Experiences and views of carers regarding the physical health care of people with severe mental illness: An integrative thematic review of qualitative research

Abstract

Accessible summary What is known on the subject? People with severe mental illness (SMI) have high rates of physical illnesses, and carers are core partners in managing their physical health. Qualitative research on carers' views/experiences of physical health care is limited, and there is no published systematic review that synthesizes the current evidence. What the paper adds to existing knowledge? Carers' views from seven articles were synthesised into nine themes and six subthemes describing their perceived facilitators, barriers and roles regarding the physical health care of people with SMI. Carers' voiced similar concerns to those previously identified by professionals and service users, particularly in relation to poor service access/responsiveness and communication difficulties with healthcare professionals. What are the implications for practice? Mental health nurses should be aware of the risk of diagnostic overshadowing and ensure they are both responsive and sensitive to carers concerns about the physical health of people with SMI. It is essential for mental health nurses to actively involve carers in managing physical health, especially in formulating physical healthcare plans and providing clear practical advice/information. Abstract IntroductionPeople with severe mental illness (SMI) have high rates of physical illnesses. Informal carers are core partners in addressing these issues, however research on their views/experiences is limited and there is no systematic review published on the topic. AimThis integrative thematic review explored the experiences and views of carers on physical health care in SMI by synthesizing the existing qualitative research findings. MethodsSix databases were searched from 2000 to 2021. Data were extracted and synthesised using thematic integrative analysis. The quality of included studies was assessed with the JBI Critical Appraisal Checklist. ResultsFive studies were included. Nine themes were identified conceptualising carers' perceived facilitators, barriers and roles regarding physical health care for people with SMI. DiscussionCarers felt that receiving practical help and a specialised role for mental health nurses would facilitate better physical health care. Lack of coordination/communication and poor service access/responsiveness were common barriers, often compounded by diagnostic overshadowing. Carers are involved in promoting healthy lifestyles, monitoring physical health and supporting access to services. Implications for PracticeMental health nurses should ensure they are responsive to carers' concerns and proactively support them to promote the physical health of people with SMI.

Mental health bias in physical care: An integrative review of the literature

“…Two narrative reviews (Knaak et al, 2017; Lawson, 2018) and one integrative review (Ho et al, 2022) comprise the remainder of the sample. These reviews provide unique perspectives on differing aspects of the literature.…”

Diagnostic overshadowing: An evolutionary concept analysis on the misattribution of physical symptoms to pre‐existing psychological illnesses

“… 2018 ; Giddings 2013 ; Ho et al . 2021 ; Molloy et al . 2021a ; Perrone McIntosh 2021 ; Shefer et al .…”

“…While the phrase invites images of a diagnosis obscuring others with its bulk, the stigma attached to mental illness is itself the concealing mass (Ho et al . 2021 ; Perrone McIntosh 2021 ; Shefer et al . 2014 ; van Nieuwenhuizen et al .…”

“…Diagnostic overshadowing presents one possible factor behind this inequity (Happell et al 2016;Ho et al 2021). The Encyclopedia of Autism Spectrum Disorders defines the term 'diagnostic overshadowing' as a 'negative bias impacting a clinician's judgment regarding co-occurring disorders in individuals who have intellectual disabilities or other mental illness' (Kanne 2013).…”

“…presented in the literature sample include stigmatization and underestimation of individuals with mental illness as well as delays they experience in receiving appropriate care(Cromar- Hayes & Seaton 2020;Geiss et al 2018;Happell et al 2016;Ho et al 2021;Nash 2013;Stoklosa et al 2017). Providers' fear of violence from patients with mental illness presents another recurring theme(Fontesse et al 2021;Hext et al 2018;Perrone McIntosh 2021;van Nieuwenhuizen et al 2013 van Nieuwenhuizen et al ).…”