While you may have heard before that mental illness has a prognosis of shortening your life 20+ years before, it’s not often people really drill down into why people die so much earlier.
You may wonder, is it the homeless, throwing off the curve? The rate of the mental illness among the homeless is actually not thought to be that much elevated above that of the general population. About 26% of the population faces a mental illness in any given year and researchers estimate that it presents in only 13-15% of the homeless population, with a somewhat elevated rate for the chronically homeless. Is it drug and alcohol abuse? Approximately one-third of mental illness sufferers self-medicate, but the general population does so at a rate of about 22%, not that much lower. The longevity studies have controlled for unnatural deaths, so it’s not suicides bringing down the curves.
I have another theory.
A few years ago, I was having gallbladder attacks. In a period in excess of 6 months, with regular visits to the family doctor and one visit to the emergency room, this went undiagnosed. It was not until a stone lodged itself in my biliary duct in such a way that caused both pancreatitis and visible jaundice that I was able to get treatment, in a second visit to the emergency room. This is just one story in a series of stories that I have like this, but there is a common theme to every one: doctors do not effectively treat people who have a standing psychiatric diagnosis for their physical problems.
The problem starts at the differential diagnosis. Persistent adrenal stress is basically like having a venom-saline drip that can disrupt almost any/all of your organ functions, not to mention neurological/behavioral issues. Occam’s razor keeps doctors stuck there. With almost all psychiatric illnesses, you have a diagnosis that’s already confirmed. It explains basically everything a patient could possibly present to you. Bam, done. Nothing but net, right? So the doctor hands the patient a referral, or if they are already being treated by a mental health professional, hands them a bill and a to-go bag of disappointment.
So here is a question or two that I would just like an answer to: even if a doctor has a patient where the psychiatric problems legitimately are causing physical/endocrine/cardiopulmonary/pain/etc problems, why doesn’t the doctor treat the symptoms? If blood pressure is high because of general anxiety, for example, the prognosis is actually worse for the heart than an abled person with high blood pressure, so why aren’t they treating the high blood pressure? Why do they give less care as when more care is warranted? When a patient is in the care of a mental health professional, why does their psychiatric diagnosis remain on table for a differential diagnosis in the first place? What use is a diagnosis in hand with no treatment? How are people with psychiatric diagnoses supposed to get competent care for their physical health?
Here is my suggestion, and it is quite radical: doctors should treat their abled and mentally ill patients with the same standard of care. Advise people with untreated illnesses to see mental health specialists, sure, but also treat them. This practice of dismissing patients this way is killing them.