Interventions to Promote the Utilization of Physical Health Care for People with Severe Mental Illness: A Scoping Review

Abstract

Background: The main contributor to excess mortality in severe mental illness (SMI) is poor physical health. Causes include unfavorable health behaviors among people with SMI, stigmatization phenomena, as well as limited access to and utilization of physical health care. Patient centered interventions to promote the utilization of and access to existing physical health care facilities may be a pragmatic and cost-effective approach to improve health equity in this vulnerable and often neglected patient population. Objective/Methods: In this study, we systematically reviewed the international literature on such studies (sources: literature databases, trial-registries, grey literature). Empirical studies (quantitative, qualitative, and mixed methods) of interventions to improve the utilization of and access to medical health care for people with a SMI, were included. Results: We identified 38 studies, described in 51 study publications, and summarized them in terms of type, theoretical rationale, outcome measures, and study author’s interpretation of the intervention success. Conclusions: Useful interventions to promote the utilization of physical health care for people with a SMI exist, but still appear to be rare, or at least not supplemented by evaluation studies. The present review provides a map of the evidence and may serve as a starting point for further quantitative effectiveness evaluations of this promising type of behavioral intervention.

Risk prevalence, readiness and confidence to change lifestyle risk factors among clients of community mental health services

“…This demonstrates a need for further education and training to upskill mental health professionals in provision of preventive care, as well as for research which explores avenues to build client readiness and confidence. Such efforts may consider the broader contributors and social determinants of inequity, including low health literacy (Hassan et al, 2020), stigma and discrimination (Morgan et al, 2021a), lack of appropriate physical health services/ interventions (Richardson et al, 2020), underpromotion and cost of services/interventions that do exist (Strunz et al, 2022), and unclear roles/responsibilities among health professionals (Laugharne et al, 2016). In addition to upskilling CMHS clinicians in delivery of preventive care, alternative approaches from previous research include the integration of a dedicated preventive care practitioner into mental health services which could see positive changes in readiness and confidence rates and overall preventive care (Fehily et al, 2020(Fehily et al, , 2022.…”

The role of the dually certified primary care/psychiatric mental health nurse practitioner in treating high-needs/high-cost patients

“…To further complicate their situation, people with SMI receive inadequate primary care or attention to physical health care needs (Strunz et al, 2022). On average, people with SMI have a life expectancy of up to 20 years less than the general population.…”

“…In addition, traditional care models are medical/surgical or problem oriented, which are ineffective for high-needs patients (McCarthy et al, 2015). Even coordinating care across disciplines has not been consistently effective (Strunz et al, 2022). National agencies such as the Agency for Health care Quality and Research, as well as the White House (Reducing the Economic Burden of Unmet Mental Health Needs 2022, Issue Briefs), have expressed concerns about poor treatment and escalating costs for high-needs/high-cost patients.…”