should it be any different for someone with serious mental illness? But that’s not how it typically goes. The odds have it that individuals with serious mental illness (schizophrenia and other psychotic disorders, bipolar disorder and major depression) will have lives that are characterized by poorer overall health that will end on average somewhere between ten to twenty-five years earlier than would be expected if they didn’t have the mental illness.

That was the story for my Uncle Hank, who was diagnosed with schizophrenia in his early twenties and died in a psychiatric institution for older adults. He lived his entire adult life on a locked, inpatient psychiatric unit. He was not among those discharged to the community in the sixties. His recreation was going out for a smoke. With the passage of the years, his overall health declined steadily. He was seven years younger than my dad, and he died ten years ago. His life was shorter and his overall health more compromised than my dad’s – who is still alive and well at the age of 86. His story is unique and personal; it is also typical.

But it doesn’t have to be this way. And if the energy and determination of those in attendance at this week’s international conference, Healthier Longer Lives, is any indication, it is a new dawn for thinking about what it means to live with serious mental illness. Five takeaways:

1.

Serious mental illness kills. The data are eminently clear: those diagnosed with SMI are vulnerable to poorer health and shorter lives – by a big margin. Individuals with SMI die ten to twenty-five years earlier than the general population. Much of this is due to failures of the health care system. We know that individuals with serious mental illness receive less and lower quality healthcare for all that ails them. And the foreshortening of lives starts early, In fact, individuals with SMI are 24 times more likely to die by suicide within a year of their first psychotic episode as compared to unaffected peers. For others, compromised health and poorer quality of life endures over decades due to certain behaviors and health conditions that are often poorly addressed or even left untreated, including tobacco use, obesity, substance use, cardiovascular disease, diabetes mellitus, HIV/AIDS and other infectious diseases (e.g., tuberculosis).

Healthier Longer Lives International Conference had the honor of hosting the launch of the World Health Organization Guidelines for the management of physical health conditions in adults with severe mental disorder. The Guidelines are designed to assist health systems in setting priorities and assist clinicians around the world on how to recognize and treat health conditions that are common to individuals with SMI with the aim of improving overall health and life expectancy.

2.

Communities and belonging. Individuals with SMI are vulnerable to losing social connections – strangers don’t want so sit next to them, friends fall away, families get frustrated and shut out. This social isolation is deadly. Living a healthier, longer life requires mobilizing the troops: family members, mental healthcare providers, other healthcare providers, housing, community programs, and social programs. Fountain House is a community that invites individuals with SMI to become members and aims to provide a foundation for recovery. Fountain House was founded in the late 1940’s by six psychiatric patients when they were discharged from Rockland State Hospital. They believed that they could offer each other support in their recovery by providing each other social community. They called their group “We Are Not Alone.” There are now hundreds of Clubhouses around the world, helping hundreds of thousands of individuals with SMI find community and social connection in ways that are lifesaving. Ironically, my uncle was also a patient at Rockland State Hospital.

3.

Purpose, feeling needed and meaningful work. I find purpose, feel needed, and find meaning in my relationships and in my work. They are core to my well being. The same is true for individuals with SMI, and programs that look beyond the individual’s diagnosis to understand that everyone has value, everyone has something to contribute, result in improved health and quality of life for individuals with SMI. Clubhouses around the world are beginning to empirically document the ways in which their programs address these universal needs and the benefits of such programs for their members.

4.

Serious mental illness starts early. Seventy-five percent of mental disorders will emerge by the age of twenty-four. If we are going to be effective at addressing serious mental illness, we need to start early – and schools and cities are getting mobilized. Amy Kennedy, Education Director of The Kennedy Forum and former middle school teacher, reminded us that although kids spend an enormous amount of time at school, teachers are ill equipped to recognize mental health problems, and if they do, they are not trained to know what to do next. She advocated for getting mental health curricula into schools. New York is one of the first states to do so beginning this academic year. And recognizing that young people have the potential to be agents of change themselves, CitiesRISE highlighted the roles that young people can play and the potential of cities to enable “young people to grow up, develop resilience, and lead productive lives through mainstreaming mental health across sectors.”

5.

It comes down to money and morals. It is a twenty-first century scourge that individuals with SMI are abandoned by society and left to languish due to the debilitating features of their illnesses. The moral argument should be sufficient to mobilize change, but we also know that not treating SMI is foolish from an economic perspective. The economists who joined us for the conference minced no words: it makes economic sense to invest in individuals with SMI. It costs society a lot more when we put our heads in the sand. As Patricio Marquez from the World Bank argued, mental illness “is an economic development issue around the world” and “investing in mental health is essential in twenty-first century knowledge economies.”

It was an honor to serve on the Conference Advisory Committee. Thank you to all the delegates who came from near and far, including Fountain House Members, World Health Organization, National Institute of Mental Health, World Psychiatric Association, Substance Abuse and Mental Health Services Administration, The Kennedy Forum, World Bank, PanAmerican Health Organization, private foundations, ThriveNYC, citiesRise, Fountain House, Grand Challenges Canada, World Bank, Global Mental Health Programs at Columbia University, Tata Foundation, Graham Boeckh Foundation, MQ Foundation, and many more…

 

The bottom line: achieving healthier, longer lives for individuals with serious mental illness will mean healthier, longer lives for all. As Dr. Gary Belkin, Executive Deputy Commissioner of Health-Mental Hygiene in the New York City Department of Health and Mental Hygiene said, it is time to be bold in imagining a better world. Anything less will not get us where we need to be.