Alarming statistical evidence has been mounting in recent years that those with psychiatric disabilities offer face significant health care challenges. Of greatest concern is one stark reality: on average, people with serious mental illnesses are dying twenty-five years earlier than the general population. Although there is a temptation to assume that a major cause of this is due to much higher rates of suicide within the population of those with mental illnesses, in fact the data reveal that the increased mortality in this group is primarily due to treatable medical conditions – smoking, obesity, substance abuse, and psychotropic medication side effects. As a result, more and more mental health programs – in community mental health centers, psychiatric rehabilitation programs, Veterans Administration services, and consumer-run operations – are incorporating health and wellness programs and helping consumers to focus on healthier lifestyles.
From the perspective of a community inclusion advocate, good physical health is both a precursor to an integral part of community participation. On the one hand, physical health is an essential aspect of good mental health – and we learn more every day about the mind-body connection. On the other hand, active and enthusiastic participation in community life often presupposes good physical health.
While the growing number of programs to promote good physical health within mental health settings is a very positive sign, it is also true that mental health programs can do more to encourage and support individuals with psychiatric disabilities in taking advantage mainstream health and wellness programs that already exist in a variety of non-mental health community organizations.
The Metabolic Syndrome
Researchers have identified a convergence of physical health problems that commonly impact those with serious psychiatric disabilities:
- smoking – there is little question today about both the short-term and long-term negative consequences of smoking, yet many of those still in state hospitals, group living facilities, and on their own in the community smoke nonetheless, and smoke a lot. While it is not easy for anyone who has smoked cigarettes regularly to give up smoking, consumers find it particularly difficult. Smoking is no longer allowed in most residential programs and day services and smoking cessation programs in community mental health centers, psychiatric rehabilitation programs, and consumer-run services have shown considerable success. However, it is also recommended that these settings look toward other smoking cessation programs – in senior programs, community centers, schools and colleges, public health clinics, etc. – to provide a non-psychiatric setting in which consumers can begin to give up their smokes.
- obesity – look around: the number of persons in our society who are overweight or obese is significant, and research says it is a continuing and serious problem. Those with psychiatric disabilities face similar challenges – large and nutritionally questionable institutional meals, the difficulties of eating well on a limited budget, and the growth of ‘portion size’ in our society at large all make it very difficult for people to maintain a healthy weight – all made more problematic by the reluctance of so many to exercise regularly. Mental health programs can do more to institute diet and exercise programs –‘eat less and move more’ initiatives, but they can also turn to a variety of community resources – the local gym, a nearby YMCA, a senior center, etc. – to help consumers address weight and diet issues in an arena outside the realm of psychiatric diagnosis.
- substance abuse – the still emerging recognition that significant numbers of the people cared for in either the mental health or the substance abuse systems are struggling with both mental illness and substance abuse has forced the development of programs that simultaneously grapple with both issues: these ‘double trouble’ groups have proven very effective, in part because treatment for either mental health or substance abuse separately does not seem to work. More can be done, however, to help those with psychiatric disabilities participate in community programs designed to limit the incidence of substance abuse.
Finding Good Physical Health Care
It can be difficult for individuals with psychiatric disabilities to access good physical health care. Both private physicians and public health clinics – if they know that an individual has a psychiatric disability –tend to discount the physical complaints of their patients, often until it is too late. But it is often true that people with psychiatric disabilities do not seek out physical health care for their problems, and more must be done to make sure that every consumer receives appropriate physical health care as well. Doctors and nurses and other health care professionals may need additional training if they are to adequately assess, and treat people with psychiatric disabilities.
One outstanding resource promoting health care – both specifically for those with mental illnesses and for the general public is the Collaborative Support Programs (CSP) of New Jersey.
For more information about the wellness programs of the CSP of New Jersey, visit:http://www.cspnj.org/common.php?pg_id=8