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University of Virginia Researchers Find Greater Need for Medical Care of Mentally Ill

People with severe mental illness are much more likely to die younger, whether from physical illnesses or injuries, than members of the general public, said researchers at the University of Virginia's Southeastern Rural Mental Health Research Center. That finding, they said, points to a critical lack of medical care among people with serious mental health problems.

In a study published in the August issue of the American Psychiatric Association's journal Psychiatric Services, U.Va. senior research scientist Bruce P. Dembling and co-authors Dr. Donna T. Chen, U.Va. psychiatric research scientist, and Dr. Louis Vachon, professor in the Boston University School of Medicine's psychiatry department, said severely mentally ill patients died an average of 8.8 years earlier than the general population. They had a significantly higher number of accidental and intentional injuries, the researchers said.

The study, Life Expectancy and Causes of Death in a Seriously Mentally Ill Population, compared 1,890 mortality records of adult patients served by the Massachusetts Department of Mental Health (DMH) and those of 320,916 adults among the general population, all of whom died between 1989 and 1994.

Our purpose was to describe causes of death that distinguish a contemporary population of persons with serious mental illness from the general population, the authors wrote. They said the study revealed a gap in health services and a need for better coordination between health and mental health providers. This was indicated by the remarkably high number of deaths from undetermined causes among DMH patients, i.e., injuries that cannot be positively judged as accidental or intentional. This category has not been addressed by previous studies. The lack of information, the authors said, reflects the social isolation and lack of medical care that place seriously mentally ill populations at risk.

The authors also said that death records probably understate the impact of mental disorders. The low rates of mental disorders reported among suicides suggests this understatement is true for both the DMH and non-DMH populations, Dembling said. Mental health providers are not likely to have direct knowledge of patient deaths, which generally occur outside their settings or after care has ceased. Conversely, medical caregivers and death certifiers may be unaware of a history of mental illness. Even when they are aware, they may not associate a mental illness with medical conditions and subsequent death.

The authors found lower rates of cancer and circulatory disease among the DMH population, although they said this could also be due to underreporting of these conditions, and that further studies would be useful to examine this possibility.

A common misunderstanding is that the higher rates of injury, suicide and earlier deaths are inevitably the fault of the state mental health system, Dembling said. In fact, improving this poor outcome will require effort across a spectrum of public and private institutions responsible for the health and social welfare of persons with serious mental illness.

The state treats the most severely disabled people, a population at particularly high risk of complications from physical illnesses that affect everyone. There is a great need for more integration of medical and mental health care, Dembling said.

In a commentary accompanying the article, Massachusetts Department of Mental Health Deputy Commissioner Paul Barreira wrote, Only with a clearer understanding of the relative importance of the various risk factors can programming toward reducing mortality among people with serious mental illness be implemented…Future investigations of these factors will require the collaboration of the many agencies that contribute to the care of this vulnerable population.

August 2, 1999