There is no question people with a severe mental health diagnosis die on average of 15–20 years younger than the general population; meaning long-standing chronic illnesses throughout a lifespan will impact the body and its longevity and health. I think this makes complete sense. Poorly managed symptoms and tough, difficult living resulting from unhealthy thinking may mean a briefer, more sickly life. Studies continue to evidence further data suggesting that the mortality gap is due to higher co-morbidities linked with other somatic diseases.
Lessons from lived experience
I’ve seen this first-hand during my time in a state hospital as a patient on the admissions unit. A patient was in the phone room with me, getting help from a staff member to use the unit phones. The patient was called out for meds, leaving the staff member with me alone in the room. It was the other patient’s birthday, and she revealed her age. She was in her forties. I was shocked. I was utterly baffled as to how this patient had aged so much in her forty years. She looked seventy and an unhealthy seventy. I was so puzzled I asked the staff member if she was confused about her age. He said: ‘Why?’ I explained that she looked much older. He said words I will never forget during my time healing: ‘She lived a tough life.’ It clicked how much my choices and behaviors impact how long and the quality of life, living, and health.
Unhealthy lifestyle choices
People living with a mental health disorder dont always make the best decisions when enacting healthy living behaviors in their life. Why? In most cases, the nature or manifestation of mental health symptoms interfere with people making better choices for healthy living. Indeed, severe cognitive disruptions may interfere much more with identifying healthy decisions. Without an ongoing and straightforward thought process, people have little hope but to hope that their choices will pan out and work for them. Therapists and peers familiar with mental health disorders know that bizarre thoughts can mean strange and less productive actions and behaviors. Even worse, a fixed or solvent delusional system even slightly enmeshed into a thought process may result in unhealthy choices and decisions, resulting in unfavorable mediating factors and behaviors with poor outcomes in terms of healthy lifestyle choices.
The literature and research
According to a randomised control trial study, lifespans are shorter with more severe mental health disorders. The study protocol aimed to evaluate the efficacy of psychosocial and behavioral interventions targeting improving the lifestyle and the health of patients with severe mental illnesses.
- Outcomes. The study used the BMI (body mass index) as an anthropometric parameter to evaluate the study’s outcomes in terms of health. The efficacy and effectiveness of the interventions implemented in the study carried a primarily evidenced belief in medicine and health sciences to improve patient experiences and yield a more healthy reduced BMI reading. The idea is that patients’ life spans will increase for people with severe mental health disorders who carry unhealthy practices due to their organic brain disease and dysfunction.
- Missing considerations and variables. But the study leaves out a few critical pieces of information. The study engenders largely stereotypical beliefs on people with severe mental health disorders when evaluating lifestyle habits and various expressions of living with a mental health disorder. Meaning, the picture painted of the lives of people with severe diagnoses is limited and very narrow, and very motionless, with little consideration for upward social mobility and lifestyle changes. Also, this is a very medical model approach to apply so-called psychosocial interventions in people’s lives with different needs, cultures, habits, and patterns of living. I suggest that the authors of this research casually assume that people with a mental health disorder are stuck in limited options between choosing unhealthy practices, dietary, and sedentary lifestyles or healthy ones in a black and white variable in possible outcomes. The truth of the lives of people with complex mental health disorders could be more nebulous. Akin to acute conditions, they fall along a large spectrum of lifestyles and patterns of living depending on other intermediating factors without even considering the impact of manifest active symptoms.
- Additional considerations. Where is the data tracking the exercise routines of the mentally ill? I am going to go ahead and tell you. The study utilises data from the hospital systems in several counties. Given that all counties have the same basic setup for outpatient treatment centers, the location and whereabouts of the six areas of this study are irrelevant and only put the limited data front and center into serious question. I have journeyed to treatment centers, both in-patient, and outpatient, in the USs, Caribbean, Europe, and Asia. Strangely, though topography and population varied, the same structure, design element, and practices are implemented with slight variation except for the arrangement of the acronym the clinician uses to pronounce the intervention and its spelling. I am not impressed by the transnational data pool evaluating the positive health routines and physical exertion practices for people with a mental illness in the US or beyond. We need to remember people in the hospital, or treated in an outpatient network, are being prescribed very high doses of trial medication. Even modern-day atypical psychotics are highly sedating medications promoting the same lethargy and in-activity associated with severe mental illness. Indeed, where is the data pool from people not prescribed sedating medication to manage their disease? Researchers need to consider and begin to look at how eliminating the use of debilitating anti-psychotic drugs to control symptoms will only lead to more health when people experience a sharper drop in the frequency of invasive medical interventions. No question, lifespans can only benefit when minor damage to the nervous system is a task and goal for people living under strict and risky med management regimens. Medical issues complicating life on the level of health are less rampant.
- Implications for future research. This study seems like another medical intervention hailed as the new gold standard of psychiatry and psychotherapy. But, with enough inspection, a very different narrative is playing out in the world of mental health treatment in this research. We cannot misread studies like this and the limited insights and glaring omissions offered. Further intrusive interventions push the agenda of medicine and psychiatry on people with a mental health diagnosis without facts instead of promoting science on the assumption of stereotypes and other unfair and misrepresentations of people with a mental health disorder. Indisputably, the BMI is an excellent index to use when framing the hazards of actual side effects, weight gain, nerve damage, and retardation of reflexes, etc. The goals, however, of this study’s intervention were clear and seemingly innocuous: an improvement in dietary habits; decreased or reduced smoking; and the discontinuation or reduction of sedentary behavior and other unhealthy lifestyle choices.There is no question that everyone should employ more healthy lifestyle choices. When we treat our bodies better, we are going to live longer without too much scientific evidence jargon. While this is true, does it mean that our mental health, per se, will improve, or is it more likely to improve over time? Furthermore, symptoms tend to de-activate over time with some disorders when a person’s mental health improves. Does this mean active MH symptoms shorten the lives of people living with a condition? Not necessarily, but the study does not evaluate this relationship in terms of quality of life and signs, which may complicate healthy decision-making. The research estimates both the causal or proximate circumstances involved and surrounding this question. So, what is this study considering in the end? I suggest this study makes more significant claims and assertions about a person’s physical health status with co-morbid mental health conditions than the quality of living with an MH disorder and its actual impact on the lifespan. The chief complaint or primary problem treated for the pool of this study’s participants’ most significant issue was their physical health problems. Instead, in very uncertain terms, this study failed to make a real connection between the lifespan of a person and their morbidity unless the people also had a severe somatic complaint and a chronic mental health condition.
- Limitations to the study and research. To make this claim, let’s take a quick look at the exclusion criteria. The study excludes people with a worsening clinical status of in-patient admission in the previous six months. The people in this study were stable, non-symptomatic, and may not require intensive treatment or direction to experience further improvement and relief from their symptoms. I fully believe that there are low levels of stress in people with mental health disorders and few issues to live without incident healthily. People stable in their mental health does not have to work too hard to maintain their health and continue living stable once their treatment is in fact and there are few stressors to overcome.
The work ahead
The people selected for this study experienced longer lifespans because they were already healthy. In this sense, no groundbreaking treatments and new interventions achieved more extended periods of success and stable living. As I said, we all should strive to be more proactive in our health. However, studies like this make it all too apparent the lack of real true scientific merit in studies rolled out in the last decade. Ultimately, until critical thinkers and researchers unpack the scientific results and inquiries chartered in present-day research. The need to advance research won’t seem as critically urgent. Researchers can no longer jeopardise the lives of mentally ill people and the familiar stereotypes and data circulated because it is easy to serve up a lack of information than charter new research.
Max E. Guttman, LCSW is a psychotherapist and owner of Recovery Now, a mental health private practice in New York City.
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