Causes of death and comparative mortality in Texas public mental health clients, 2006–2008

Seriously mentally ill patients are known to have rates of mortality much greater than those of the general population. Prior research in Texas has shown inpatient Public Mental Health Clients (PMHCs) treated in in-patient settings were subject to greatly increased mortality, but little is known about the mortality of PMHCs in an outpatient setting in Texas. For this study outpatient service records for PMHCs treated in Texas were combined with death data from the Texas Department of State Health Services for 2006–2008. Frequencies of causes of death, age-adjusted death rates, standardized mortality ratios, and life expectancies were calculated from these data. The most frequent causes of death were external causes, followed by circulatory disease, and then neoplasms. Examination of the outcomes suggests that substance abuse plays a major role in the mortality of PMHCs in Texas in the form of drug overdoses, tobacco-related cancers, and alcoholic liver disease. Prevention efforts should therefore aim at integrating mental health services, substance abuse services, and careful medical and pharmacological monitoring, including medication monitoring to prevent suicides and accidental overdoses.