Life, death, the mental illness label, and Minnesota

Minnesota is one among a number of states giving lip service to doing something about the high mortality rate among people in Mental Health treatment. This concern grew in part out the stir caused by a 16 state study published in 2006 showing that people with serious mental illness diagnoses are dying on average 25 years earlier than the general population. A new initiative in the state of Minnesota was designed to help deal with this disparity in death rates.

Minnesota Medicine covers this initiative in an article, Minnesota 10 by 10.

The National Association of State Mental Health Program Directors’ 2006 report “Morbidity and Mortality in People with Serious Mental Illness” highlights the fact that people with schizophrenia are 2.3 times more likely to die from cardiovascular disease than people in the general population, 2.7 times more likely to die from diabetes, 3.2 times more likely to die from respiratory disease, and 3.4 times more likely to die of infectious diseases. The report states that people with serious mental illnesses die 25 years earlier on average than members of the general population. The report also highlights the fact that the increasing use of second-generation antipsychotic medications, which are associated with weight gain, diabetes, dyslipidemia, insulin resistance, and metabolic syndrome, is adversely affecting lifespan.

This effort grew out of a Substance Abuse and Mental Health Services Administration (SAMHSA) summit to address the issue. The participants in this summit recommended the measuring of 10 health indicators and 2 process indicators for all people labeled “mentally ill” served by the mental health/illness system. Members of the groups participating in this summit have pledged to reduce early mortality by 10 years within 10 years time.

Not surprisingly statistics in Minnesota showed people dying at earlier ages in mental health treatment than people not receiving mental health treatment.

Consistent with the findings in other states, people with serious mental illnesses in Minnesota die much earlier than the general population on average. The median age at death for the general MHCP population was 82 years. The median age of death for people on MHCP plans with serious mental illnesses was 58. Our results showed the trend was consistent regardless of the patient’s gender.

Heart disease in Minnesota was the number 1 cause of death amongst people receiving mental health treatment there. People labeled “mentally ill” were found to be dying of heart disease on average 27 years earlier than the rest of the population who died of heart disease.

What surprised our work group was the fact that persons with bipolar affective disorder and schizoaffective disorder die significantly younger than those with schizophrenia alone; the median age of death for those with bipolar affective disorder and schizoaffective disorder was 51; for those with schizophrenia it was 62.

My immediate thoughts on the subject are that the culprit here is likely to be polypharmacy. Bipolar disorder is thought to involve bouts with depression and mania, two disorders in their own right, while schizoaffective disorder is seen as a state between schizophrenia and a mood disorder, such as bipolar disorder. Psychiatrists confronted with this kind of dilemma could be prescribing drugs for each of these conditions and, with psychiatric drugs, studies have been done showing that people die earlier for every psychiatric drug they are prescribed.

While it is good that Minnesota is making an effort, however meager, to do something about the problem, I have my doubts as to whether anything substantial is being accomplished here at all. Healthier diets, and quitting smoking can’t hurt, but the real problem that lies behind these deaths is the use of psychiatric drugs. Reduce deaths by 10 years in 10 years and you’re still 10 to 15 years behind the general population. The easiest way to improve a person’s chances of living longer is by getting that person out of, and away from, the mental health/illness system entirely. We have a word for getting a person out of the mental health/illness system completely, and that word is recovery. People need to be rescued from such a system when it is hell bent, however unintentionally, on their own destruction.