Mental illness contributes more todisability adjusted life yearsthan any other condition worldwide, with unipolar depression leading the way. And yet, prioritizing mental health among the assortment of concerns and actions of population health thinking remains a distant hope. There are many reasons for this, starting with the historical stigma around mental illness and continuing with our lack of understanding of brain processes—and therefore behaviors—at the cellular or molecular level. But perhaps one of the core reasons is that we do not keep in mind the extraordinary burden of death associated with mental health disorders.
Most obvious aredeaths due to suicide. There are about 1 million suicide deaths a year globally, or about one every 40 seconds, and suicide is the second leading cause of death among 15- to 29-year-olds globally. Far from the popular rendering of suicide as a rich country problem, more than 75% of all suicides happen in low- and middle-income countries. Mental illness is the clearest driver of suicide.
Perhaps less obviously, a range of deaths from other conditions are, at heart, mental health problems. Deaths from cigarette smoking are really deaths due to nicotine addiction; that is6 million deaths a year, or one every 5 seconds. And the more than3 million deaths a yearlinked to alcohol are linked to misuse of alcohol, also a mental health problem. The current opioid overdose crisis, our leading killer of young adults, should have ended our innocence about the relationship of death and mental health disorder.
The consequences of mental illness extend beyond an enormous burden of lost years of productive life to a large burden of death. It seems to us that we must include death from mental illness in any discussion of health and the consequences of non-communicable disease. Only in this way will we pay as much attention to mental health—in our research and in our practice—as it deserves.
Warmly,
Michael Stein & Sandro Galea