Contextual Factors in the Health of People With Serious Mental Illness

Abstract

People living with serious mental illness (SMI) have shorter life expectancies than the general population. We examined how contextual factors influence the physical health of this population. We conducted interviews, focus groups, and participant observations with stakeholders from six behavioral health organizations. We found that consumers’ avoidance of overt disagreement during medical visits, their mistrust of medical institutions, and cultural variations in body image influenced the clinical encounter. Mental health providers’ ambivalence about intervening in consumers’ physical health, primary care providers’ misattribution of physical symptoms to mental disorders, and providers’ stigmatization of consumers shaped clinical encounters. Consumers’ diets were shaped by food environments and social norms associated with traditional diets. Internal and external factors impacted consumers’ physical activity. In this article, we illustrate the importance of considering contextual factors in the development and implementation of interventions aimed at improving the physical health of people with SMI.

Developing a peer-based healthy lifestyle program for people with serious mental illness in supportive housing

“…Many of our participants lived in communities where access to affordable healthy foods and safe spaces for physical activity were scarce, while fast food was, in contrast, abundant and accessible [35]. Similar neighborhoods have been described in other studies examining the lives of people with SMI [36], reinforcing the need for adaptations that help participants navigate challenging food environments. Strategies for building healthy eating patterns must also be sensitive to participants' budgets and address all stages of healthy eating from planning and shopping to preparing meals.…”

Health behavior change benefits: Perspectives of Latinos with serious mental illness

“…In addition to understanding cultural perspectives about health behavior change, clinicians and researchers must be aware of the multiple socioeconomic and language barriers that adversely affect Latinos with and without SMI (Cabassa, Siantz, Nicasio, Guarnaccia, & Lewis-Fernández, 2014; Stanhope & Henwood, 2014). Family obligations and resulting fatigue and lack of time often interfere with physical activity participation (D’Alonzo & Fischetti, 2008; Im et al, 2010).…”

A Qualitative Study on Primary Care Integration into an Asian Immigrant-specific Behavioural Health Setting in the United States

“…There is a continuum of coordination and collaboration between primary care and behavioural health, ranging from coordinating services, co-locating services to integrating practices and building an interdisciplinary team of care [15]. Integrated care may be particularly effective for racial and ethnic minority populations with serious mental illness, given they face higher rates of chronic illnesses, lower rates of healthcare utilization and poorer quality of care than U.S. non-Hispanic White counterparts [7161718]. …”

“…Nonetheless, integration efforts remain difficult due to an insufficient understanding of the critical processes that bridge primary care and behavioural health services, and treatment elements that impact care [242526]. A lack of diversity in patient samples further limited understanding of integrated care implementation in non-white populations [162427]. As healthcare reform initiatives supporting integration continue to expand for individuals with serious mental illness, it is necessary to examine how primary care-behavioural health integration models can be implemented effectively, particularly in healthcare settings serving minority patients.…”