Patients with serious mental illnesses deserve better care and support, as they are often neglected and left to struggle.

Patients with a diagnosis of a serious mental illness, are not only falling through the cracks of healthcare, they are receiving a lack of primary care and attention to the illnesses that may be brought on by their psychotropic medications. The situation is dire and it is having, a tremendous effect on those in this category.

Although SMI and less severe mental illnesses aren't clearly defined, the term is commonly used for diseases that greatly affect daily life. Bipolar disorder, schizophrenia, major depressive disorder, and post-traumatic stress disorder are all types of serious mental illness (SMI). The SMI crisis may be more of a care crisis than an increase in the incidence of mental health issues. Less than half of people with SMI are getting effective physical treatment, even though there are effective drugs, psychiatric treatments, and rehabilitative care options available.

Even the available treatment options are used in a rather catchy manner. Patients are treated for individual diagnoses instead of considering their overall health and the potential side effects of multiple medications (polypharmacy). How many prescribers are truly conversant in pharmaceutical interactions? I remember working at a large psychiatric hospital where the internist (referred to as the “medical doctor” as opposed to the psychiatrist) in charge of the unit asked me why all the patients were developing diabetes.

An investigation into the particular medication that was preferred for anyone with schizophrenia revealed that one of the side effects was diabetes. No one on the medical staff seemed to know that initially, and that only came to the fore when more than half of the patients now had diabetes. Of course, this was a hospital where a patient’s infected foot had to be bathed in a refrigerator vegetable drawer in the dayroom.

When state inspections were scheduled, comforters and blankets were put on all the beds in one unit. After the inspectors left, these disappeared and were never seen on the beds or on the unit again.

The hospital was sued for lack of adequate care and staffing, and the advocates won. They regularly came for inspections and team meetings, but little changed. A physician was told, by the medical director, to examine a young man who said he was being raped nightly by another patient, but he did no examination.

According to recent meta-analyses, one in three with SMI have metabolic syndrome. As a result of this condition and others, the life expectancy of those suffering from SMIs, including schizophrenia or bipolar disorder, is significantly lower than that of the general population.

A large portion of this life loss can be attributed to a 2–3 times higher risk of cardiovascular morbidity and mortality. Some of the psychotropic medications cause excessive weight gain. Younger SMI cohorts exhibit a larger incidence of physical multimorbidity than those without severe mental illness, indicating a need for earlier intervention.

In the US, people with serious mental illness live 20 to 25 years less due to a lack of primary medical care and an inability to access care or maintain treatment without sufficient management. Consider what this statistic indicates in terms of how we value people with SMI’s.

As a result of a lack of available public hospital beds, many individuals with SMI are treated solely in correctional facilities. Because of the dismantling of the disability safety net, many have lost their housing. Few people get the variety of rehabilitation therapies they need to return to a higher level of functioning.

Although about 70% of those with SMIs indicate they would like to work, only about 20% can get jobs. As a result, those referred to rehabilitation facilities work in sheltered workshops or temporary employment positions managed by the facilities. I wondered where they would put the former television producer patient on our unit.

Many of them wander the streets, are homeless, and are disconnected, and the facilities that may be offered are not always appropriate or safe. For someone to refuse to go to a homeless center, to me, makes sense when you consider that there has been a reported high incidence of criminality in these centers. Therefore, it's not paranoid to refuse admission and to indicate you would rather sleep on the street.

The current state of treatment for SMI is shocking. Most primary care physicians who aren't trained in psychiatric diagnosis write most prescriptions for anxiety and depression medications (somewhere over 60% of scripts). What type of therapy is offered if psychotherapists are not trained in the skill-based interventions that research shows are most beneficial, like dialectical behavior therapy or cognitive behavior therapy for those with SMI?

I worked in a hospital where each unit had a psychologist who used a different theoretical orientation; patients would be switched to a new unit, and therapy was little more than sitting there. Tell me how a Freudian type of therapy works for people with schizophrenia. IMHO, I don’t believe it can.

And there’s the matter of fees and finding someone who can offer appropriate therapy for those with SMI. These patients must rely on Medicaid, which many healthcare providers don’t enroll in and don’t accept; cash only for too many is the watchword. How many provide pro bono services? I suspect some may accept one or two patients.

Furthermore, few mental health providers use conventional measures to measure outcomes. In most medical fields, disregarding measurement and not relying on reliable scales or tests would be unimaginable. However, in mental health care, it has been quite common. Some even fail to write detailed treatment plans with a means to measure any progress.

We can address this issue by improving policies, educating healthcare professionals, and giving early access to services for those with SMI.