A renowned Stellenbosch University (SU) psychiatrist is part of an international group of experts calling for radical action to end mental health related deaths. Prof Soraya Seedat, head of the Department of Psychiatry at SU's Faculty of Medicine and Health Sciences, is one of 40 global experts to publish a research article in the prestigious journal, Lancet Psychiatry, mapping the factors that increase the risk of early death among people with mental health conditions, and offering solutions to address these issues.
“One in three South Africans has a mental health condition, and mental disorders rank among the top ten leading causes of disease burden in South Africa," says Seedat, who is also co-director of the South African Medical Research Council's Unit on Anxiety and Stress Disorders.
“Physical health conditions and suicide are the two foremost reasons that people with mental illness die many years earlier than people without any mental illness. Both are preventable and need to be prioritised, as too do other factors that contribute to the increased risk of premature death, such as trauma exposure, unemployment, income insecurity, social exclusion, stigma and poor access to healthcare," she says.
The research followed an innovative approach that brought together mental health clinicians, researchers, people with lived and living experience, policy planners and carers to identify causes and craft solutions to address the issue. “There are several common, concrete solutions that, if implemented, can substantially reduce the risk of people with mental illness dying much earlier than they should be," says Seedat.
A media statement by MQ Mental Health, detailing the research and proposed solution can be found below.
Leading researchers call for action to end mental health related deaths
People with severe mental illness die too soon; their lives are scandalously short. This is due to the tragedy of suicide as well as a disproportionately high rate of physical health problems with low detection.
Now, a new paper published in the Lancet Psychiatry has called for radical action on a global scale to put an end to the growing mortality rates of people with mental illness and mental distress.
The paper, written by 40 global experts, followed an extensive road mapping process of evidence reviews and consultation with mental health researchers, clinicians, policy experts and people with lived and living experience of mental illnesses and suicide.
The group mapped the range of factors which increase the risk of early mortality for people who are suffering from mental health conditions. These include adversities such as traumatic life events, unemployment, stigma and marginalisation, lack of meaningful societal relationships, and poor access to healthcare, education, housing, and income security.
Although these factors are widely acknowledged, more research is urgently needed into the ways we can reduce these risks and deliver changes to both medical and wider government policies, to improve the life expectancy for people diagnosed with mental health conditions or in mental distress.
The paper, produced by MQ Mental Health Research, sets out ambitious goals for implementing concrete solutions, and calls on government policy-makers to coordinate their response to the mental health challenges we face nationally and globally. The paper also challenges the private sector such as social media companies and employers to make changes now to save lives in the future.
The 18 recommendations outlined in the paper include delivering integrated healthcare, community-based interventions, restriction of access to lethal means of suicide, reduction of inequalities as well as increased investment in mental health services and research.
The paper's lead authors are Professor Rory O'Connor, Director of the Suicidal Behaviour Research Laboratory at Glasgow University and Professor Carol Worthman from the Anthropology Department at Emory University in the USA.
“Globally, too many people die prematurely from suicide and the physical health problems associated with mental illness and mental distress. These devastating losses are preventable," says Professor O'Connor.
“For this first time, we have brought together a multidisciplinary global team of academic, policy, clinical, and lived and living experience experts with the specific aim of understanding the driving forces behind these deaths together with what needs to be done to tackle this public health crisis.
The time to act is now, to rebuild health-care systems, to prioritise mental health funding, and address the effects of stigma, discrimination, marginalisation, gender violence, and victimisation."
The paper offers a practical roadmap for implementing the solutions, but the authors are keen to make it clear that any solutions must be co-designed by people with lived and living experience of mental illnesses in order to be successful. The paper's authorship itself integrated many people with first hand and family experience of mental illness.
"From the very start, Gone Too Soon has prioritised the knowledge and expertise that comes from having lived and living experiences of mental illness," says mental health campaigner and contributor to the paper, James Downs.
“As someone with longstanding serious mental illness, comorbidity, and suicidality, it has been meaningful to have an active role in this ambitious research alongside world-leading experts. By integrating experts by experience on an equal footing, we have aimed to create a fuller, more representative knowledge of the problems that underpin why people like me are likely to live shorter and more difficult lives as a result of mental illness. I hope the solutions we have proposed are more impactful as a result of lived experience being included in the project, and that we have set an example for how to co-produce knowledge and co-design more effective solutions together."
The authors recognise that this is an ambitious paper, and the solutions must be implemented across all levels of society, including at a global political level.
“The Gone Too Soon road mapping process revealed cross-cutting factors behind mortality from both suicide and mental health comorbidities," says Professor Carol Worthman. “We also discovered that many of these factors operate across the social-ecological spectrum, from individuals through families, communities, and society.
These insights open possibilities for common solutions that reduce premature mortality from both suicide and comorbidities and suggest opportunities to leverage ramifying effects via strategic interventions.
That our global team combined diverse expertise and living and lived experience was crucial for identifying common cross-cutting factors and recognizing the local forms they take, thus advancing inclusive efforts to promote human welfare."
This paper was made possible by funding from The William Templeton Foundation for Young People's Mental Health. The full paper will be available to view from 23:30 on Thursday the 11th of May: https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(23)00058-5/fulltext
- People with severe mental illnesses can have their lives shortened by up to 10 years in comparison to the general population. This is due to the complex relationship between physical and mental health as well as through suicide.
- Systematic underfunding of mental health services compared with physical health services is a major global problem
- Suicide still remains one of the top 20 causes of death globally, claiming the lives of over 703,000 people annually. Low and middle-income countries bear the brunt with at least 80% of suicides.
- Socioeconomic disadvantage and trauma are key risk factors for suicide. Although suicide can affect people from all backgrounds, those who are socially disadvantaged are disproportionately at risk of suicide and premature mortality from mental illness.
- People with mental illness are more likely to experience systematic social exclusion, such as homelessness, which is also associated with premature mortality.
- Too often, health-care professionals misattribute physical health problems to an existing mental health condition, which delays people with such conditions from receiving health care they need for their physical health conditions.
The 18 proposed solutions:
|Integration of mental and physical care|||
|1. Eliminate silos in health care||Integrated primary youth mental health care services. Group therapy improves depression and HIV treatment |
|2. Improve collaborative care models||Task-shared integrated collaborative care for patients with depression and diabetes or alcohol in South Africa|
|3. Improve care-provider training, capacity-building||EMERALD multi-national programme. WHO EQUIP training programme|
|4. Access to primary care services with capacity to treat mental and physical health problems||Integrating mental health therapy into primary care. RESHAPE stigma reduction for carers in Nepal|
|5. Improve screening, early identification and treatment of comorbidities||Garrett Lee Smith Youth Suicide Prevention Programme. Portable MRI in LMICs|
|Prioritisation of prevention while strengthening treatment|||
1. Policies to restrict access to lethal means
and decriminalisation of suicide
|Banning pesticides in Sri Lanka |
2. Media/social media engagement to tackle
stigma and prevent suicide
|Engagement of the Malaysian media community on safe reporting of suicide|
|3. Policies targeting upstream factors to regulate tobacco & support adequate diet/nutrition||WHO recommendations for tobacco cessation and management of substance use disorders |
|4. Work-based interventions to promote healthy workplaces||Mental Health in the Workplace guidance|
|5. Early intervention, education and public mental health awareness & training||Postnatal home visitation to support parenting and infant healthy development |
|6. Community-based interventions, peer engagement|
Communities That Care Plus (CTC Plus): a
community-based planning and implementation system for youth in US
|7. Improve access to effective treatments and personalised medicine||Access to psychosocial treatments for suicidal thoughts and behaviour|
Optimisation of intervention synergies across social-ecological levels
and the intervention cycle
|1. Strategies to reduce stigma, discrimination, marginalization, gender violence & victimisation||Women-centred, advocacy, and home-visitation programmes. Stigma reduction strategies|
|2. Action to reduce income inequality, such as income support & acute cash transfers||National cash transfer programme in Brazil|
|3. Increase investment in mental health||Investment in mental health and suicide-prevention saves lives and is cost effective|
|4. Redesign health systems to focus on factors that cause illness & improve treatment||Integrated care for severe mental illness, Ethiopia. Guidelines for high-performing hospitals |
|5. Harness digital opportunities & big data||Passive sensing on mobile devices to improve mental health services in Nepal. App co-design|
|6. Better understanding of interplay between biomarkers & psychosocial risk factors||Cortisol-trauma relationship in suicide risk. Bio-markers of environmental risk factors in depression|
About the lead authors:
Professor Rory O'Connor, Director, Suicidal Behaviour Research Lab, Glasgow University
Professor O'Connor is a co-lead author of the paper and a Professor of Psychology. He is the Director of the Suicidal Behaviour Research Laboratory in Glasgow, one of the leading suicide and self-harm research groups internationally, and is President of the International Association for Suicide Prevention.
Professor Emerita Carol Worthman, Professor of Anthropology, Emory University, Atlanta
Professor Worthman has had a long career studying and teaching at Harvard, MIT and Emory University where she holds the Samuel Candler Dobbs Chair Emerita in the department of Anthropology. She also directed the Laboratory for Comparative Human Biology.
James Downs, Lived Experience contributor and Mental Health Advocate
James is a mental health campaigner with lived experience of mental health conditions, including an eating disorder. He has written and spoken about his experiences many times in the media. James is a lived experience advisor on this paper.
About MQ Mental Health Research
MQ is a global charity committed to scientific research into understanding different mental health conditions, developing new interventions and championing prevention of mental illness.
For more information please contact: firstname.lastname@example.org 07775 752 512