This is a paper that looked at the mortality of people in the US with insurance who had a first psychotic break.

I’m not sure why they are surprised by these figures. Psychosis has a mortality. Clinicians know this.

Young people experiencing first-episode psychosis (FEP) are 24 times more likely to die within the year of diagnosis than their age-matched peers, reported a study published April 6 in Schizophrenia Bulletin. The findings highlight the importance of intensive clinical intervention at the early stages of psychotic illness and the need for widely available coordinated specialty care programs.

“We expected to see the elevated mortality from previous research, but none of that prepared us for the excess mortality on the scale we observed,” said Michael Schoenbaum, Ph.D., lead author and senior advisor for mental health services, epidemiology, and economics at the National Institute of Mental Health (NIMH).

The unusually high 12-month death rate in youth with FEP—1,968 per 100,000—should be a “wake-up call,” Schoenbaum told Psychiatric News. In the general population, only people over 70 years old have 12-month mortality approaching the rates observed among patients with psychosis in this study.

But this is the abstract (the paper is behind a paywall that I cannot get through)

Objective: To assess 12-month mortality and patterns of outpatient and inpatient treatment among young people experiencing an incident episode of psychosis in the United States. Method: Prospective observational analysis of a population-based cohort of commercially insured individuals aged 16–30 receiving a first observed (index) diagnosis of psychosis in 2008–2009. Data come from the US Department of Health and Human Services’ Multi-Payer Claims Database Pilot. Outcomes are all-cause mortality identified via the Social Security Administration’s full Death Master File; and inpatient, outpatient, and psychopharmacologic treatment based on health insurance claims data. Outcomes are assessed for the year after the index diagnosis. Results: Twelve-month mortality after the index psychosis diagnosis was 1968 per 100000 under our most conservative assumptions, some 24 times greater than in the general US population aged 16–30; and up to 7372 per 100000, some 89 times the corresponding general population rate. In the year after index, 61% of the cohort filled no antipsychotic prescriptions and 41% received no individual psychotherapy. Nearly two-thirds (62%) of the cohort had at least one hospitalization and/or one emergency department visit during the initial year of care. Conclusions: The hugely elevated mortality observed here underscores that young people experiencing psychosis warrant intensive clinical attention—yet we found low rates of pharmacotherapy and limited use of psychosocial treatment. These patterns reinforce the importance of providing coordinated, proactive treatment for young people with psychosis in US community settings.

There is one problem. Coordinated, proactive treatment is expensive. It requires a socialized system, with enough legal teeth to remove autonomy from the equation. Such a system of community treatment orders and community based psychiatric care kind of exists in New Zealand and the UK where there is basically no private (or Medicaid/Medicare funded) psychiatry: it has to be funded by research and state grants in Australia and the USA.

And there is little evidence, after 20 years of first evidence psychosis clinics, that it makes a huge difference in long term outcomes.

What we do know is that the people we see now are more complex, with more co occurring conditions (including substances) and have less robust families, less robust coping skills, and less social or cognitive capital.

The press release and the abstract make assumptions that a more proactive model may work. It probably does work better than neglect. It may be that neglect is an option in the USA: may that not be so. It certainly is not an option in the Antipodes.