Gone Too Soon: priorities for action to prevent premature mortality associated with mental illness and mental distress


Rory C. O'Connor, Suicidal Behaviour Research Laboratory, School of Health & Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK. Electronic address: rory.oconnor@glasgow.ac.uk.
Carol M. Worthman, Department of Anthropology, Emory University, Atlanta, GA, USA.
Marie Abanga, Hope for the Abused and Battered, Douala, Cameroon.
Nikoletta Athanassopoulou, IfM Engage, University of Cambridge, Cambridge, UK.
Niall Boyce, Wellcome Trust, London, UK.
Lai Fong Chan, Department of Psychiatry, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia.
Helen Christensen, Faculty of Medicine & Health, University of New South Wales, Sydney and the Black Dog Institute, Sydney, NSW, Australia.
Jayati Das-Munshi, Department of Psychological Medicine, King's College London, London, UK; Institute of Psychiatry, Psychology, and Neuroscience, and Centre for Society and Mental Health, King's College London, London, UK; South London and Maudsley NHS Trust, London, UK.
James Downs, Royal College of Psychiatrists, UK and Faculty of Wellbeing, Education, and Language Studies, Open University, Milton Keynes, UK.
Karestan C. Koenen, Harvard TH Chan School of Public Health, Boston, MA, USA.
Christine Yu Moutier, American Foundation for Suicide Prevention, New York, NY, USA.
Peter Templeton, The William Templeton Foundation for Young People's Mental Health, Cambridge, UK.
Philip Batterham, Centre for Mental Health Research, College of Health and Medicine, The Australian National University, Canberra, ACT, Australia.
Karen Brakspear, Medical Research Council, Swindon, UK.
Richard G. Frank, The Brookings Institution, Washington, DC, USA.
Simon Gilbody, York Mental Health and Addictions Research Group, University of York, York, UK.
Oye Gureje, WHO Collaborating Centre for Research and Training in Mental Health, Neuroscience, Drug and Alcohol Abuse, University of Ibadan, Ibadan, Nigeria.
David Henderson, Department of Psychiatry, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA.
Ann John, Swansea University Medical School, Swansea University, Swansea, UK.
Wilbroad Kabagambe, The Alive Again Foundation, Kampala, Uganda.
Murad Khan, Brain & Mind Institute, Aga Khan University, Karachi, Pakistan.
David Kessler, Bristol Population Health Science Institute, Centre for Academic Mental Health, Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK.
Olivia J. Kirtley, Center for Contextual Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium.
Sarah Kline, United for Global Mental Health, London, UK.
Brandon Kohrt, Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA.
Alisa K. Lincoln, Institute for Health Equity and Social Justice Research, Northeastern University, Boston, MA, USA.
Crick Lund, Health Services and Population Research Department, King's College London, London, UK; Centre for Global Mental Health, King's College London, London, UK.
Emily Mendenhall, Edmund A Walsh School of Foreign Service, Georgetown University, Washington, DC, USA.
Regina Miranda, Hunter College, Department of Psychology, The Graduate Center, City University of New York, New York, NY, USA.
Valeria Mondelli, Department of Psychological Medicine, King's College London, London, UK.
Thomas Niederkrotenthaler, Department of Social and Preventive Medicine, Suicide Research & Mental Health Promotion Unit, Center for Public Health, Medical University of Vienna, Vienna, Austria.
David Osborn, Division of Psychiatry, University College London and Camden and Islington NHS Foundation Trust, London, UK.

Document Type

Journal Article

Publication Date



The lancet. Psychiatry








Globally, too many people die prematurely from suicide and the physical comorbidities associated with mental illness and mental distress. The purpose of this Review is to mobilise the translation of evidence into prioritised actions that reduce this inequity. The mental health research charity, MQ Mental Health Research, convened an international panel that used roadmapping methods and review evidence to identify key factors, mechanisms, and solutions for premature mortality across the social-ecological system. We identified 12 key overarching risk factors and mechanisms, with more commonalities than differences across the suicide and physical comorbidities domains. We also identified 18 actionable solutions across three organising principles: the integration of mental and physical health care; the prioritisation of prevention while strengthening treatment; and the optimisation of intervention synergies across social-ecological levels and the intervention cycle. These solutions included accessible, integrated high-quality primary care; early life, workplace, and community-based interventions co-designed by the people they should serve; decriminalisation of suicide and restriction of access to lethal means; stigma reduction; reduction of income, gender, and racial inequality; and increased investment. The time to act is now, to rebuild health-care systems, leverage changes in funding landscapes, and address the effects of stigma, discrimination, marginalisation, gender violence, and victimisation.


Psychiatry and Behavioral Sciences