Mentally ill overlooked for health care -Palm Beach (FL) Post

By Carolyn Susman

This is a horror story that just happens to fall on Halloween.

Some may think "horror" is a little strong, but anyone concerned about the state of the nation's severely mentally ill will agree that description is apt for the findings of a paper co-authored by a Florida Atlantic University professor, Dr. Charles Hennekens.

Hennekens, and Dr. John W. Newcomer, have put together in writing what separate studies have shown: That patients with severe mental illnesses such as schizophrenia, bipolar disorder and depression lose an average of 25 years or more of life expectancy due - not to suicide - but to cardiovascular disease (heart attack) that isn't diagnosed or treated or even given the degree of preventive care that the average patient receives.

This isn't a question of prejudicial treatment, Hennekens says, but of doctors who are missing signs of disease, patients who are noncompliant when placed on medications, poor access to medical care for these patients, and even the antipsychotic drugs used to treat their illnesses.

"I'm not in favor of assessing blame, but in pointing out the problem," Hennekens says, when asked why there is such an under-diagnosis of heart disease among these patients.

"I think they're an under-served population and I'd like to call attention to this pressing clinical problem and get public attention for it."

Coupled with the fact that these mentally ill, he said, are fatter, smoke more, and are less physically active than the general population, the outlook isn't good unless care for them is changed.

"I don't think it's fair to blame it on drugs, doctors, or patients," says Hennekens, who formerly was a professor of medicine at Harvard Medical School.

"It has to be a shared responsibility. It's a big mistake to place blame. This is a multifaceted problem."

He says he has gotten a positive reaction from both cardiologists and psychiatrists since the paper was published Oct. 17 in the Journal of the American Medical Association.

But when asked how realistic is his call for improved education among doctors and patients and a reallocation of resources to deal with this issue, he backs away.

"I'm an academic. My research brings problems to those involved with problem solving. I'm not qualified to say how realistic it is, because it depends on how seriously it's taken by those people."

Among the findings published:

* Patients with severe mental illness have nearly twice the incidence of diabetes, high cholesterol, high blood pressure and obesity as the general population.

* Patients with diabetes and severe mental illness are less likely than patients with diabetes and no mental illness to receive the acceptable standard of care.

* There is a crucial need for new approaches for prevention and treatment of cardiovascular disease in patients with severe mental illnesses.

* Research should be directed at finding antipsychotic medications with less adverse cardiovascular impact.

* If nothing changes, "avoidable premature mortality" from heart disease among the severely mentally ill "is likely to continue and increase in severity."