For the inmates, cardiovascular disease is mental illness 
Author Message
 For the inmates, cardiovascular disease is mental illness

Killing Poor People With Cardiovascular Disease -
Another Reason To Expel The Mental Health Industry from the Medical Profession

Mentally ill at risk of early death, state finds

             By Larry Tye, Globe Staff, 6/5/2001
             Page A01 of the Boston Globe.

             The death rate among young {*filter*}s with mental illness is more
 than triple that of their peers statewide, according to a just-completed
 study of its clients by the Department of Mental Health.

             And it is not just the premature deaths that the report's
 authors say are disturbing, but the causes of those deaths.

             Heart disease is the biggest culprit for the 25- to 44-year-old
 age group, killing DMH clients at nearly seven times the rate in the wider
 population of Bay Staters that age. Suicide rates also are significantly
 higher for that age group, along with those 15 to 44, while the chance of
 contracting a deadly pulmonary disease is elevated for everyone from 25 to
 64.

             The report, the first of its kind in the country, adds
 statistical heft to worries that patients and providers have long had about
 the physical disabilities that too often accompany mental ones. And it has
 fueled the department's determination to uncover the causes of the elevated
 risks and to battle against them.

             ''One message from this study is that mental illness is a
doubly
 terrible disease: There's a stigma attached to it, and people with it are
 living under a death sentence,'' says Marylou Sudders, the commissioner of
 mental health. ''They die younger than their nondisabled counterparts and
 they die of illnesses we don't expect people at that age to die of.''

             Judy Karp knows all about such premature deaths. Her
36-year-old
 daughter, Jennifer, died in April of obesity that was likely a byproduct of
 her mental illness.

             ''It was the {*filter*} she was taking, plus her nutrition was
 horrible because the {*filter*} make you want sugar. She was 130 pounds
 overweight. She became a couch potato person with no interest in
exercise,''
 says Karp, a retired high school teacher in Brockton who set up a fund in
 her daughter's name to support nutrition and exercise programs for the
 mentally ill.

             ''My reaction to this report is, thank goodness that someone
 other than I thinks in the same vein and is starting to do something about
 it.''

             The department study focused on the more than 60,000 people it
 served in 1998 and '99, comparing their death rates to those for the whole
 population of Massachusetts. While the overall age-adjusted mortality rates
 were lower for DMH clients than for their peers in the wider population,
 researchers say that is not a useful comparison given how few clients the
 department has in the high-risk categories of infants and over-75s.

             In age groups where most clients fall, however, the difference
 in death rates is significant and disturbing.

             In 1998 their death rate for those 15 to 24 years old was 45
 percent higher than the average statewide, and the next year it was nearly
 triple. The two biggest factors accounting for that difference were a
 suicide rate that was six times higher and a much greater risk of
accidental
 death.

             For mentally ill clients 25 to 44, the death rate was more than
 three times higher than the statewide figures in 1998 and again in 1999.
The
 most notable contributors were nearly seven times as much heart disease and
 more than seven times the suicide rate. As for those aged 45 to 64, the
gaps
 in death rates were smaller but substantial. The rate of deadly heart
 disease was higher for them, too, as was death from pulmonary conditions.

             There also was a gender distinction between DMH clients and
 their peers: Women with mental illness seem to be at greater risk of heart
 disease and suicide. The gap between females and males on both measures was
 almost nonexistent among the mentally ill, while among Massachusetts
 residents as a whole men are more likely to die of heart attacks and more
 likely to commit suicide.

             No one is certain what accounts for all those differences, in
 part because this study is one of the few to quantify them and may be the
 first to do it by age. An earlier study in Massachusetts found that current
 and former DMH clients were dying as much as nine years earlier than their
 counterparts in the general population.

             The precise causes may be unclear, but Dr. Ken Duckworth, the
 department's medical director and supervisor of the study, said he has his
 clear suspicions. They start with who it is that the agency serves - with
 its clients being poorer than the statewide average, smoking more, being
 less likely to have strong family support networks, and including a
 disproportionate share of African-Americans, who as a race face higher risk
 of heart disease.

             Other factors, Duckworth says, include the way psychotropic
 {*filter*} can cause weight gain, which raises the risk of everything from
 cardiac conditions to lung disorders. The mentally ill also are known for
 their poor nutritional habits. Then there is the way that some doctors
 distrust people's description of physical illnesses once they know they
have
 mental ones.

             The way to change all that, says Moe Armstrong, is for patients
 and providers to start being candid with one another about the special
 physical risks facing people with mental illness. ''We do a horrible job
 being outfront and honest,'' argues Armstrong, who suffers from
 schizophrenia and paranoia and is one of the best-known, best-liked mental
 health counselors in Massachusetts.

             ''We have to discuss what kind of lifestyles we are going to
 create that don't have these peculiar, horrible side effects that come from
 our weird eating habits,'' he adds. ''In our quest for normalcy, we don't
 talk about it.''

             The DMH says it's committed to updating its report every year,
 pushing mental health providers to take more seriously issues such as
 smoking cessation and nutrition education, fine tuning suicide prevention
 programs, and pursuing more research on why the mentally ill are dying
 young.

             Officials say they are encouraged by their success in keeping
 the rates of AIDS and cancer relatively low among their clients, and feel
 they can achieve the same results with heart and pulmonary diseases. The
 key, Duckworth says, ''is to change the culture within the mental health
 community.''

             ? Copyright 2001 Globe Newspaper Company.



Tue, 25 Nov 2003 22:19:07 GMT
 
 [ 2 post ] 

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