Research to Improve Health and Longevity of People with Severe Mental Illness
― • Meeting Summary
Office for Research on Disparities and Global Mental Health (ORDGMH)
Division of Services and Intervention Research (DSIR)
National Institute of Mental Health (NIMH)
On September 10-11, 2012, the NIMH Office for Research on Disparities and Global Mental Health (ORDGMH) and Division of Services and Intervention Research (DSIR) convened the meeting, “Research to Improve Health and Longevity of People with Severe Mental Illness.” The purpose of the meeting was to assess the state of the science in preventing and treating medical comorbidities in people with severe mental illness (SMI) and identify the most critically needed research to reduce premature mortality in this vulnerable group. The 11.4 million people in the U.S. with SMI carry a heavy disease burden, in addition to having a mental illness. They die 11-32 years prematurely from largely preventable comorbid medical conditions—e.g., heart disease, diabetes, cancer, pulmonary disease, and stroke—which occur more frequently and have earlier onset in this population. Low rates of prevention, detection, and treatment further add to these health disparities. While effective approaches to these common conditions and their health risk factors exist for the general population, evidence is needed on how to bring these effective strategies to people with SMI.
NIMH brought together the leading researchers on medical comorbidities in people with SMI and on prevention and treatment within the general population for diabetes, heart disease, tobacco use, and drug abuse. They were joined by policy leaders pioneering innovations in their states to address comorbid medical conditions in people with SMI; advocates for people with SMI; community mental health center leaders; representatives from other NIH institutes, including the National Heart, Lung and Blood Institute, the National Cancer Institute, and the National Institute on Drug Abuse; and, representatives from key federal agencies, including the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Agency for Healthcare Research and Quality.
The meeting began with an overview of the issues in premature mortality in people with SMI, and key considerations in developing services interventions for this population. Speakers presented prevalence estimates of comorbidities in people with SMI based on the National Survey on Drug Use and Health, with comparisons to same-age cohorts without a mental illness. For all medical conditions and health risk factors identified, and across all age groups, prevalence rates were generally higher for people with SMI, often dramatically so. NIH-funded researchers then presented key findings on health interventions shown to be effective in the general population for drug abuse, for prevention of cardiovascular disease and diabetes, and for tobacco cessation, as well as how these interventions could be adapted to meet the needs of people with SMI.
The afternoon of the second day featured presentations from currently funded NIMH grantees on the state of the science on health interventions for people with SMI. These investigators presented key findings on approaches for diabetes self-management, fitness and health, and reducing cardiovascular disease risk for people with SMI, highlighting the many significant knowledge gaps and the most pressing research questions. Next, a panel of NIMH researchers explored health care issues related to race, ethnicity, or gender of persons with SMI, highlighting the dearth of science in this area.
The day ended with participants forming break-out groups to synthesize the presentations and discussions, and to develop a set of proposals for high impact approaches targeting one or more health risk factors that could improve health outcomes among people with SMI. The groups also identified facilitators and barriers to implementing the recommended strategies, and the research needed to move the recommended strategies forward.
The products of the break-out groups were presented, discussed, and refined at the beginning of the second day, generating some promising strategies for further development. The next session considered favorable platforms and contexts for future research activities. Representatives from two state offices of mental health, New York and Ohio, described innovative policy initiatives addressing the health of people with SMI within their states. Staff from SAMHSA discussed their Primary and Behavioral Health Care Integration grants program, after which staff from the National Council for Community Behavioral Healthcare presented an overview of relevant policy and financing issues, including how the patient-centered medical home may represent an opportunity to advance the health of people with SMI.