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The findings of a linked paper by Lawrence and colleagues (doi: 10.1136/bmj.f2539 ) raise disturbing questions about our disregard for the duration and value of the lives of people with mental illness. 1 It has been clear for more than 50 years that people with the more disabling forms of mental illness do not live as long as those without mental illness. 2 This finding has been repeatedly reported across decades and continents. 3 4 Evidence from low and middle income countries is sparse, 5 6 despite poignant accounts from colleagues in such countries of people with severe mental illness being abandoned in forests or deserts when families can no longer cope. Lawrence and colleagues' research covers new ground by focusing on reduced life expectancy among people with a broader range of mental illnesses, rather than those with severe conditions only. However, their results support the accumulating evidence that inequalities between those with and without mental illness are not improving.
For the past 20 years, the mortality gap among people with mental illnesses (around 15 years for women and 20 years for men) has not been closing in Australia or Scandinavia-two of the most affluent parts of the world with among the most accessible health systems. 1 7 We are coming to understand that this excess mortality is not the result of higher suicide rates, but rather a combination of socioeconomic, healthcare, and clinical risk factors. 8
What are the implications...