Taking assertive action to avert an early death

Today, I received a very disconcerting e-mail from a 52 year-old female peer. Now that she has entered her early 50s, she has become terrified about the 25-year disparity in length of life confronting public mental health clients.

I want to reassure her about her own future:

Our findings* about early death are not a death sentence for you. Repeat: no, they are not a death sentence. Rather, they are a very strong and clarion call to take action to preserve and enjoy life.

Why am I able to say this? Essentially, most of the factors that can lead to an early death can be changed.

Let’s examine the most salient ones:

> Unhealthy lifestyle factors: One can quit smoking or doing alcohol/drugs, and one can begin to eat healthier foods.

> Metabolic syndrome: One can control obesity through exercise and other wellness activities, such as walking and dancing.

> Chronic illnesses, such as heart disease or diabetes: One can work with a primary care physician to delay, monitor, and control these conditions.

> Demoralization and lack of hope: One can develop and maintain a strong social support network to help prevent the corrosive negative effects of social isolation and withdrawal.

Self-management of personal health is essential to address all of these different risks. To manage one’s own health, one must become literate regarding one’s personal risk factors for early death. Then, one must become activated and address them, one by one.

For almost two decades, peers have been organizing wellness programs throughout our country. These programs not only are exceptionally valuable to teach one about literacy and activation, but also to offer direct support from other peers who have confronted similar concerns with their health.

Likewise, the health and medical homes being implemented under the Affordable Care Act (ACA) also can be very important for self management of one’s health. As part of everyday practice, these new systems include primary medical care that routinely measures blood pressure, blood sugar, and blood lipids to monitor and control risk for heart disease and diabetes. These are two of the leading causes of early death among persons with behavioral health conditions.

Under the ACA, these health and medical homes also have begun to monitor and control depression and alcohol/drug use. Both are known risk factors for suicide or accidental death due to opioid overdose.

I would be very misleading, however, if I left you with the impression that the quest to avert early death simply is an effort to avoid or control disease. Rather, as we have known very well for the past 70 years, good health also is a complete state of wellbeing—physical, mental, social, and spiritual.

Wellbeing primarily comes from the capacity to lead a good life in the community. To do this, one needs good friends and family members who provide essential social support. One also needs a permanent home and a job, both of which promote community tenure and personal self-esteem.

In closing, I would say to you: You can lead a long, healthy, and happy life. Our most recent findings** will give you much hope. They show that the difference in length of life actually disappears with good care.

Now we need to make this reality more than just a remote possibility for all persons served in public mental health systems.

References

*Colton CW and Manderscheid RW. Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Prev Chronic Dis 2006;3:A42.

** Pratt LA, Druss, BG, Manderscheid, RW, and Walker, ER. Excess mortality due to depression and anxiety in the United States: results from a nationally representative survey. Gen Hosp Psych 2015;12:003.