A man with severe mental illness dies suddenly at the age of 52 . He had been living successfully in the community for 5 years without a hospitalization and worked for the past 6 months in the first job he had held for more than 20 years
His family is in shock, having been caught completely by surprise by his death, and asks why this has happened. Which of the following responses accurately reflects the research on mortality and serious mental illness and best addresses the family's question? a. "A certain number of people die young from undetected diseases, and it's just one of those sad things that happens sometimes to unlucky people.".
b. "Mentally ill people tend to die much younger than others, perhaps because they do not take as good care of their health, or smoke more, or are overweight.".
c. "We will have to wait for the autopsy to see for sure what happened. He had had some medical problems, but we were not expecting this.".
d. "We are all surprised. He had been doing so well, and he sees the nurse every other week; all we knew was wrong was that he was overweight.".
B
The family is in distress; because they do not understand his death, they are less able to accept it and are seeking specific information to help them understand what has happened. Persons with severe mental illness die an average of 28 years before their peers without such illnesses. This may be a result of health care practitioners attributing their somatic complaints to their mental illness, to being unable to recognize or report symptoms indicating an impending health crisis, to not being able to afford or access health care, to poor health care practices, or to symptoms such as apathy and impaired judgment that lead them to choose unhealthy lifestyles. Medications can contribute to cardiac dysrhythmias, obesity, sedentary lifestyles, and diabetes. Finally, mentally ill persons have higher rates of smoking and substance abuse than the general population. Therefore, the most accurate answer indicates that seriously mentally ill people are at much higher risk of premature death for a variety of reasons. Staff who understand this would not have been surprised that such a patient died prematurely, and they would not attribute his death to random, undetected medical problems that are found in the general population. Although it is true that the cause of death will not be reliably established until the autopsy, this response fails to address the family's need for information.
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