Review: Inequalities in healthcare provision for people with severe mental illness

Abstract

There are many factors that contribute to the poor physical health of people with severe mental illness (SMI), including lifestyle factors and medication side effects. However, there is increasing evidence that disparities in healthcare provision contribute to poor physical health outcomes. These inequalities have been attributed to a combination of factors including systemic issues, such as the separation of mental health services from other medical services, healthcare provider issues including the pervasive stigma associated with mental illness, and consequences of mental illness and side effects of its treatment. A number of solutions have been proposed. To tackle systemic barriers to healthcare provision integrated care models could be employed including co-location of physical and mental health services or the use of case managers or other staff to undertake a co-ordination or liaison role between services. The health care sector could be targeted for programmes aimed at reducing the stigma of mental illness. The cognitive deficits and other consequences of SMI could be addressed through the provision of healthcare skills training to people with SMI or by the use of peer supporters. Population health and health promotion approaches could be developed and targeted at this population, by integrating health promotion activities across domains of interest. To date there have only been small-scale trials to evaluate these ideas suggesting that a range of models may have benefit. More work is needed to build the evidence base in this area.

Patterns of psychiatric diagnoses in inpatient and outpatient psychiatric settings in Saudi Arabia

“…Compared with the general population, people with serious mental illnesses (SMI) exhibit higher rates of undiagnosed and untreated medical illnesses and higher morbidity and mortality from physical illnesses, primarily because of modifiable lifestyle risk factors 8 . The poor psychiatric and medical health outcomes in people with SMI may primarily be attributed to disparities in access to, utilization of, and provision of health care [9][10][11][12] .…”

General practitioner management of chronic diseases in adults with severe mental illness: a community intervention trial

“…[1][2][3][4][5] Higher mortality is frequently associated with 'lifestyle choices', such as smoking, poor diet, physical inactivity, substance misuse and abuse and unsafe sexual practices. 3,6 However, even after adjusting for behavioural risk factors, mortality remains high for this population.…”

Applying the World Health Organization Mental Health Action Plan to evaluate policy on addressing co-occurrence of physical and mental illnesses in Australia

“…Yet, access to health care and standards of care within these services are often found to be wanting. [25][26][27] Consumers, carers and health professionals report being treated with disdain when voicing physical health problems; 28 with their somatic concerns misinterpreted as being about mental health problems, they also experience diagnostic overshadowing. 29 In mental health services, screening and follow-up of risk factors for the range of physical illnesses that consumers may encounter is ad hoc, 30 even for what are known to be the most acknowledged problems by clinicians, such as metabolic syndrome.…”

“…22 The WHO Action Plan has been acknowledged within health care integration policy in other regions, such as Britain. 37 Although reviews and commentaries have considered health policy in Australia with respect to co-occurrence of mental and physical illness, 23,26,34 there has not been a comprehensive review of the content and implementation of relevant policies in Australia at state and national levels. The purpose of the present paper is to review Australian policy in order to facilitate progress on integrated care, such as to reduce physical health care inequality for mental health consumers.…”