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Why Do Individuals with Severe Mental Illness Die Before Their Time?

Curtis B. Flory and Rose Marie Friedrich


A fact that is seldom discussed, but alarmingly true, is that the death rate is significantly higher for those who are severely mentally ill than it is for the general population. This finding is well established and has been reported in numerous studies since 1942. The mortality rates for both natural and unnatural causes of death among clients is more than twice that of the general population. A recent study in Massachusetts by B. Dembling, covering the period 1991-93 reported that individuals with severe mental illness died 19 years prematurely. The average age of death for the severely mentally ill population was 52.4 years versus 72.8 years for the general population.

The largest single contributor to premature death is suicide, which is 10 to 15 times higher than in the general population. Also contributing to early death are poor health habits, including heavy smoking, obesity and alcohol abuse. The presence of diseases such as heart disease and diabetes, which may be undiagnosed and untreated account for a significant number of those who die prematurely. Accidental deaths are much higher in this population as well.

Persons with severe mental illness who are included in "The Forgotten Population" are at particularly high risk for early death because their needs have been ignored in service planning. In order to obtain first-hand information about the consequences of lack of adequate services, we sent questionnaires to members of the former NAMI Hospital and Long Term Care Network and AMI affiliates in Iowa and Massachusetts. Our research findings presented in this column represent responses from 220 NAMI families in 23 states.

Unavailability of services resulted in increased disability for many clients and impacted every aspect of their lives. The average client studied had been ill for 21 years and most (78%) suffered from schizophrenia. In the words of family members:
"It (lack of services) has caused my son to be totally disabled. The combining of so many failures in treatment has left him with so many residual problems that his potential for success is minimal.
Our son's quality of life deteriorated steadily over the years from his ability of manage his own art gallery and participate in civic affairs until he was finally living in a pup tent, eating "hand-outs"---- alone in the woods."

The overall quality of life was often nonexistent for many in "The Forgotten Population" and families reported an abnormally high incidence of factors that are associated with premature mortality including: (1) suicide attempts, (2) high risk for accidents, and (3) pervasive medical problems.

High incidence of suicide attempts


42% of the clients in the study had attempted suicide. Of those who had attempted suicide, most had made multiple attempts. Families lived in constant fear of suicide:

"We have constant fear she will kill/hurt herself, sadness that she is so unhappy, helpless and guilt. (Has made 3 suicide attempts in the past)."

Many clients in the study were at high risk for suicide. They were primarily male, single, unemployed and often lived alone. They demonstrated chronic, relapsing illness, which required frequent re-hospitalizations; had poor response to their medications and many felt hopeless about their future. Suicide and suicide attempts were attributed to lack of adequate services:

"Having a child take his life is, in my estimation, the most stressful event a parent can go through. Because of the terrible services for mentally ill people, both my husband and I are working very hard to change things. After 2 1/2 weeks of hospitalization our son came home, and neither the state facilities, nor our information about his illness prepared us to deal effectively with him."

Risk of accidental death was high


Approximately 20% of the clients had experienced homelessness and many had become victims of violence;

"Our daughter was beaten, homeless, injected with IV drugs to keep her under control while someone tried to get her money. She was left to deteriorate to the point where she could not even speak . . . . .The end result of her homelessness was hepatitis C, burns on her abdomen and she was hit by a car. This would not have occurred if she had adequate treatment."

One quarter of the clients studied had experienced stays in jails or prisons. The number of incarcerations ranged from 1 to 50 times. One family whose daughter had been jailed described the potential for rape, harassment by the police, and lack of proper medication and treatment for her illness.
Lack of accessibility to professionally supervised, protective residential settings had devastating consequences:

"My son was in a residential center and they refused to admit him to the crisis unit even though he had been running away every day for 3 days --- blisters covered his feet. The third time he ran in front of a car and was in a coma for 5 weeks. The lower bones in both legs were fractured. Now he has severe ambulatory problems and brain damage."

Symptoms of the illness often interfered with good judgment and put clients at risk of accidental death:

"(When my daughter is not living in a residential care facility) she becomes extremely ill. She becomes a danger to herself because she is not aware of reality. She has gotten lost, walks out into traffic, does not eat or care for herself and chain smokes. The danger of fire is always there."

"Since 1986 our daughter has been committed 12 times. Court appearances are horrible but at the same time we are relieved she will be getting treatment. These commitments come after months of no medications and we are frantic that she will be raped, killed or become a missing person.

Medical problems were pervasive


48% of the clients studied had medical illnesses and 21% had substance abuse problems which were often ignored in treatment. Poor health habits and side effects of medications contributed to poor physical health:

"My son has become terribly obese because of the meds and because of lack of stimulation. He should have help with his poor diet and should be encouraged to work a few hours a day and should get some exercise."

The life-threatening consequences of the unavailability of professionally supervised residential settings for those with medical problems were cited:

"When he lived alone the stress on him and the family was terrible. He did not take his meds, no structure, no work, walked 3 miles back and forth to our mother's house several times a day, distressed. He is borderline diabetic, drank regular Pepsi and ate candy bars. He was found in his apartment in a coma from this when the apartment building was on fire. Had it not been for the fire, he may had died."

Families pointed out the need for qualified staff. As funding cuts are implemented, decisions are being made by staff who were untrained in the medical aspects of care and consequently these needs received inadequate attention.

What Can Family Members Do?


Family members can advocate for quality care! The following are priorities: