According to the National Comorbidity Study Replication, >25% of people in the United States have some type of mental illness. The prevalence of serious mental illness has been estimated at 6.2%. Patients with severe and persistent mental illness have significantly reduced life expectancy relative to the general population. On average, pooled populations of public sector inpatients and outpatients die 25–30 years earlier than unaffected individuals in the general population, according to recent data from multiple states in the US. Schizophrenia and bipolar disorder together account for ∼23,000 deaths and >20 million life-years of disability worldwide each year. The most common cause of mortality in these individuals is cardiovascular disease (CVD), not, as might be assumed, suicide (Figure 1). Heart disease and stroke are the most common causes of death in patients with serious mental illness, accounting for ∼40% of deaths, underlying the dramatically decreased life expectancy in these patients.

Serious mental illness is associated with a significant reduction in life expectancy of ≤30 years. Among patients with schizophrenia, mortality due to coronary heart disease is ∼50% higher than that of the general population.

Patients with schizophrenia have substantially higher rates of cardiovascular risk factors (smoking, high cholesterol, hypertension, physical inactivity, obesity/overweight, and diabetes) than the general population. Approximately 75% of individuals with schizophrenia smoke compared to ∼25% of the general population. Patients with schizophrenia also have lipid profiles that are significantly worse than those of individuals in the general population.

The 12-month and lifetime prevalences of bipolar I and II disorder in the United States are 2.0% and 3.3%, respectively. Similar to schizophrenia, bipolar disorder is also associated with premature and excess mortality, with an estimated loss of ∼15 years of life expectancy. Most of the excess mortality in individuals with mood disorders results from natural causes, not suicide. Again, similar to schizophrenia, the most common cause of death in patients with bipolar disorder is cardiovascular disease (CVD), which occurs approximately twice as often in this group as in the general population. Although the data are more limited than in schizophrenia, people with bipolar disorder are differentially affected by medical comorbidity. Bipolar disorder is associated with elevated risk of a wide variety of comorbid medical illnesses, including migraine, asthma, chronic bronchitis, hypertension, and gastric ulcer, which compound disability and increase the burden of the disease.

Patients with schizophrenia have a markedly reduced lifespan compared with the general population. In the United States today, patients with schizophrenia have an average life expectancy of ∼61 years, about 20% lower than that of the general population, in which life expectancy is ∼76 years.

Physicians treating patients with serious mental illness need to overcome a number of hurdles to ensure that appropriate health care is provided to these often underserved patients. The Community Mental Health Act of 1963 established community mental health centers (CMHCs) that provide patients with access to psychiatric care, with the unintended consequence of separating mental health care from physical care. CMHCs do not always have adequate resources to screen, monitor, and treat cardiovascular disease (CVD): they lack sufficient funding, have limited staff, and often do not have laboratory facilities for monitoring lipids and blood glucose.

Cardiovascular disease (CVD) remains the number one cause of death in the United States and most developed countries and is expected to remain so for much of this century. Rates of obesity have increased 2–4-fold over the last 2 decades in the US and this condition is linked with early development of hypertension, hyperlipidemia, diabetes, and atherosclerosis. The prevalence of diabetes is also increasing, and the rise of diabetes in young people 18–29 years of age was 40% in the period between 1990 and 2001. The World Heart Federation (WHF) has estimated that CVD will become the number one cause of death in the world by 2020, surpassing infectious disease in developing countries. Metabolic disorders are on the rise in general. However, as highlighted in the discussions presented in this supplement, patients with serious mental illness appear to represent a special population who are particularly vulnerable, with rates that surpass the general population.