Op Ed January 9, 2020 – by Vic Topo
Over the course of my thirty-five year career, I have been asked what it is that I enjoy most about serving as CEO of a NH community mental health center. What comes to mind first is being in a position where I lead organizational changes that better the lives of people with mental illness. The nature of my work, my team’s work, and our center’s mission not only changes lives but also saves lives, from suicide, drug addiction, and other serious risk factors and conditions.
The question that I am not asked very often, but which I speak freely about with employees, colleagues, and the general public, is the worst part of leading a behavioral health organization: being informed of the sudden or even expected death of a person we or others are serving. While there are a wide variety of circumstances and often complex clinical conditions involved, these deaths almost always have one thing in common: they are premature. These individuals are dying 20 to 25 years sooner than the general population; in some states, it’s closer to a 30 year difference.
A recent New York Times story described the “mortality gap” as the biggest health disparity we don’t talk about. This is not new; it was highlighted in the first Surgeon General’s Report on Mental Health and Mental Illness in 1999. Although the report included recommendations to overcome this trend, it has actually gotten worse in many places throughout the U.S.
There are many reasons for this, which include increased prevalence and incidence of suicide, substance use, smoking addiction, medications that cause excessive weight gain, and, some would say, the economic toll and contributing factors of the “great recession” of 2008. Many of these “health shocks” are associated with clinical conditions being treated every day, which include schizophrenia, major depressive disorder, bipolar disorder, among others. Lifestyle choices of poor nutrition, lack of exercise, smoking, etc., make this all the more challenging. In many cases there are also the co-morbidities involving those with diabetes, hypertension and heart disease.
Younger generations, especially Generation Y (Millennials), are now being considered most at risk for premature death. One of the reasons is the risk taking behaviors they engage in, coupled with suicidal tendencies that some have with their mental illnesses. This is especially true for males who are prone to more lethal means of suicide such as weapons and/or hangings. In fact, right here in New Hampshire, a recent Suicide Prevention Report included the grim reality that, from 2013 to 2017, suicide was the second leading cause of death for those in the 15-34 age group, ahead of cancer. For ages 35-44, it’s the third leading cause after cancer. These numbers are above the national rate trending for the same time period.
The first thing we need to do to reverse this trend is acknowledge that we have a tremendous gap between what we know and what we have done or should do. But going back to 2003, NH actually recognized sooner than many other states the need for a wellness philosophy that focuses on the importance of physical activity and close collaboration with primary care providers working with people with mental illness.
At the forefront of this recognition was my colleague and friend Ken Jue, former CEO of Monadnock Family Services in Keene, who invented a program called InSHAPE. The program, which includes fitness and nutrition coaching and smoking cessation counseling to improve cardiovascular health for those with serious mental illness, was adopted by all ten NH community mental health centers and became a national model. While the target group was primarily adults, InSHAPE could also be very beneficial and even life saving for younger generations.
This early stage recognition does indeed prepare New Hampshire for a number of other interventions, strategies and solutions, which include:
- Smoking cessation has been, is now, and will continue to be a life saving solution.
- Any increase in physical activity will greatly benefit the overall mental and physical health of people who are at risk.
- The plain fact is that some medications that treat and improve psychiatric symptoms also cause weight gain and obesity, and being prescribed two or more medications makes it even more challenging.
- All psychiatric providers should place as much importance on physical health and wellness as they do in addressing the psychiatric and psychosocial factors affecting their clients.
- And finally, any and all suicide prevention efforts and programs will continue to be instrumental in preventing premature death.
Narrowing the “mortality gap” for people with mental disorders will continue to be a daunting challenge for all of us in the helping field and in society at large. We need to work to reverse the fatal trending that is happening around our country and be mindful that it includes individuals that you or I know as part of our own circle of families and friends. Helping prevent just one more person from dying prematurely will make a lasting difference.
Vic Topo is President and CEO of the Center for Life Management in Derry.