The authors of a new report on mortality rates within the schizophrenic population of Ontario have supported the claim that the condition should be considered a “life-shortening disease”.
The American Psychiatric Association defines schizophrenia as a chronic brain disorder, and it affects around 1% of the population. Common symptoms include hallucinations, issues with motivation and concentration, and a breakdown of the relationship between one’s thoughts, emotions, and behaviour. When untreated, patients are known to fall into a deep withdrawal from reality, where perception is coloured by fantasies and delusions.
Through psychiatric treatment, the majority of schizophrenia patients do show improvements over time, making the condition largely manageable. But misconceptions about the disease and the behaviour of patients abound.
Most commonly, it is often conflated with split-personality disorder but this is a separate condition. The perception of a schizophrenic individual’s capacity for violence and danger is also false, as this is rare, and the majority of patients live with families and not in psychiatric wards or hospitals.
Bearing the burden of their reality
The study examined trends across a 19-year period (1993-2012) in Ontario and found that people with schizophrenia have a three-fold mortality gap in comparison with the general population. This is in spite of the fact that the majority of patient deaths are from normal causes. Although life expectancy for patients has risen by three years since 1993, they are still dying roughly eight years sooner than the general population.
Variables accounted for included sex, age, income bracket, and urban versus rural, and the most vulnerable schizophrenic patients were noted as young, female, rural, and from low income neighbourhoods.
The authors suggest that healthcare access and higher rates of modifiable lifestyle factors such as smoking, alcohol and drug abuse, poor diet, and a lack of exercise are probable reasons for the disparity. Schizophrenic people are more vulnerable to addiction, but the key link is disputed.
Theories include genetic vulnerability, self-medication from social issues as well as the side-effects of medication, but the Schizophrenic Society of Ontario (SSO) cites recent research that suggests that the impact of the disease on the nervous system (increased sensitivity to the power of substances) is responsible.
Another issue is the increased likelihood of obesity and diabetes for patients, which may be linked to the weight gain associated with anti-psychotic medications. All of these factors make morbidity an ever more real possibility.
The probability of death by middle age
Other noteworthy data trends include the linear mortality trend of the general population (rising steadily with age) versus the middle-age peak for schizophrenia patients. Around 63% of patient deaths in 2012 were between the ages of 35 and 65, compared to only 18% for the non-psychiatric group. A total of 52% of all patient deaths were linked to the two lowest income brackets.
Similarly, the percentage of suicides was four times higher among the patient population (4.7% versus 1.2%).
This issue is not unique to Ontario or Canada, however. Even in countries with top class healthcare such as the Scandinavian nations, there remains a wide mortality gap between the general and schizophrenic population, according to a 2011 study.
The authors of the 2011 study argue that their research is further evidence that expansion of the welfare state model is necessary to continue closing the life expectancy gap. In Ontario, it is closing, but the question is whether the same logic can be applied here. Can we accelerate the process through further subsidization?
A safety net for the most vulnerable
A separate 2011 paper jointly-submitted by the SSO and the Canadian Mental Health Association (CMHA) argued that ensuring baseline social security, raising awareness in the workplace and community, and reintegration into the workforce (where feasible) will help stabilize the severely mentally ill as well as cut down on public costs.
“SSO and CMHA Ontario strongly believe that social assistance must be re-conceptualized as a holistic safety net rather than a program of last resort,” say the authors. “The vision and delivery of social assistance programs should be informed by and aligned with broader policy frameworks such as poverty reduction, social inclusion, and human rights.”
As of 2017, there is evidence of increased commitments at government level to support those struggling with mental illness. In February, a mental health investment plan was announced which includes expanded youth support, social housing (around 17,000 units), and corrections system support among others. The government has set aside $140 million for these support schemes.
The effects of these investments will naturally take time to show results, but for a mental health system that has been criticized as being “in crisis”, they can’t come too soon.
