Integrated Care to Address the Physical Health Needs of People with Severe Mental Illness: A Mapping Review of the Recent Evidence on Barriers, Facilitators and Evaluations

Abstract

People with mental health conditions have a lower life expectancy and poorer physical health outcomes than the general population. Evidence suggests this is due to a combination of clinical risk factors, socioeconomic factors, and health system factors, notably a lack of integration when care is required across service settings.Several recent reports have looked at ways to better integrate physical and mental health care for people with severe mental illness (SMI). We built on these by conducting a mapping review that looked for the most recent evidence and service models in this area. This involved searching the published literature and speaking to people involved in providing or using current services.Few of the identified service models were described adequately and fewer still were evaluated, raising questions about the replicability and generalisability of much of the existing evidence. However, some common themes did emerge. Efforts to improve the physical health care of people with SMI should empower staff and service users and help remove everyday barriers to delivering and accessing integrated care. In particular, there is a need for improved communication among professionals and better information technology to support them, greater clarity about who is responsible and accountable for physical health care, and greater awareness of the effects of stigmatisation on the wider culture and environment in which services are delivered.

The evidence‐based group‐level symptom‐reduction model as the organizing principle for mental health care: time for change?

“…Meeting these needs is difficult, as they require life style changes for which care is allocated to different services. Optimal management involves collaboration between complex bureaucracies managing separate budgets, giving rise to a range of barriers. The available evidence suggests that the simple integration of budgets may not be enough to impact outcomes and that the area of mental health care can learn from other health areas where such integration has been attempted.…”

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

“…drop-in appointments, warm hand-offs where one provider physically guided patients to another provider) used in many integrated care settings. Streamlining funding structures and providing continuous funds are required to sustain integration [38]. For example, the use of electronic health record system facilitated providers to share data and coordinate treatment efforts.…”

“…For example, the use of electronic health record system facilitated providers to share data and coordinate treatment efforts. However, building an information system that allows collection and maintenance of information from multiple agencies require adequate IT infrastructure and financial support [38]. Currently, behavioural health providers are not reimbursed for implementing electronic health record systems through HiTech incentives from the Federal government [39].…”

“…Establishing a shared vision and understanding of integrated care is required for successful collaboration between organisations. The literature suggested that within interdisciplinary teams, it is also critical to have clarity about the specific aspects of care for which individuals in the team are responsible and accountable, supported by effective communication between team members [38]. Shared protocols, joint action plans and decision-making tools could be helpful in setting responsibilities with expected outcomes for providers.…”

COVID-19 from the perspective of urban and rural general adult mental health services

“…CMHTs have needed to quickly adapt their model of care more rapidly than any other time in living memory. The premature mortality and poorer physical health status associated with mental disorder recognised prior to the COVID-19 pandemic (Rodgers et al, 2018) further complicates the vital need to balance physical and mental health needs of service users.…”