Tuesday, December 9, 2008

Mental Illness Can Kill

A brief article published on the Time web site December 3 shed long-overdue attention on the tragically shortened lifespan of patients enduring chronic mental health conditions. All the anecdotal observations of behavioral health professionals, though, had never framed our patients' untimely deaths as starkly as the National Association of State Mental Health Program Directors (NASMHPD).

Scrutinizing data from 16 states, the organization concluded severe mental illness mercilessly shaves an average 25 years off a patient's life. This study, titled "Morbidity and Mortality in People with Serious Mental Illness," was published two years ago, however. Time's citation of this rather dusty report is telling about the dearth of literature questioning this sobering state of affairs.
While this health crisis results from the conspiracy of mutltiple factors, incuding an impetuous healthcare system and an uneven system of decision-making among non-psychiatric care providers, our patients' lives provide the most direct and disquieting call for more attention.

The Psychiatric 'Lifestyle'
Undoubetdly chemical abuse portends an abbreviated life for anyone and psychiatric patients abuse alcohol and drugs at an alarmingly high rate. Estimates vary, but investigators more or less agree around 50% of the chronic mentally ill are substance abusers or addicts. Pair that with the emerging rule of thumb that drug addicts die within 15 to 20 years of the onset of their addiction and an unsettling outlook materializes.
Beyond the socially proscribed drugs, the chronic mentally ill smoke tobacco at nearly twice the rate of the rest of us. In a 2000 study published in the Journal of the American Medical Association, examiners found that 41% of psychiatric patients smoked versus 22.5% of the general population. Patients rhapsodize romantically of their tobacco because a good smoke really is the brightest moment in their otherwise hellish existence. Hospitals encourage the habit, too, because we know that nicotine provides a soothing balm to our customers’ otherwise pulsing nerves. Nurses distributing cheap generic cigarettes to a patient's trembling, nicotine-stained hands is a common visual in our post-modern mental health system.
Beyond the high walls of the hospital grounds, clients often lead cruel, unforgiving lives, especially those most seriously ill. They may sleep in parks or homeless shelters, with little or no money either because they are locked outside the entitlement system or because they spend what few dollars they do get on alcohol and drugs.
The luckier ones--those whose behavior can be maintained with minimal supervision and who receive government benefits--may win a bed at a board and care facility. Some of these housing businesses are well-maintained in tidy neighborhoods. All too many of them, though, are in dilapidated buildings where the stench of feces on bed sheets, urine in hallway corners and aging cigarette smoke permeate the air. Their locations are often in the tenderloin, where scoring a gram of crack is easier than buying a gallon of milk. Typically these patients receive the Federal government’s $637 per month in Supplemental Security Income, plus any additional monies their state provides. Typical board and care rents are around 90% of that amount. Filling our belly on $50 or $100 a month is virtually impossible for even the most frugal of us.
Feeding a drug addiction costs even more dearly. One favorite drug among psychiatric patients is crack, a 1/10th gram of which costs $10-$25 on the street. Another cherished drug, methamphetamine, will set a patient back about $25 for 1/4 gram, barely enough to get a party started. The swift decline of a drug-addicted client's cash supply, then, is easily predicted.
When one is fiending for another fix, there is no limit to what they might do or with whom they may do it. Trading sex for drugs is hardly unusual, but as condoms became a must-have for recreational intercourse, the opportunities for exposure to HIV and assorted other bugs increased. If you have to be anally penetrated by a stranger for your next bump of crystal, chances are you didn't stop off at the market for a pack of Trojans.
Injectable drugs are as much to blame as any informal sodomy for our patients' deteriorating health. Dirty needles carry the double trouble of HIV and Hepatitis C. People with chronic mental illness are infected with Hepatitis C at a staggering 11times the rate of the general population, and carry HIV at eight times than the rest of the population, according to a 2001 study published in the American Journal of Public Health. Survival rates for Hep C hover around a depressing 50% after just five years of infection.

In the face of these unforgiving statistics, the disheartening NASMHPD study referenced at the beginning of this post looks almost sanguine. The numbers reveal more than just life expectancies and callous realities, though. They mirror a blind spot in our present system of care that taunts us with the question, Do we care enough to do anything about it?

PHOTO: Courtesy of Martin Walls, Kent, UK.
Sphere: Related Content

No comments:

Custom Search