Lucy Ozarin – one of the first women psychiatrists to serve in the Navy and one of only seven women psychiatrists to serve during World War II – turns 103 today! I had heard all kinds of superlatives about Lucy from my mother-in-law, but when I had the honor of actually meeting her a while ago, I was even more awed than I had expected by the sparkle in her eyes and her generative mind. As I write this Five on Friday on Lucy’s birthday, I am gazing out over the Tuscan hills that are graced with olive trees many hundreds of years old. Some date back to Roman times. They continue to be productive and bear fruit – about 30 kilos of olive oil per year.
These centenarians have got me thinking: when it comes to life expectancy, why is it that individuals with mental illness are not likely to be so fortunate as Lucy or the long-lived olive trees?
People are living longer all over the globe. Life expectancy increased by 5 years between 2000 and 2015 – the fastest increase since the 1960s. Gains were greatest in Africa where life expectancy increased from 50.6 to 60 years –mainly due to improvements in child survival, progress in malaria control and expanded access to antiretroviral treatment for HIV. In the US, life expectancy is now 78, a steep increase from the average life expectancy when Lucy was born, which was a mere 59 years.
But not for all. An analysis of 203 studies from 29 countries across 6 continents reports that people with mental illness live on average 10.1 fewer years than those without mental illness, even after controlling for other factors. “Natural causes” such as heart diseases, stroke, pulmonary diseases, and infectious diseases account for 67% of the deaths. “Unnatural causes” like suicide and accidents account for another 17%, with the remainder attributed to other and unknown causes.
Trouble getting care. Individuals with mental illness have limited access to health care. Some cannot afford the cost, have no insurance or have insurance that denies coverage. Mental health and primary health care are inadequately integrated around the world, which often means that mental health providers fail to recognize and address other health care needs, while other health providers fail to recognize and respond to mental health needs. And then there is the phenomenon of “diagnostic overshadowing”: a tendency for providers to attribute patients’ physical symptoms to their mental illness if they have a known mental illness. All this means that people with mental illness are less likely to get the care they need.
Environment matters. Olive trees thrive on the arid, sunny slopes that grace the Italian landscape. Likewise, when it comes to mental health, environment matters. As a military psychiatrist in World War II, Lucy saw more than 75 years ago that the trauma of war could wreak havoc with soldiers’ psychological well-being. And as a community psychiatrist, Lucy recognized that people with mental illness are frequently marginalized and stigmatized, most often living in unsafe neighborhoods with limited social support. They are more likely to be poor and at risk for homelessness, all of which contribute to their shorter life expectancies.
Greater risk for comorbid health conditions. Mental disorders are linked to higher rates of death caused by cardiovascular disease, stroke, diabetes mellitus, respiratory diseases, and some cancers. Certain behaviors like smoking, substance abuse, and physical inactivity – all of which are more common among people with serious mental illness – increase risk for health problems. And as many people with mental illness know, medications that may be critical for psychiatric stabilization often cause side effects such as weight gain, thereby contributing to risk for other health problems.
In her 103 years, Lucy has lived through the Great Depression, the invention of sliced bread and PopTarts, the atrocities of WWII and the Holocaust, the exuberance of Woodstock, and the revolution of the Internet. What would she say about the travesties of Charlottesville and Barcelona and the people whose lives have been cut short? Heather Heyer, plowed down outside the white nationalist gathering, was 32 years old when she died standing up for the values of diversity and equality. The 14 people who were killed in Barcelona could have been any of us. Their lives have ended too early and unnecessarily – just like those with mental illness.
I like to imagine that the olive trees on the hills endure and continue to bear fruit to honor these everyday heroes whose lives are cut short – whether from the tragedy of terrorism or the tragedy of a failing mental health system. Individuals for whom marble statues would never do.