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Week 2014

September 15–21

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Last Updated: 1/30/2014

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Tracking Wellness Measures to Increase Life Expectancy Among People with Mental Health and Substance Use Disorders

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“The shockingly early mortality of people with serious mental health problems is the most extreme and despicable negative outcome you can have. People are dying because they aren’t getting the care they need. We have no organized system in place to measure it, and therefore we cannot manage it.”

—Ron Manderscheid, executive director of the National Association of County Behavioral Health and Developmental Disability Directors

A Crisis

People diagnosed with mental health problems are dying prematurely from preventable health conditions at a dramatically accelerated rate compared to people who do not have these problems.1 Add to that, people with serious mental health problems also experience higher incidences of an array of serious adverse health conditions, such as obesity,2 diabetes, the metabolic syndrome, osteoporosis, periodontal disease, and diseases contracted via sexual dysfunction that are induced or accelerated by atypical antipsychotic medications.3 People with mental health problems don’t receive primary or preventive health care as often as the general population and avoid seeking medical care for reasons—all common excuses—that include fear of coercive treatment, fear of commitment to a psychiatric facility, and lack of adequate insurance.4 When individuals need medical attention, those with mental health problems often end up using expensive emergency room services. And, for the most part, this appalling health inequity is virtually unknown by the public at large.

Health disparities for people with mental health problems are due to a variety of factors, including social determinants like significantly higher rates of unemployment or under employment,5,6 higher rates of homelessness or living in substandard housing,7 and significant odds of living below the poverty line.8,9 Mental health consumers are also more likely to be incarcerated or victimized10—particularly when they live in impoverished communities—or to learn, and thus practice, helplessness and hopelessness. Crushing poverty, lack of access to health education, and relentless traumatic experiences all conspire to negatively impact the lives of people with mental health problems. The serious physical health issues these individuals experience as a result of these factors create significant obstacles to successful employment, financial stability, comfortable housing, adequate education, satisfying relationships, and community involvement.11

Collecting and Centralizing Data

While federal, state, professional, and mental health and healthcare advocate calls to action have attempted to address these unacceptable health disparities, there has been no nationwide approach to collecting information about this problem to date, nor is there a centralized repository for data to inform researchers and decision makers who could develop programs, policies, and practice to impact or increase life expectancy for this population. The data collection systems that exist don’t adequately measure strengths, wellness, and factors that promote positive emotional and physical health. And— historically—the public health and mental health systems have collected conflicting information through their separate data collection systems: Public health measures the prevalence of health behaviors and chronic disease, whereas mental health tracks disease prevalence and health care use.

Health disparities, which are largely related to risk factors like obesity, smoking, and lifestyle habits, among many others, can be modified by the individuals who experience them12 and improved by access to social support, stress management, and other healing and alternative practices that are currently not accounted for in most data collection protocols. For example, robust wellness data and tracking efforts need to assess the presence of elements like purpose in life, active involvement in satisfying work and play, joyful relationships, a healthy body and living environment, and happiness.13

A Challenge

The ongoing challenges to collecting and integrating data14 about both physical and behavioral health are clear: National data are not available on the mortality of persons with behavioral health problems,15 nor is there a systematic approach to monitoring the effectiveness of treatment, services, and supports for these issues.16 Add to these factors that the broadest national efforts to date to integrate the collection of physical and behavioral health measures are represented by merely including chronic conditions measures to the Collaborative Psychiatric Epidemiology Surveys and depression measures to the Behavioral Risk Factor Surveillance System (BRFSS).17

Although some states have enhanced their data collection methods by implementing mental health modules on the BRFSS,18 there is still a need for both medical and mental health surveys to gather more robust information about the physical health challenges that people with mental health problems face. There also is a need to look at long-term progress and trends in people’s health and to regularly measure screening and treatment for serious medical conditions and wellness dimensions on state and national levels. Federal and state entities need to coordinate to establish sound and consistent methods to gather, track, and use data prudently to inform practices and affect policies. People with mental health problems should have leadership roles in the design of data collection systems and policy formulation.

Success in improving population-based physical and mental health outcomes requires addressing and measuring the impact of some root causes of disparities, including overall wellness* and impacts of social determinants that include poverty, education, employment, health care, and housing. Data in the areas of health risk behaviors, medical co-morbidity, medical and mental health service use, and quality of care needs to be examined.

It is critical to regularly measure relevant information about health, wellness, and risk factors to track and monitor the outcomes and effectiveness of system efforts to extend the lifespan of people with mental health problems. To accomplish this, it will be important to set clear and integrated surveillance, research, and programmatic approaches and develop systematic methods of collecting, analyzing, and managing information.19

This training teleconference features experts who have taken action towards prolonging the life expectancy of people with mental health problems. They will share how stakeholders can assure that health and wellness data indicators are established and systematic methods of tracking, reviewing, and responding to trends are transparent and relevant.

The Goals

Participants in this important teleconference will hear recommendations about some of the essential components, including multidimensional indicators of wellness and social determinants of health that data and reporting collection systems should track. Participants will also learn about innovative practices in states like Maine and Oregon that address mind/body/spirit health and that focus on enhancing life expectancy and quality of life.

Target Audiences

  • Mental health consumers, survivors, current and past recipients of behavioral health services, peers, family members, and mental health organizations
  • Mental health and behavioral health providers
  • Primary care providers
  • Mental health and behavioral health and public health researchers

Presenters

Meghan Caughey, MA, MFA
A wellness-informed policy development consultant to public and private organizations throughout the State of Oregon, including the Benton County Health Services and the Addictions and Mental Health Division of the Oregon Department of Human Services, Meghan Caughey pioneered the application of mindfulness and movement in peer support programming. She also created the first peer specialist-training program in Oregon to receive state approval for certification. Caughey has also developed outcome measurement tools for peer support services, co-chaired the Consumers Legislative Committee in the state’s most recent legislative session, and is actively involved in the process of reforming the Oregon State Hospital system.

A national speaker and writer on mental health reform, wellness, art, and healing, Caughey is also a visual artist whose paintings and drawings have been featured in numerous medical journals and books. Her work is informed by her experience of having more than one hundred psychiatric hospitalizations that included shock treatments, seclusion, and restraint.

Caughey, who is vice president of Mental Health America of Oregon, recently founded VISIONS—Art for Resilience and Transformation (ART), an organization that strives to use art for activism and social justice in transforming mental health systems. A certified peer specialist, she has a bachelor’s degree in psychology, a master of arts in visual art, and a master of fine arts in pictorial arts.

Elsie J. Freeman, MD, MPH
Elsie J. Freeman began her career in public mental health services research and administration in 1995 at the Massachusetts Department of Mental Health. Now medical director for the Maine Department of Health and Human Services (DHHS), where she has served since 2004, Dr. Freeman focuses her energy on health care quality improvement, public health program development, policy and planning for publicly funded health care systems, implementing the principles of the Institute of Medicine’s report on quality within mental health and health systems, and integrating mental and physical health and public health in services research. A member of several DHHS work groups on confidentiality, evidence-based practices, critical incident reporting, psychopharmacology quality improvement, and integrated health care, Dr. Freeman is also the State of Maine’s representative on the Medical Directors Council of the National Association of State Mental Health Program Directors (NASMHPD).

Dr. Freeman also serves on an advisory group for integrated care sponsored by the Maine Health Access Foundation, Maine’s largest health philanthropy, and has served on the Board of Directors of the Maine Center for Public Health. She served for two decades as the director of multidisciplinary neuropsychiatry evaluation clinics in the Harvard Department of Psychiatry and has concentrated her clinical work on the overlap between psychiatry, neurology, developmental disorders, and chronic health conditions.

Dr. Freeman, whose undergraduate degree is from Smith College, received her medical degree from Duke University and her public health degree from Harvard University. She trained at Children’s Hospital in Boston, is board certified in pediatrics, and completed training in both adult and child psychiatry within the Harvard system at Massachusetts Mental Health Center and at McLean Hospital.

Ron Manderscheid, PhD
Throughout his diverse career, Ron Manderscheid has emphasized consumer and family concerns. Currently Executive Director of the National Association of County Behavioral Health and Developmental Disability Directors, an organization that represents county and local authorities in Washington, D.C., Dr. Manderscheid is also an adjunct professor at the Johns Hopkins University’s Bloomberg School of Public Health Department of Mental Health. He is a member of the Secretary of Health and Human Services Advisory Committee on Healthy People 2020, president-elect of ACMHA–The College for Behavioral Health Leadership, and serves on the boards of the Employee Assistance Research Foundation, the Danya Institute, and the FrameWorks Institute. He also writes the Manderscheid Report, a monthly commentary for Behavioral Healthcare.

A former branch chief of the Survey and Analysis Branch of CMHS, SAMHSA, Dr. Manderscheid was a senior policy advisor on national health care reform in the office of the Assistant Secretary for Health at the U.S. Department of Health and Human Services. He also held a variety of positions within the National Institutes of Mental Health, including chief of the Statistical Research Branch, where he was instrumental in implementing the National Reporting System and the Mental Health Statistics Improvement Program. He also previously served as director of mental health and substance use programs at SRA International.

Principal editor for eight editions of Mental Health, United States, Dr.Manderscheid has authored numerous scientific and professional publications on services to persons with mental illnesses. He has received countless federal and professional awards, including the Federal Executive Institute Alumni Association’s Meritorious Service Award in 1999; multiple instances of HHS Secretary’s Distinguished Service Award; the American Association for Psychosocial Rehabilitation’s Irving T. Blumberg Humanitarian Award in 2002; the American College of Mental Health Administration’s Saul Feldman Lifetime Achievement Award in 2003; and the Knee-Witman National Distinguished Award in Health and Mental Health Policy in 2009.

Dr. Manderscheid, who is also a graduate of the Federal Executive Institute, holds a bachelor of arts in sociology from Loras College, a master of arts in sociology/anthropology from Marquette University, and a doctorate in sociology with a specialization in social psychology and statistics from the University of Maryland.

* Wellness includes an eight-dimensional model, and a wellness lifestyle includes a self-defined balance of health habits such as adequate sleep and rest, productivity, exercise, participation in meaningful activity, nutrition, productivity, social contact, and supportive relationships.


1 Parks, J., Svendsen, D., Singer, P., Foti, M.E., & Mauer, B. (2006, October). Morbidity and mortality in people with serious mental illness [Technical Report]. Retrieved July 8, 2010, from http://www.nasmhpd.org/general_files/publications/med_directors_pubs/Technical%20Report%20on%20Morbidity%20and%20Mortaility%20-%20Final%2011-06.pdf [PDF format - 1.06 Mb]External Web Site Policy.

2 MacLean, L., Edwards, N., Garrard, M., Sims-Jones, N., Clinton, K., & Ashley, L. (2009). Obesity, stigma and public health planning. Health Promotion International, 24(1):88–93.

3 Allison D.B., Mackell J.A., McDonnell DD. The impact of weight gain on quality of life among persons with schizophrenia. Psychiatr Serv. 2003 Apr;54(4):565–7.

4 Hahm, H., & Segal, S.P. (2005). Failure to seek needed health care among the mentally ill. American Journal of Ortho Psychiatry, 75(1), 54–62.

5 Bush, P.W., Drake, R.E., Xie, H., McHugo, G.J., & Haslett, W.R. (2009). The long-term impact of employment on mental health service use and costs for persons with severe mental illness. Psychiatric Services. Aug. 60(8):1024–31.

6 Anda, R.F., Felitti, V.J., Fleisher, V.I., Edwards, V.J., Whitfield, C.L., Dube, S.R., & Williamson, D.F. Childhood Abuse, Household Dysfunction and Indicators of Impaired Worker Performance in Adulthood. The Permanente Journal, 2004;8(1):30–38.

7 Browne, G., Hemsley, M., & St. John, W. (2008). Consumer perspectives on recovery: a focus on housing following discharge from hospital. International Journal of Mental Health Nursing, Dec.17(6):402–9.

8 American Community Survey (2008). Retrieved on January 4, 2010, from www.euro.who.int/DOCUMENT/E81384.pdf.

9 Fremstad, S. (2009). Half in Ten: Why Taking Disability into Account is Essential to Reducing Income Poverty and Expanding Economic Inclusion. Paper published by the Center for Economic and Policy Research, Washington, D.C..

10 Anda, R.F., Felitti, V.J., Walker, J., Whitfield, C.L., Bremner, J.D., Perry, B.D., Dube, S.R., & Giles, W.H. The Enduring Effects of Abuse and Related Adverse Experiences in Childhood: A Convergence of Evidence from Neurobiology and Epidemiology. European Archives of Psychiatry and Clinical Neurosciences, 2006: 56(3):174–86.

11 Hutchinson, D.S., Gagne, C., Bowers, A., Russinova, Z., Skrinar, G.S., & Anthony, W.A. (2006). Framework for health promotion services and for people with psychiatric disabilities. Psychiatric Rehabilitation Journal, 29, 241-250.

12 Healthy People 2010. A systematic approach to health improvement. Retrieved September 4, 2010, from http://www.healthypeople.gov/Document/html/uih/uih_2.htm#deter.

13 Dunn, H.L. (1961). High-Level Wellness. Arlington, VA: Beatty Press; Dunn, H.L. (1977). What high-level wellness means. Health Values 1(1), 9–16.

14 Manderscheid, R., Druss, B., & Freeman, E. (2008). Data to manage the mortality crisis. International Journal of Mental Health, 22(2), 49–68.

15 Everett, A., Mahler, J., Biblin, J., Ganguli, R., & Mauer, B. (2007). Improving the health of mental health consumers: Effective policies and practices. Paper presented at Wellness Summit, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, Rockville, MD.

16 E.J., Colpe, L.J., Strine, T.W., Dhingra, S., McGuire, L.C., & Elam-Evans, L.D., et al. Public health surveillance for mental health. Prev Chronic Dis 2010;7(1). Retrieved September 4, 2010, from http://www.cdc.gov/pcd/issues/2010/ jan/09_0126.htm.

17 Manderscheid, et al. (above).

18 Freeman, et al. (above).

19 Lando, J. & Williams, S.M. (2006). Uniting mind and body in our health care and public health systems. Preventing Chronic Disease, 3(2): A31.

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