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Confronting Mental Health Challenges Exacerbating Mortality Crisis

February 1st, 2023

Since the end of 2019, life expectancy in the US has declined by almost 3 years, from 78 years, 10 months to 76 years, 1 month. This is an unprecedented and unexpected loss in the modern era. Although due in part to the direct effects of the COVID-19 pandemic, we must be alarmed that increased suicide and drug overdose rates both played a role in this precipitous drop. Between 2020 and 2021, the number of suicides increased from 46,000 to 48,000, and the rate increased from 13.5 to 14.1 per 100,000 population. Between 2019 and 2021, the number of drug deaths climbed from about 71,000 to 108,000, while the rate increased from 21.6 to 28.3 per 100,000 population from 2019 to 2020.

Unfortunately, these national population numbers mask a very serious reality in the behavioral health field. My own research shows that persons with mental illness receiving care in the public mental health system, typically those with serious mental illness, are likely to die 25 years earlier than other persons in the general. These numbers recently have been reaffirmed by the World Health Organization. Further, those living in the community with depression or anxiety who do nor receive treatment are likely to lose 7 or 8 years of life. When substance use is comorbid with mental illness, these losses become even larger.

Taken together, this evidence leads to the observation that COVID-19 likely is associated with a disproportionate increase in mortality among the population of persons with behavioral health conditions. Additional support for this is provided by further research that shows persons with mental illness or substance use conditions are more likely to contract COVID-19 and are more likely to suffer from long COVID.

Clearly, premature mortality on this scale is a profound public health crisis. The key question is: What steps can be taken to address it?

In the immediate future, effective crisis response services must be built throughout the US to prevent suicide and drug overdose deaths. The new 988 emergency response number is a critical first step in configuring this system. Local response teams also are essential. The latter will be much more difficult to configure because of our current behavioral health human resource shortages. Peers, community health workers, and physician assistants can and should be deployed now.

In the intermediate term, we must expand our integrated care services. Many of the premature deaths of those with mental health or substance use conditions are due to chronic physical diseases, such as heart disease, diabetes, etc. Good integrated care can do much to prevent and ameliorate these conditions. Recent implementation of virtual services has done much to propel the development of integrated services nationally. We must continue to expand these services.

In the longer future, we must address the problems of living in our communities. Drug overdose deaths, suicides, and alcohol-related cirrhosis of the liver are “diseases of despair.” They have their origins in the problems of community living and failure of mutual support. We must learn how to address these issues and build happier, more effective communities that promote personal and family wellbeing. Please review your county mental health status from the US News Healthiest Community Initiative and compare how your county ranks with the healthiest counties in the nation.

Importantly, President Joe Biden’s behavioral health initiative can provide essential resources to help us address each of these issues. We must advocate vigorously so that this initiative is funded in fiscal year 2023. As President Franklin Roosevelt wanted to say in a speech never delivered because of his untimely death, “The only limit to our realization of tomorrow is our doubts of today.” We can overcome our doubts, and we can address our mortality crisis.

Ron Manderscheid, PhD, is the former president and CEO of NACBHDD and NARMH, as well as an adjunct professor at the Johns Hopkins Bloomberg School of Public Health and the USC School of Social Work.

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