Stigma inflicts harsh toll on mentally ill, but society pays too

mentalnyt-300x142Although Americans keep making progress toward ending the stigma associated with mental disorders, including trying to put public funding for the diseases’ treatment on a more even footing, patients with serious mental illness suffer unfairly and harshly still due to their conditions.

Dhruv Khullar, a doctor at NewYork-Presbyterian Hospital and a researcher at the Weill Cornell Department of Healthcare Policy and Research, has written a painful piece for the “Upshot,” an evidence-based column for the New York Times. His article, “The Largest Health Disparity We Don’t Talk About,” reports that:

Americans with depression, bipolar disorder or other serious mental illnesses die 15 to 30 years younger than those without mental illness — a disparity larger than for race, ethnicity, geography or socioeconomic status. It’s a gap, unlike many others, that has been growing, but it receives considerably less academic study or public attention. The extraordinary life expectancy gains of the past half-century [for most in this country] have left these patients behind, with the result that Americans with serious mental illness live shorter lives than those in many of the world’s poorest countries.

He says that the mentally ill, by and large, defy stereotypes and don’t overdose, kill themselves more often, or get in wrecks but succumb to the same maladies that most of us do: cancer, heart disease, stroke, diabetes and respiratory problems. But, he says:

Those with serious mental illness are more likely to struggle with homelessness, poverty and social isolation. They have higher rates of obesity, physical inactivity and tobacco use. Nearly half don’t receive treatment, and for those who do, there’s often a long delay.

Khullar calls out doctors, nurses, and hospitals for failing to move past their own prejudices, which may cause them to be so pessimistic about the capacity of patients with mental illness to live well or to be healthy so as to treat them well or to attribute to their mental disorders symptoms and issues that are real and physical.

He cites a recent New England Journal of Medicine commentary that has gotten some attention, in which Brendan Reilly, a Dartmouth doctor, describes the dismal disregard with which a series of physicians treated his mentally troubled brother. The brother had serious spinal damage degeneration, but doctors told him his declining mobility and pain were in his head or his medications were to blame. “Once they find out you have a mental illness,” Dr. Reilly quoted his brother as saying, “it’s like the lights go out.”

That’s shameful. But in my practice, I certainly see not only the major harms that patients suffer while seeking medical care but also their nightmares in accessing and affording safe, efficient, and excellent medical care, including for their mental health.

The trouble is, as we’re learning as a society, there’s nothing benign to the neglect of mental disorders. We end up paying, in big ways, for doing so. Hospitals are finding that many of their “frequent flyers,” patients whom they can’t turn away but turn up all too often for budget-busting emergency room care, have not only major and chronic physical conditions but also serious and untreated mental illness. Experts know that many substance abusers, including those caught up in the increasingly lethal and costly opioid crisis, have “co-morbidities” — their addiction appears with un-diagnosed or untreated mental disorders.

The New York Times, coincidentally, has just run another story about state and local programs that hope to better lives and reduce government spending by helping one-time  prisoners readjust to life beyond bars. Many of them struggle now and become expensive red-ink recidivism statistics because they don’t get the help they need for one of their major obstacles to a free and more normal life: their mental illnesses. Indeed, listen to law enforcement officials across the country and too many jails and prisons are overwhelmed by individuals who behave criminally but also are desperately mentally ill and in dire need of therapy and treatment.

With the United States leading the world in its per capita rates of incarcerating its people, and with too many private firms profiting too much from running factories of fear and repeating criminality, we taxpayers have stark but simpler choices: We need to do far better in helping to reduce or end the suffering of those with mental illness, or we can pay an ever-rising price.

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