Serious mental illness and cancer: Treatment outside the box
“On average, Americans with major mental illness die 14 to 32 years earlier than the general population.”
Every time I hear it, I’m alarmed. Contrary to popular belief, most people with serious mental illness do not die from suicide or violence. They die from the same conditions as those without serious mental illness – cancer, heart disease, diabetes. While these illnesses are often preventable, manageable, and treatable, they require medical treatment that often is not accessible to people with serious mental illness. That’s not to say that services aren’t available; they are “accessible” by our standard definition. But what I’ve come to learn is that we need to redefine health care access for the seriously mentally ill. One doctor at Massachusetts General Hospital in Boston is demonstrating what this means.
Dr. Kelly Irwin, a psychiatrist and researcher at Massachusetts General Hospital, is piloting a new model of care to improve outcomes for patients with serious mental illness and cancer. (Watch this short video to learn more about Dr. Irwin’s inspiring work.) While cancer itself is devastating, serious mental illness adds another level of complexity. Patients often receive diagnoses at later stages and struggle to complete treatment. As a result, their mortality rates are higher than for people without mental illness.
That’s not to say that services aren’t available; they are “accessible” by our standard definition. But what I’ve come to learn is that we need to redefine health care access for the seriously mentally ill.
Flexibility leads to accessibility
Dr. Irwin’s approach to treatment focuses as much on the individual as it does on the system of care. She not only works with patients to address their unique psychological challenges, but she works within the hospital to change the way care is provided to these patients. What does this mean? In one word, flexibility. Dr. Irwin creates a more flexible, accessible system of cancer treatment for her patients by challenging the rigid care processes that are a cornerstone of our health care system. Anyone familiar with cancer treatment knows there is a strict treatment regimen, requiring attendance at multiple appointments per week at specific times and locations. For people with serious mental illness, following these schedules is challenging, if not impossible.
Dr. David P Ryan, Clinical Director at Massachusetts General Hospital Cancer Center, said it best: “We wouldn’t ask somebody who was paraplegic to walk up a flight of stairs. Why are we asking somebody with severe mental illness to show up at 8:30 in the morning every Tuesday on the button for a 20-minute appointment?”
Creativity leads to flexibility
Dr. Irwin figures out creative ways to make the system accessible for her patients. For example, she convinced Mass. General’s radiology department to offer “windows” of time for one of her patients to receive treatment rather than specific appointment times. Through this simple approach, her patient completed treatment. Another patient wouldn’t keep her appointments. While similar cases are often dismissed, Dr. Irwin persevered, bringing the patient an iced coffee to the homeless shelter for several weeks. Earning her trust, Dr. Irwin was able to work with the patient to arrange for care amenable to her.
As it turned out, each of the 30 patients enrolled in the pilot has a similar success story: barriers to treatment were broken down, opening the door to cancer treatment for a population whose mental illness realistically made traditional cancer regimens a non-option.
Dr. Irwin’s pilot has been startlingly successful in developing a proof of concept: her work is saving lives. Period. However, what would it take to build a model like this to scale? The answer is time – the time required to build trust with patients who have been alienated from the health care system their entire lives. The time necessary to convince an oncologist that there might be another way. Unfortunately, time is one of the few commodities our health care system does not compensate. However, Dr. Irwin’s work is building a strong case to think differently about how to make care accessible – through intensive patient engagement and flexible systems of care. Both require investments in time, but I believe it would be time well spent.