With all of the information and smack that’s out there about earlier morbidity and mortality with the <+25 years earlier death to you if you live with mental diversity, receive psychopharmacological and other clinically necessary psychiatric torture in an American Public Community Mental Health treatment provider, then, well, hats off to you, Friend.

The average age of death is 52 years old. Gender not withstanding. Race not withstanding. US regions not withstanding. Frontier. Rural. Urban. None of it matters. Dying an earlier death than the general population is now a given if you fit the population’s demographics.

45% of all people with mental illness, have 2+ physical disorders (co-morbidities).

• Nearly half (45%) of all individuals living with any mental disorder have two or more debilitating physical disorders further lowering their quality of life and leading to a significantly high rate of comorbid physical issues.
• Average age of death is now 52 years old for an individual living with an SPMI diagnosis.

 

A medically, clinically necessary diagnosis substantiating the use of psychotropic medication dosing is geared to control and manage exhibited DSM-5 symptomology popularized and normalized by the American Psychiatric Association, the American Medical Association, National Association of Social Work and the American Psychological Association.

Forty-six (46) years ago, in 1967, 1:3 American adults filled a prescription for a “psychoactive” medication, with total sales of such drugs reaching $692 million. In its’ June 2008 report the GAO determined that one in every sixteen young adults in the United States is now diagnosed with an SPMI (Whitaker, R., 2010).

In 2010, $16.1 billion was spent on antipsychotics in the US, to treat depression, bipolar disorder and schizophrenia. $11.6 billion was spent on antidepressants, while $7.2 billion for the treatment for ADHD.

Suicide completion numbers worldwide today occur every 40 seconds with injury accounting for 30-40% of excess mortality, and where 60% of premature deaths in persons with a diagnosis of schizophrenia are due to medical conditions such as cardiovascular, pulmonary and infectious diseases. World Health Organization (2016). Retrieved April 11, 2016 http://www.befrienders.org/suicide-statistics.

• Physical comorbidities are the leading reasons why people with SPMI are dying 25 years earlier than the general population not receiving Public Community Mental Health. There are higher frequencies of multiple general medical conditions that more than double the rate of premature deaths from these conditions.

Many argue that the employment of peer providers is more than a simple addition to the human service workforce, seeing it as a critical means by which to transform services into care that is recovery-focused. But it has also been argued that evidence is needed from studies examining the impact implementing a peer workforce has on access to care, cost of services, participant outcomes, and provider outcomes (Hardin, Padron, & Manderscheid, 2014).

There is also a growing recognition that poor mental health and complex physically related health problems are linked, often with deleterious outcomes for the seriously mentally ill (e.g., Brekke et al., 2012). There is an emerging notion that peer providers are a crucial link in services that are coordinated in Integrated care environments.  Peer providers have a history in stepping up to help with continuum of care in infectious diseases, vector diseases, chronic illnesses to whole health, substance use and health outreaching, educating in communities regionally and nationwide.

 “The Modern Asylum,” Op-Ed piece by Dr. Christine Montross, a Rhode Island Butler Hospital staff psychiatrist, wrote in The New York Times (2015), “… my patients with chronic psychotic illness cycle between emergency hospitalizations and inadequate care treated by community mental health centers (receiving) twenty minutes of attention every three months. Many struggle with homelessness. Many are incarcerated.”

Montross goes so far as to state that the need for modern Asylum “… is care for vulnerable patients, the severely mentally disabled” citing “… escalating prison and court costs, inpatient hospitalizations… chaos and suffering” can best be treated in a modern warehouse for the mentally ill “citizens.”

Trending talk of reinstitutionalization, trans institutionalization and Asylum warehousing of the “infirmed” are stigmatizing and is an outright example of scapegoating man, woman, child or youth who may live with a psychiatrically label and who is persecuted because of it. This is a promulgation of Recovery. It will unduly increase numbers of involuntary inpatient, forced medication, seclusions and restraints to individuals and create a climate of perpetrated “clinically and medically necessary” psychiatric treatment which inflicts trauma. It will further normalize medical based psychiatric compliance that dismisses Recovery based oriented systems of care and its’ embrace of a strengths-based and self-directed US Peer.

I defer that current primary models for health care delivery are the medical model and the wellness model. Integrated health care delivery carves in the best practices of treating disease, improving quality of life by encouraging healthy life style choices and focuses on preventing disease before treatment is necessary. It collocates behavioral and physical integrated environments and systems of care.

 

As well, trending workforce development is a SAMHSA Center for Integrated Health Solutions (CIHS) priority. To meet the seven core strategic goals identified in SAMHSA’s Action Plan on Behavioral Health Workforce Development, the CIHS elicited the guidance of an array of experts and drew upon published literature.

Goals identified include:

Goal 1: Expand the role of consumers and their families to participate in, direct, or accept responsibility for their own care;

Goal 2: Expand the role and capacity of communities to identify local needs and promote health, and Wellness;

Goal 3: Implement systematic federal, state, and local recruitment and retention strategies; Goal 4: Increase the relevance, effectiveness, and accessibility of training and education; Goal 5: Actively foster leadership development among all segments of the workforce;

Goal 4: Enhance available infrastructure to support and coordinate workforce development effort;

Goal 5: Implement a national research and evaluation agenda on workforce development.

Mitigating rising health care costs, a fundamental shift in reimbursement is occurring. “Patients” and organizations, alike, are inherently required to transition from an episodic, fee-for-service model of reimbursement to a new model that reimburses and encourages money in the pocket wellness and care across the health service continuum.

A wellness focus on prevention and coached self-activated management of chronic conditions that our population experiences with early intervention and prevention, care experience will improve, providers will be better able to deliver quality care seeing an overall reduction in costs.