The post below was originally posted on this blog in 2009. With the current questions about health care reform it seems particularly relevant right now. Within the next week Governor Bill Haslam of Tennessee will make a decision about whether or not medicaid expansion will be allowed in Tennessee. There is considerable political pressure on him to say no. Many public organizations have come out in favor of this as being good for the people of Tennessee. The economic benefits, the social benefits, and the health benefits have all been gone over in detail. The case is clear. Against it is pressure from Tea Party Republicans. A bill has been introduced in the Tennessee Legislature to make it illegal for the state of Tennessee to accept the expansion of Medicaid. It seemed for a long time that expansion was going to make it, but the tide seems to perhaps have changed. The results for people with mental health issues will be catastrophic.
Statistics I have seen say 25% of the people in Tennessee with mental health issues have no insurance. It basically destroys their access to mental health services, but even more importantly gives a population with a large degree of physical health issues little or no help. At a time when the importance of increasing mental health services is increasingly recognized many of the same people who speak in favor of it seem to be blind to the fact that without increased access nothing gets better.
The “mentally ill” have for a long time been a disposable population. Despite all the fine words and good intentions of so many that still remains true. Cruelty is cruelty is cruelty. The destruction that will be wrought by this action if it goes as it currently looks will be immense.
Read the post below. Many other states other than Tennessee are confronting the same issue. When you have the power to make things better mental illness should simply not be a terminal disease.
IS MENTAL ILLNESS TERMINAL?
Two years ago the National Association of Mental Health Program Directors published a study with incredible conclusions. The report analyzed data from 16 states and found on the average that people with mental illness die 25 years earlier than the general population. That’s right- 25 years early. How is that? It just doesn’t seem like mental illness should in any way, either directly or indirectly, be the cause of anyone’s early death. Mental illness shouldn’t be terminal.
The study points to several factors:
Frequently their own doctors do not pay attention to the physical health of the mentally ill. They seem to somehow think that mental health and physical health can be separated in any real way. The reports go on further to say that even when the mentally ill complain they are often not listened to. Their complaints are not taken seriously. After all they are “crazy.” Talk about the deadly results of stigma. Even doctors are guilty of looking at the mentally ill as nothing more than mentally ill and assuming that the things that are important to other people are not as important to them.
The mentally ill tend to be lower on the socioeconomic scale. Their illness or the attitude that the public has about their illness has real life vocational consequences for them. They, often because of economic status and lack of resources, do not get the best of health care, if they get it at all. Many of the other things that relate to health like diet, shelter, clothing, recreation etc. may be an issue for them as they might be for anyone low on the socioeconomic ladder.
22% of the general population smokes. 75% of people with mental illness smoke. One study showed that 44% of all the cigarettes consumed in the United States are by people with psychiatric histories. The study doesn’t really go into the reasons for this other than to comment that it was and still is common in many circumstances for cigarettes to be used as a reward for people in psychiatric care. You would probably also be safe in assuming that this population in general is more likely to have a need to medicate their moods and that cigarettes act to “calm” people whose daily experience is full of affective storms. I think part of the reason also goes back to a point made above. The assumption is made that nothing else matters about the mentally ill other than their mental illness. The expectation is that you “can’t expect them to take care of themselves.” Again it is a stigma based reaction.
Obesity is another major issue. People with bipolar or depression are about twice as likely as the regular population to be obese. This is primarily because of the side effects of the drugs they take. And again doctors do not take it as a matter of concern. They treat it as a matter of personal preference on their patients part. “I know you would like to not gain weight, but you have to take your meds.” Most doctors who prescribe psychotropic drugs do not, in my experience, treat the resulting obesity as a serious health risk. In their eyes it is the “price of doing business.”
Obesity related illnesses, like diabetes are so prevalent that one doctor called them an “epidemic.” For example 13% of schizophrenic adults over 50 have a diagnosis of diabetes. The national average is 8%. Many anti-psychotics and anti-convulsants have extreme risk of medical consequences that do pose a risk to physical health.
Virtually all of these things are treatable or fixable. But some things have to change. The physical health of the mentally ill must be treated as seriously as that of those without mental illness. I don’t think the problem is that people are purposely mean or hurtful. It is more the result of ingrained attitudes toward mental illness that most people are not even aware they hold and when they are aware consider them common sense that is obvious to anyone. Mental illness may not be terminal, but the social consequences of mental illness (stigma) without question are. It is not just a matter of being fair and equitable although that is an essential consideration. It is, as this study clearly shows, a matter of life and death.
One of the major weaknesses of our mental health system is that often it tries to treat mental illness with cookie-cutter recipes that ignore the context of the lives of those who it is trying to help. Trying to treat mental illness without taking into account the social consequences of mental illness for those who have it is an exercise in foolishness and self deception. The result of this approach is not just a system where many fall between the cracks. It is a system where large numbers of those afflicted are left to live in the cracks.