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Sarah Linden, MPH

Project Coordinator, National Council for Behavioral Health

The Largest Health Disparity Gap in the Nation: What You Can Do to Close It

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It’s a statistic you’ve probably seen before – people with serious mental illness die an average of 15 to 30 years younger than those without. This difference represents the largest health disparity in the U.S.; larger than gender, racial or socioeconomic differences. And unlike some of the other gaps that are slowly closing, it isn’t shrinking.

It’s easy to assume the high mortality rate is a consequence of mental illness – suicide, overdose, accident. In fact, people with serious mental illness are not dying from their mental health conditions. They’re dying from the same physical health conditions that plague the general public – cancer, heart disease, stroke, pulmonary disease and diabetes.

What’s Causing the Disproportionately High Mortality Rate?

Like most questions related to health, there is no easy answer.

  • Risk Factors: People with serious mental illness are more likely to engage in risky health behaviors, for example they are more than twice as likely to use tobacco.
  • High Rates of Comorbidity: All relationships may not be fully understood yet, but data clearly shows high rates of comorbidity between serious mental illness and cardiovascular disease, diabetes and stroke.
  • Health System Factors: Individuals with serious mental illnesses are less likely to receive primary care; instead they access the public mental health system and/or psychiatrists as their primary health care providers.
  • Clinician Bias: Dr. Dhurv Khullar writes in The New York Times that clinician biases are likely at play as well.
    • Therapeutic Pessimism. Dr. Khullar describes this as the belief that people with serious mental illness won’t get better. This can lead to a “what’s the point” approach to treatment.
    • Diagnostic Overshadowing. This is the bias toward attributing every patient complaint to their mental illness, resulting in serious complaints or concerns not being acted upon. One study found that patients with mental illness were significantly less likely to undergo cardiac catheterization when they have heart attack symptoms. Another found individuals with mental illnesses were less likely to receive cancer screening and follow-up care.This infographic was created by the National Behavioral Health Network director Taslim van Hattum.

What Can You Do?

It’s not surprising that the solution is as multifaceted as the problem, and it’s still developing. But there are few things that health professionals can do.

Check Your Biases

This is a challenging undertaking, but it is essential in the fight to close the disparities gap! If you are a clinician working with a person diagnosed with a serious mental illness, here are some things you should ask yourself:

  • Has this patient been screened for cancer? Diabetes? Heart disease? If not, why?
  • Does this patient have modifiable risky health behaviors such as tobacco utilization? If so, have you started to engage in conversations with the patient about quitting smoking? If not, why?
  • Does your treatment plan for your patients with serious mental illnesses include addressing their physical health in addition to their mental health? If not, why?
  • Has your patient complained about health concerns during recent visits? If so, have you followed up on them? If not, why?

The Institute for Healthcare Improvement has recommendation to reduce implicit bias.

Integrate Primary Health Care into Behavioral Health Care

In recent years there has been a push to integrate mental health care into primary care settings, but the integration can happen the other way too. If you work in a behavioral health setting, consider implementing cancer screenings, whole health programs and/or tobacco cessation programming. For more information, visit the SAMHSA-HRSA Center for Integrated Health Solutions.

For additional resources on tobacco cessation and cancer control, visit the National Behavioral Health Network.