The concept of “wellness” is in the wind these days, and a lot of the impetus for this is directly related to research findings that grew out of a 16-state pilot project sponsored by SAMHSA in 2006. When the results came in, an unsettling outcome was identified: People diagnosed with a mental illness and involved in the public system had a significantly shorter life span than the average American. In fact, up to 25 years shorter.
In Behavioral Healthcare's January issue, Ronald W. Manderscheid, PhD, contributed a comprehensive article on the 10 by 10 goal, a project to increase mental healthcare consumers' life expectancy by 10 years in the next 10 years. We want to bring you up to speed on this effort, and the most interesting way to do this is to chat with our friend Paolo Delvecchio, associate director of consumer affairs at SAMHSA's Center for Mental Health Services.
Paolo has worked for SAMHSA for the past 13 years. His job largely has consisted of promoting consumer participation and fostering recovery in federally funded programs. Over the years, he has been a persistent, diligent, and reliable voice of reasonable advocacy, fueled by a quiet passion and commitment to helping people recover from mental illnesses.
We asked Paolo to start by telling us the single most encouraging aspect of the 10 by 10 goal, and his reply will delight you: “Most of it's reimbursable!” On the downside, we asked Paolo what worried him the most about this tragic early mortality figure, and he responded, “We're going backward.”
“Backward?” we mused. “How can that be?”
“A study conducted in the 1990s revealed a reduction in life span of 15 years. Now, some 15 years later that has increased to up to 25 years,” he told us.
Now we are becoming even more worried. Lori, as part of her recovery, has been taking psychotropic medications for the past 30 years. Paolo, too, is recovering from a mental illness, so both shared a moment of silent concern. We both want those additional 25 years that everyone else is expecting to have.
Paolo went on to tell us that the average life expectancy in the United States recently has been revised upward to an all-time high of 78 years. However, by comparison, the average life expectancy of those diagnosed with a mental illness is in the mid-50s, which was the average life span in the United States in 1920.
Paolo gave us a quick summary of the National Association of State Mental Health Program Directors' (NASMHPD) 2006 analysis of the factors that contribute to this problem:
There has been a significant increase in cardiovascular disease. NASMHPD found that more than 50% of this increase was due to smoking. In fact, people diagnosed with a mental illness smoke twice as many cigarettes as the general population.
While the suicide rate for people with mental illness has increased, it accounts for only a small portion of the 25-year disparity.
There has been a significant increase in obesity and diabetes, partially due to the side effects of medication, especially related to antipsychotics, particularly atypicals.
One of the elements of the 10 by 10 campaign is a wellness pledge that organizations sign as a gesture of support and commitment to being part of the solution. In addition, SAMHSA and Boston University created a Web site (http://www.bu.edu/cpr/resources/wellness-summit/pledge.html) this past December to share creative wellness approaches. The campaign has identified three groups that need education and training:
primary care providers, who need to be better informed about how to work with mental health “consumers” to identify physical health symptoms and problems related to early mortality;
people diagnosed with mental illnesses, who need to know about and take responsibility for managing their physical conditions, and more about how to participate in planning solutions through shared decision making; and
behavioral healthcare staff, who need more information on the indicators of physical problems that lead to early mortality. They need skill development in addressing these issues in ways that promote hopefulness and self-help.
Next month we'll give you some specific “how-tos” that can guide you in developing your own wellness services and programs, and here are some ways you can get started. First, read Dr. Manderscheid's article on the 10 by 10 campaign at http://www.behavioral.net/manderscheid0108. Then, take a close look at what's happening in your behavioral health programs:
Is there any emphasis on wellness?
Is there any emphasis on preventing physical health problems by detecting early signs of problems?
Is body mass index (BMI) a required part of the service user's record?
If physical health information is collected, is it discussed with service users? Do they understand the implications? Have they been given suggestions about how to take responsibility for managing physical health problems?
Also, go to the wellness campaign Web site and read the latest information. See what you can start doing immediately to raise the quality of your service users' physical health.
By sharing our chat with Paolo, hopefully we have raised your level of awareness about the importance of physical health for people who have been diagnosed with mental illnesses. But it would be a waste to close without touching your heart, so in closing Lori shares Anna's story with you, which drives home the point of this article.
Anna, age 55, was extra tall with amazingly premature white hair—long, thick, and curly wild, usually reined in with a rubber band or two. She had a softness about her that, early on, gave way to brief eruptions of anger and suspicion. She was smart; she knew her way around. She had been homeless for a long time, had a brief stint in jail, and had been hospitalized several times. She had learned to protect her “edges” by not letting anyone get too close to her.
I met Anna in a peer employment training class in which I was a guest lecturer. Anna later told me that she hadn't believed a thing I had said. Her struggle with her illness had left her cynical and doubtful that things really ever could get any better. She was fairly sure she would not become a peer support employee. She was glad, however, that she had taken the class because she learned how to question the reliability of her feelings and squelch invalid eruptions before they got her in trouble.
At the graduation ceremony, Anna talked about the freedom she had experienced in the class from loneliness, and how she was starting to hope she could get a job in peer support work. A few days later I interviewed her for a position as a recovery coach in a new program in which peers work with people to create their own treatment plan. She got the job!
At her request, Anna was assigned to work at the same site where she received services. She felt connected to the staff, and she didn't have transportation to get to other sites anyway. The staff, who had seen Anna through her toughest times, were inspired by having her work alongside them. They said she gave them hope that others could recover too.
Several months passed before I saw Anna again, although I occasionally heard about how well she was doing. Then one afternoon as I passed by the reception desk and caught sight of Anna, she moved away when she saw me approaching. “Don't touch me!” she warned. “You can't touch me now. I'm sorry; you just can't. I'm here to get my medical records. There's something wrong with me.”
“OK,” I agreed. “Anything I can do to help?”
“No, I don't think so. I have to take these records to the hospital.”
The next day after not being able to get Anna on her cell phone, I called the hospital to see if she had checked in.
“Are you a relative?”
“No, I'm her employer.”
“Hold on. I'll have to find someone who can talk to you.”
After what seemed like an eternity, a new voice came on the line. “I'm sorry to have to tell you this, but Anna is deceased. She passed away last night.”
“What do you mean? I saw her yesterday and…. What happened?”
“The cause of death was kidney failure.”
How could anyone die of kidney failure when she was walking around the day before? How could anyone die of kidney failure in a hospital, with it going undetected until too late? After further investigating, it was clear that the hospital staff had overlooked Anna's physical concerns, and had attributed her complaints to the fact that she had stopped taking her psychiatric medication as prescribed. She was on the psychiatric ward when she died of kidney failure. Her physical concerns had gone unaddressed until it was too late.
Her life, and the contribution she could make, had been cut short due to a misunderstanding of her symptoms. She is one of the numbers that shows up on Paolo's graphs describing those who die 25 years early for no good reason. Anna could have benefited from wellness services like those identified by the 10 by 10 campaign. We hope you will be able to begin to blend wellness services into your behavioral health programs to enhance the lives of those like Anna.
P.S. In an upcoming issue, Behavioral Healthcare will have a feature story by Dori Hutchinson, ScD, on this topic. Dori knows more about this subject than most of us, and we encourage you to heed what she says.Lori Ashcraft, PhD, directs the Recovery Opportunity Center at Recovery Innovations, Inc., in Phoenix. She is also a member of Behavioral Healthcare's Editorial Board.
William A. Anthony, PhD, is Director of the Center for Psychiatric Rehabilitation at Boston University.
To contact the authors, e-mail firstname.lastname@example.org.
In the 1920s, some complained that people with mental illness were living too long. Read about this outrageous perspective at http://www.behavioral.net/borders071808.Behavioral Healthcare 2008 September;28(9):8-12