Improvement of care for the physical health of patients with severe mental illness: a qualitative study assessing the view of patients and families

Abstract

BackgroundPatients with severe mental illness (SMI) experience more physical comorbidity than the general population. Multiple factors, including inadequate seeking of healthcare and health care related factors such as lack of collaboration, underlie this undesirable situation. To improve this situation, the logistics of physical health care for patients with SMI need to be changed. We asked both patients and their families about their views on the current organization of care, and how this care could be improved.MethodsGroup and individual interviews were conducted with patients and family of patients to explore their needs and preferences concerning the care for the physical health of patients with SMI, and to explore the shortcomings they had experienced. Using thematic analysis, responses were firstly divided into common topics, after which these topics were grouped into themes.ResultsThree major themes for the improvement of the physical care of patients with SMI were found. Firstly, the reduced ability of patients with SMI to survey their own physical health interests requires health care that is tailored to these needs. Secondly, the lack of collaboration amongst mental health care professionals and general practitioners (GPs) hinders optimal care. Thirdly, concerns were expressed regarding the implementation of monitoring and supporting a healthy lifestyle. Patients with SMI welcome this implementation, but the logistics of providing this care can be improved.ConclusionsAn optimal approach for caring for the physical health of patients with SMI requires a professional approach, which is different to the routine care provided to the general public. This approach can and should be accomplished within the usual organizational structure. However, this requires tailoring of the health care to the needs of patients with SMI, as well as structural collaboration between mental health care professionals and GPs.

Understanding experiences of and preferences for service user and carer involvement in physical health care discussions within mental health care planning

“…A crucial organisational barrier in our findings was the dilemma and lack of clarity around service responsibility - mental health or physical health services - for provision of physical health care. Interestingly, this reflects previous International qualitative research whereby mental health and primary care health care systems have been found to operate in silo, resulting in no clear preference as to which physical-mental professional should provide the physical care [3]. However, our unique framework with specific relevance to physical-mental health domains may help to resolve this recurring dilemma for mental health professionals through ensuring transparency of service responsibility via coordinating care with physical professionals, and documenting those meaningful physical health care discussions and outcomes on a living care plan that either professionals may consult to clarify provision of physical health care, and to give context on their physical health needs.…”

Enabling healthy living: Experiences of people with severe mental illness in psychiatric outpatient services

“…) and it has been suggested that there is a need for clarifying the division of responsibilities of care and support provision across agency borders (van Hasselt et al . ).…”

Poor monitoring of physical health in patients referred to a mood disorders service

“…Hence, there is a persistent need for further, larger and more comprehensive evaluations in other clinical settings. There are significant healthcare barriers to overcome to ensure that monitoring is undertaken [van Hasselt et al 2013], such as reducing uncertainty within clinical teams about whose 'responsibility' it is to undertake screening [Crabb et al 2009;Vasudev and Martindale, 2010], enhancing access to basic equipment, and improving the confidence of mental-health professionals in interpreting laboratory results [De Hert et al 2011]. Although there are logistic challenges in arranging screening for people with severe mental illness, significant opportunities for screening and interventions to reduce morbidity and mortality are being missed.…”