Shortened lifespan for mental illness sufferers consequence of stigma, lack of care

Aug 19, 2018

Credit Kiran Foster/Flickr

Americans who suffer from a severe mental illness, including depression and bipolar disorder, have a life expectancy 15 to 30 years shorter than those without mental illnesses, according to a New York Times article published earlier this year.

Dr. Dhruv Khullar, an attending physician at New York - Presbyterian Hospital and a researcher at the Weill Cornell Department of Healthcare Policy and Research, wrote the article after caring for patients with mental illnesses and watching the effects mental struggles have on physical health.

“A lot of times, these types of statistics jump out at you, but what really motivated me to write this article was the experience that I was having with a lot of patients that I cared for in the hospitals and in the clinic,” Khullar said. “I noticed how much more difficult it was at times to concentrate on a lot of the physical issues that they were having.”

The correlation between mental illness and early death leads some to assume the short lifespan is due to suicide or mental-health-related accidents, like drug overdoses. However, Khullar said people suffering from a severe mental illness die from chronic illnesses, like cancer and heart disease, just as most of the population does.

Even though the cause of death for those with mental illness is typically similar to those without, the lack of knowledge and acceptance of mental illness causes a stigma that leads doctors to treat the two types of patients differently, Khullar said.

Khullar identified two main biases that contribute to the contrast in care: therapeutic pessimism: doubting a patient’s ability to get better if they suffer from a mental illness; and diagnostic overshadowing: attributing a patient’s physical symptoms to their mental illness rather than another explanation. Both can lead to a patient lacking sufficient care if they have a mental illness.

“Part of going to a doctor is developing that trust with the doctor so that you’re able to come forward with what’s going on,” Khullar said. “A lot of people who have mental health problems don’t feel that trust and don’t feel like their mental health problems would be something that they can talk about with their clinician.”

Since the life expectancy disparity is likely due to this culmination of factors that ultimately deprives a patient of sufficient medical care, Khullar said the solution requires a multi-faceted approach.

First, professionals and loved ones alike should educate themselves on the reality of mental illness and how to approach those who suffer in a way that eliminates the social stigma surrounding it.

“A lot of people who struggle with that mental illness grapple with the extent to which they should admit it to themselves or talk about it with loved ones, and certainly with people that they don’t know,” Khullar said. “We have to develop a more open health care system that allows people to come forward when they’re having these types of systems.”

Second, behavioral health specialists need to be brought into the primary care setting to assist doctors in how a person’s mental illness can affect their physical health. Khullar said there is a lot of training among medical students in this area, but there is always more that could be done.

Last, Khullar said it is important for health care professionals to remember the big picture when it comes to mental illness and realize that, though they may only see these patients for a few days, for a person suffering from a mental illness, that is their entire life.

“The big thing to recognize is that we don’t know what it’s like, often, or we forget what it’s like, to be ill when we’re caring for patients,” Khullar said. “For every patient, that is their life, and that is their experience. And so, we need to respect it and we need to honor that.”