How many times do we have to see our clients, friends and coworkers receive a diagnosis of breast cancer, chronic obstructive pulmonary disease (COPD) or coronary disease at an early age? How many times do we see these same people pass away from “natural causes” in their 30s, 40s and 50s, while we see the average life span of people grow from 51 years in 1910 to 78 years in 2010?
The sad fact is that for those among us living with a mental health diagnosis, the average life expectancy is conservatively 10 years less than those who don’t have that challenge and it also accounts for 8 million deaths worldwide annually. NAMI and other research suggest that the life expectancy gap is actually 14 to 31 years shorter for those with a mental health issue. The mortality rate for people with schizophrenia is four times higher than those without this diagnosis and those with a bipolar disorder have a 13 year decreased life expectancy. This is a reflection of our broken system and communities in need of healing and compassion.
Much of this early mortality is attributed to “natural causes” such as heart disease, pulmonary diseases, cancer, cerebrovascular, respiratory, and lung diseases. Elizabeth Walker, a researcher at the Emory University Rollins School of Public Health in Atlanta, writes, “People with mental health disorders have a high prevalence of chronic medical conditions, with fewer resources to manage these conditions. People with mental health challenges are dying prematurely and at a rate far exceeding their peers without this diagnosis.”
How many people that we love and care for have to die before their time and how many times do we have to plan services and mourn their passing? This disturbing health crisis is often overlooked. According to the National Institutes of Health (NIH), life expectancy has increased dramatically, unfortunately, “reductions in mortality are not shared equally in this country across racial, ethnic, and socio-economic groups or health-related conditions.”
So what can be done to start to change this shocking reality?
The first change that is needed is how we deliver services as a society. We need to be honest about the disparities in our culture. Services may be accessible with wheelchair ramps and Braille signage, however, there is no tolerance for people who are disheveled, responding to voices, have ticks, look different or have unpredictable behavior. This intolerance creates barriers so preventive healthcare, such as routine checkups, mammograms, and teeth cleaning, is out of reach. These disparities have led to women with mental health issues dying from cancer at twice the rate as the general population, and these women are also three times more likely to die from breast cancer. Researchers, Colton and Manderscheid, found that the secondary consequences of mental illness are poverty, unemployment, poor housing, stigma, and low self-esteem leading to challenges accessing healthcare, including health professionals’ misdiagnosis, less focus on physical health, low compliance with health screening and treatment, and poor communication. This has to stop! We have to create pathways to accessibility, prevention and care. We need to train more primary healthcare providers to work with people with mental health challenges, which is something Crestwood Behavioral Health has been providing to our county stakeholders. We need to design clinics, waiting rooms and services that are more accepting and inclusive of all marginalized populations. We need to develop more welcoming and validating preventive health screenings and utilization of services.
The second thing we need to do in our communities is the creation of Federally Qualified Health Clinic Clubhouses that welcome those with mental health challenges, the homeless, the disenfranchised and their families. A Clubhouse is first and foremost a local community center that offers people who have mental health challenges the hope and opportunities to achieve their full potential. During the course of their participation in a Clubhouse, members gain access to opportunities to rejoin the world of friendships, family, employment and education, and to the services and support they may individually need to continue their recovery. A Clubhouse also provides important routine health screenings that are completed in a client-friendly space, rather than in a hospital or sterile clinic setting. Crestwood is currently looking to explore creating a Clubhouse program in San Diego. Also, a mobile whole health services unit, a companion to the Clubhouse, is needed to bring health screenings and health services to the homeless where they are, whether it is under a bridge, in a shelter or at a wellness center.
The next action that needs to be taken is to launch a statewide Wellness and Resiliency Initiative similar to the one Crestwood has adopted in all of our programs that includes serving heart-healthy diets and creating client-oriented cookbooks with heart-heathy recipes and shopping guides. It includes planting organic gardens and using the farm to table approach in our meals. It is bringing Zumba and Yoga to every campus and community. It is having exercise tracks in yards that used to be used for smoke breaks. At Crestwood we support smoking cessation, sobriety and meaningful roles to help replace addiction and isolation. Crestwood also teaches meditation and mindfulness to our clients which lowers heart rate, reduces risk of heart disease and increases pulmonary capacity.
Another action we can take is to live healthier lives as healthcare providers. At Crestwood we use Wellness Recovery Action Plan (WRAP) to support our workforce, with staff being paid for time off the floor to attend WRAP groups. We provide mental health days, as well as sick days and expect our staff to do routine health screenings – modeling wellness. We employ meditation and mindfulness practices at all staff meetings and events to encourage our staff to practice mindfulness as a health and wellness practice.
At Crestwood we will continue to do our part by looking for and incorporating innovative health and wellness measures into our programs. We can truly practice self-care each day, creating a compassionate community of people caring for themselves and others. This may not move the needle on the mortality rate very quickly; however, it is a promising start that we hope will begin to create healthier, longer lives for our clients, friends and coworkers.
Patty Blum, PhD
Crestwood Vice President