By Dr David Laing Dawson and Marvin Ross
Reading the comments to this blog and others of ours, there is a lot of a-historic and naive thinking. Recently, someone posted my Huffington Post blog on Open Dialogue in Finland to the Spotlight on Mental Health group set up by the Boston Globe to foster discussion of their series on the sad state of mental illness treatment and care in Massachusetts. One person criticized it claiming that I had no right to comment because I have never been to Finland, and the Finnish psychiatrist I quoted had no right to be critical because he had never been to Lapland. This is part of what that person said:
“That paper by Marvin Ross is written around totally wrong information:
1) Marvin Ross has never been to Lapland to check what he wrote; thus he does not know what he speaks about…
2) The psychiatrist whom he telephoned in Helsinki, i.e. some 800 km from Lapland, had never been either…How she knew any of that I do not know.”
One person commented on this blog that 10 times as many people diagnosed with schizophrenia die in the first year post diagnosis than 100 years ago and that olanzapine has killed 200,000 people worldwide.
Taking data from a number of public sources, Dr. Dawson put these statistics together:
Some American Statistics
Total population: 50,000,000
A total of 91,959 “insane persons” were identified, of which 41,083 were living at home, 40,942 were in “hospitals and asylums for the insane,” 9,302 were in almshouses, and only 397 were in jails. The total number of prisoners in all jails and prisons was 58,609, so that severely mentally ill inmates constituted only 0.7 percent of the population of jails and prisons.
Average Life expectancy for entire population: low 40’s for whites
Low 30’s for blacks
2016 total population: 324,000,000
Average life expectancy: men 76, women 81 (lower than Canada and most of Europe, lower still for minority groups. Much of this improvement from 1880 by preventing childhood diseases.)
U. S. Prison population : 2,200,000 (2014)
Or 716 per 100,000 American citizens are in prison. (a seven fold increase from 1880)
Mentally ill in prison estimated/measured to be 30% to over 50%
So 700,000 to over one million mentally ill are incarcerated in US prisons.
Incarceration in jail reduces life expectancy by roughly a factor of 10 years for every 5 years incarcerated. (all inmates)
Estimates/measurements of homeless in the USA: 1.5 to 2 million.
Estimates of homeless mentally ill range from 30% to over 50%.
So 500,000 to one million mentally ill are either homeless or living in shelters.
The homeless mentally ill are not receiving consistent psychiatric treatment. The incarcerated mentally ill may be receiving some limited treatment.
Adding this up:
One to two million mentally ill people are either homeless or incarcerated in prison in the USA.
A high proportion of people with severe mental illness live in poverty.
Severe mental illness without treatment confers higher risks and co-morbidities for several serious diseases, such as cardio vascular disease. People with severe mental illness have a much higher risk of cigarette smoking and poor diet.
Untreated depression, bipolar disorder, and schizophrenia confer a much higher risk of suicide.
Homelessness and incarceration in and of itself reduces life expectancy by a considerable number of years. Neither of these groups is consistently receiving psychiatric treatment.
Psychiatric drugs do have side effects. (as do all pharmaceuticals) In a good outpatient or inpatient facility these can be monitored and treatment adjusted in partnership with patients.
But the real causes of contemporary poor life expectancy of the seriously mentally ill can be found in:
- The illness itself untreated
- Reduction and closing of hospitals.
- Incarceration in jails and prisons
- Poor or no housing. Homelessness
- Poor diet. Illicit drug use. Smoking.
- Stigma leading to isolation and victimization
- Poor, inadequate, or limited health care
- Absence of good consistent psychiatric treatment.
And the overall cost of not providing good early consistent psychiatric treatment in both inpatient and outpatient facilities is calculated in the following article: