Better Coordination of Mental, Physical Health Care Urged: Report Cites Early Deaths of Mentally Ill

Article excerpt

Psychiatrists and other members of the mental health community are working on ways to improve coordination of mental health and primary care in an effort to decrease early death among people with serious mental illness.

People being treated for serious mental illness by public mental health systems die 25 years earlier, on average, than do members of the general population, according to a report released by the National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council. About 60% of these premature deaths are attributable to medical conditions such as cardiovascular and pulmonary disease.

The report, "Morbidity and Mortality in People with Serious Mental Illness," outlines the factors contributing to this disparity in death and disease.

"This is a virtual epidemic of death," said Dr. Joseph Parks, medical director for the Missouri Department of Mental Health and president of the NASMHPD Medical Directors Council.

The report has become a sort of "rallying point," Dr. Parks said. NASMHPD is in the process of drafting a position paper on this topic and has held a series of meetings with stakeholders throughout the mental health community.

The report, released in the fall, found that the increase in mortality and morbidity is attributable in large part to preventable conditions such as cardiovascular disease, diabetes, respiratory diseases, and infectious disease, including HIV/AIDS. And mental health patients also are at greater risk for death and disease because they have generally higher rates of smoking, alcohol and drug use, poor nutrition and obesity, and unsafe sexual behavior.

Second-generation antipsychotic medications also have been associated with weight gain, diabetes, dyslipidemia, insulin resistance, and metabolic syndrome, according to the report. Access to health care is another significant factor in the higher morbidity and mortality among the seriously mentally ill, the report noted.

The report supports several national, state, and clinician-level solutions including:

* Designating the seriously mentally ill as a health disparities population.

* Adopting national surveillance activities on the health status of individuals with serious mental illness.

* Improving access to physical health care services.

* Promoting coordinated and integrated mental and physical health care services.

* Increasing Medicaid funding to cover smoking cessation and weight reduction treatments for seriously mental ill patients.

* Improving comprehensive health care evaluations by physicians.

One key strategy to improving coordination is moving toward the co-location of mental health and primary care services, Dr. Parks said. …