(June 19, 2018) Individuals with schizophrenia or severe bipolar disorder live much shorter lives than the general population, dying an average of 10 to 25 years younger depending on their country of residence and age at diagnosis.
The mortality gap between individuals with serious mental illness and the general population is well-established and as we wrote last fall, evidence indicates that this gap is getting worse not better.
In a newly published piece in Psychiatric Services, Mathew Goldman, MD, and authors argue serious mental illness should receive formal, national recognition as a disparities category because of this inequity. Other formal disparity categories include sexual and gender minorities, immigration status or obesity. The designation could impact health policy in important ways.
The National Institute of Health defines health disparities as "differences in access to or availability of facilities and services. Health status disparities refer to the variation in rates of disease occurrence and disabilities between socioeconomic and/or geographically defined population groups," whereas the United States Department of Health and Human services defines a health disparity category as a group of individuals with "a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage."
There is no question that individuals with serious mental illness have poorer access to health care and significantly worse health outcomes compared to the general population. Although some of this difference can be attributed to the symptoms and functional limitations of the mental illness disease itself, Goldman and authors point out that much of these worse health outcomes are due to the discrimination, exclusion and criminalization of individuals with serious mental illness.
The recognition of serious mental illness as a disparities category has widespread implications in public health and research. "Disparities designation puts pressure on organizations and agencies to develop quality measures for use in value-based payment models, to incentivize the development and application of evidence-based practices, and to expand resources for research to better understand the factors that result in unequal care," Goldman writes.
In addition, because disparities categories are important metrics for quality improvement in clinical settings, the designation of serious mental illness as a disparities category could force better accountability.
"We believe that the population with severe mental illness represents one of society's most vulnerable and marginalized groups with disproportionately high needs and poor outcomes," the authors conclude. "Ethical priorities compel policy makers, payers, providers, and health services researchers to maintain special focus on populations most at risk. Officially designating severe mental illness as a disparities category is a key step to enhance advocacy to influence policy solutions, practice innovations, and political will."
Elizabeth Sinclair
Director of Research
References:
- Goldman, M. et al. (2018, June). The case for severe mental illness as a disparities category. Psychiatric Services.
