Objective To compare patterns of site-specific cancer mortality in a population of individuals with and without mental illness. Methods This was a cross-sectional, population-based study using a linked dataset comprised of death certificate data for the state of Ohio for the years 2004–2007 and data from the publicly funded mental health system in Ohio. Decedents with mental illness were those identified concomitantly in both data sets. We used age-adjusted standardized mortality ratios (SMRs) in race- and sex-specific person-year strata to estimate excess deaths for each of the anatomic cancer sites. Results Overall, there was excess mortality from cancer associated with having mental illness in all of the race/sex strata: SMR: 2.16, (95% Confidence Interval: 1.85–2.50) for Black men; 2.63 (2.31–2.98) for Black women; 3.89 (3.61–4.19) for non-Black men, and 3.34 (3.13–3.57) for non-Black women. In all of the race/sex strata except for Black women, the highest SMR was observed for laryngeal cancer 3.94 (1.45–8.75) in Black men; 6.51 (3.86–10.35) and 6.87 (3.01–13.60) in non-Black men and women, respectively). The next highest SMRs were noted for hepatobiliary cancer and that of the urinary tract in all race/sex strata, except for Black men. Conclusions Compared to the general population in Ohio, individuals with mental illness experienced excess mortality from most cancers, possibly explained by a higher prevalence of smoking, substance abuse, and chronic hepatitis B or C infections in individuals with mental illness. Excess mortality could also reflect late-stage diagnosis and receipt of inadequate treatment.

Multidisciplinary and focused assessment, treatment, and discharge planning can be effective in neutralizing the risk of firearms use among psychiatric patients.

Objective Our objective was to analyze causes of death, crude mortality rates, and standardized mortality ratios among decedents identified with mental illness in the Ohio publicly-funded mental health system (“mental health decedents”), compared to all Ohio decedents. Methods Ohio death certificates and Ohio Department of Mental Health service utilization data were used to assess mortality among Ohio decedents, 2004-2007. Age-adjusted standardized mortality ratio (SMR) and age-adjusted mortality rate were calculated in race- and sex- strata. Results Mental health decedents comprised 3.3% of all 438,749 Ohio deaths. Age-adjusted SMR varied widely across the race- and sex- strata, and by cause of death. Non-blacks showed higher SMRs than blacks. Non-black females showed the highest SMRs in injury-related deaths. Decedents showed higher SMRs in death due to substance abuse, mental illness, diabetes, nervous system, cardiovascular, respiratory, and injury-related causes. With and without mental illness, top cause of death in youth was violence, and in adults over 35 years was cardiovascular disease. Conclusion Injury/violent deaths, especially in youth, should be specifically addressed to reduce excess mortality for persons with mental illness. Primary care should integrate with mental health care to better manage chronic disease, especially cardiovascular. Methodological contributions included use of linked files to compare SMR and leading causes of death between mental health decedents and all Ohio decedents. More research is needed on patterns in cause of death for age, gender, race, other demographics and mental illness. Healthcare data silos must be bridged between private sector, public, Veterans Affairs, and Department of Defense.

Twin Valley Behavioral Healthcare developed safety guidelines for injury-free inpatient management, which were implemented in 2004. The guidelines focus on best practices in the areas of verbal and physical interactions between patients and staff, administration of emergency medication, communication of critical information during precrisis and crisis periods, measurement of safety outcomes, and application of safety rules via policies and use of the agency logo, "Working Smart=Working Safe." Between 2004 and 2008 staff injuries decreased 90%--from 91 to nine injuries. Restraints and seclusions fell by 36%, patient complaints by 37%, and the need for codes for staff to assist in a psychiatric emergency by 25%.