Many people will celebrate their 80th, 90th, or even 100th birthday — but statistically people with serious mental illness don’t have the same chance at growing old. In fact, according to the World Health Organization (WHO), people living with serious mental illness have a life expectancy that is 10-20 years shorter than average. Fountain House has teamed up with WHO to put an end to that disparity.
Fountain House and the World Health Organization have established guidelines and best practices to extend and improve the quality of life for people living with mental illness to be implemented by governments and health care professionals around the world. On this page you can access articles and reports, as well as view upcoming and past events dealing with the subject of excess mortality in persons living with serious mental illness.
Watch Fountain House President Kenneth J. Dudek and Dr. Shekhar Saxena, Director - Department of Mental Health and Substance Abuse at the World Health Organization, discuss our partnership, World Health Day on April 7, our Comprehensive System of Care and the Fountain House One-in-Four 5k:
Healthier Longer Lives International Conference
In November 2018, Fountain House hosted a first-of-its-kind international conference, Healthier Longer Lives for People with Serious Mental Illness, in partnership with World Health Organization Collaborating Centre for Global Mental Health at Columbia University Medical Center, Grand Challenges Canada and citiesRISE, with technical support from the World Health Organization. The idea for the conference emerged from Fountain House's multi-year partnership with WHO to address the crisis of excess mortality in people with serious mental illness. At the convening, WHO guidelines produced through the collaboration entitled, Management of physical health conditions in adults with severe mental disorders, were released.
Healthier Longer Lives was attended by over 300 scientists, practitioners, policymakers and philanthropists from more than 30 countries. The convening showcased innovations from around the world improving the health of people with serious mental illness; presented new scientific advances; raised awareness of effective interventions; engaged partners in other fields; and created a space to inspire investment in and implementation of best practices.
Research Articles and Reports
Excess mortality in persons with severe mental disorders: a multilevel intervention framework and priorities for clinical practice, policy and research agendas
Volume 16 Issue 1 February 2017
Liu, N. H., Daumit, G. L., Dua, T., Aquila, R., Charlson, F., Cuijpers, P., Druss, B., Dudek, K., Freeman, M., Fujii, C., Gaebel, W., Hegrel, U., Levav, I., Laursen, T. M., Ma, H., Maj, M., Medina-Mora, M. E., Nordentoft, M., Prabhakarn, D., Pratt, K., Prince, M., Rangaswamy, T., Shiers, D., Susser, E., Thornicroft, G., Wahlbeck, K., Wassie, A.F., Whitefield, H., Saxena, S. (2017). Excess mortality in persons with severe mental disorders: a multilevel intervention framework and priorities for clinical practice, policy and research agendas. World Psychiatry, 16(1), 30–40. http://doi.org/10.1002/wps.20384
Persons with severe mental disorders (SMD) − i.e., schizophrenia and other psychotic disorders, bipolar disorder, and moderate‐to‐severe depression − die 10 to 20 years earlier than the general population.
The majority of deaths in persons with SMD are due to preventable physical diseases, especially cardiovascular disease, respiratory disease, and infections.
*In low- and middle-income countries (LMICs), available studies just suggest that excess mortality is similar, if not worse- with larger majority dying of physical diseases, especially infectious diseases.
The remaining deaths in persons with SMD are due to unnatural causes, including suicide, homicide and accidents (especially in the first year following discharge from an inpatient unit).
A highlight of this article were recommendations in relation to Clinical Practice, including the following:
- Patients with severe mental disorders (SMD) should have providers responsible for their mental health and physical health. If these are different providers (e.g., psychiatrist and primary care physician), there should be communication and coordination between them, so that screening, preventive services, and monitoring for antipsychotic side effects (if applicable) are ensured.
- Patients with SMD should be offered the same basic health screenings as the general population (e.g., cardiovascular risk and cancer).
- Providers should address tobacco cessation with every patient with SMD. Persons with SMD can quit and many want to quit smoking; however, practitioners often do not address tobacco cessation.
- Lifestyle interventions with an evidence base in SMD to address health behaviors, such as diet and physical activity, should be implemented. Behavioral interventions, if not already tailored, will likely need to be modified to account for motivational and cognitive challenges in this population. These may include social support strategies and environmental supports.
These interventions align with approaches and initiatives that Fountain House’s wellness programming and the Sidney. R Baer Jr. Health Center have been practicing for years, including: the integration of primary and psychiatric care in a single location, weight management and fitness activities, nutrition, substance abuse and smoking cessation.
Alongside our co-authored article, an introductory editorial by Dr. Shekhar Saxena (Director of Mental Health and Substance Abuse, World Health Organization) was published in support of a multilevel model of interventions to reduce excess mortality in persons with serious mental illness, as well as addressing challenges that the model may present in implementation. Dr. Saxena’s editorial is linked below:
Meeting Report on Excess Mortality in Persons with Severe Mental Disorders
World Health Organization Headquarters, Geneva, 18-20 November 2015
In addition to the World Psychiatry article mentioned above, a policy brief was created by Dr. Saxena that presents four examples of best-practices from around the world, one of which is the Fountain House Community System of Care, as described below:
Community as therapy – Living longer, healthier lives
Based in New York City, an inspiration to hundreds of programs in more than 30 countries, Fountain House is founded on the conviction that people with serious mental illness can live good lives.
Founded in 1948, Fountain House, www.fountainhouse.org, recipient of the 2014 Hilton Humanitarian Prize, pioneered the comprehensive community system of care that goes beyond integrated healthcare by combining medical, psychiatric and social supports. Working with Sidney R. Baer Jr. Health Center, the first health home in the US created for people with serious mental illness where patients access primary and psychiatric care in a single location, Fountain House members belong to and create an evidence-based, non-clinical community that offers wellness programming, including: weight management and fitness activities, nutrition, substance abuse and smoking cessation. It is a setting for self-initiated social interaction and personal contributions which encourages people living with serious mental illnesses to support each other in making healthier lifestyle and behavior choices as well as in obtaining jobs, education and housing. This comprehensive community system of care improves quality of life, increases medication adherence, reduces re-hospitalization and emergency room visits, and effectively addresses co-occurring medical illnesses so that people living with serious mental illness lead longer, healthier lives.
The policy brief positions the Community System of Care as a practice to be replicated and researched internationally. You can download the policy brief here.
World Health Organization guidelines on the management of physical health conditions in adults with severe mental disorders
The guidelines will be made available to healthcare providers treating people with serious mental illness everywhere. You can download the guidelines here.
Fountain House is conducting a series of panels to raise awareness about the epidemic of early mortality among people with serious mental illness. Attendees of these panels learn about the important relationship between mental and physical health and how people with serious mental illness and their advocates can get better care. These “in-house” panels educate the Fountain House community about this global public health issue and expose a new audience to the organization.
The Connection Between Mental and Physical Health
Friday, October 9, 2015 from 6:00-7:00PM
The physical health of people with serious mental illness is often ignored which leads to significant health disparities. At this panel, Dr. Lloyd Sederer discussed the important relationship between mental and physical health. Dr. Ezra Susser explained why people living with serious mental illness have a life expectancy that is 10-20 years less than the general population and shared examples of his work in Latin America. In honor of World Mental Health Day, Kenn Dudek discussed Fountain House’s partnership with the World Health Organization and Columbia University to reduce early mortality in people with serious mental illness.
Getting Better Health Care for Your Mind and Body
Monday, March 21, 2016 from 2:00-3:00PM
The changing landscape of health care provides many opportunities for people with serious mental illness to get better care. Dr. Ralph Aquila shared findings from the World Health Organization’s Consultation on Excess Mortality Among Persons with Severe Mental Disorders. Dr. Gary Belkin from the New York City government discussed how the Department of Health and Mental Hygiene is working to prioritize mental health. The panel offered practical advice that will enable people with serious mental illness and their advocates to get better care from their primary care providers.