Barriers to Somatic Health Care for Persons With Severe Mental Illness in Belgium: A Qualitative Study of Patients' and Healthcare Professionals' Perspectives.

Laurence Kohn,Benoit Gillain,Benjamin Delaunoit,Vicky Jespers,Jan De Lepeleire,Isabelle Savoye,Patriek Mistiaen,Johan Detraux,Marc De Hert,Wendy Christiaens

doi:10.3389/fpsyt.2021.798530

Abstract

BackgroundA huge and still growing mortality gap between people with severe mental illness (SMI) and the general population exists. Physical illnesses, mainly cardiovascular diseases, substantially contribute to the high mortality rates in patients with SMI. Disparities in somatic health care access, utilisation, and provision contribute to these poor physical health outcomes.MethodsA qualitative study, using semi-structured interviews, was set up to explore SMI patients' and healthcare professionals' perspectives on somatic health care in different psychiatric settings of the three Belgian regions (Flanders, Brussels, Wallonia). Interviews were digitally recorded and transcribed prior to qualitative inductive thematic analysis, using Nvivo software. The COnsolidated criteria for REporting Qualitative research (COREQ) were used for reporting methods and findings.ResultsCollaboration and information flows between psychiatric healthcare professionals, non-psychiatric healthcare professionals, and persons with SMI were troublesome. This seemed to be mainly due to stigma and prejudice and challenging communication and data transfer. Lack of sufficient training and experience to identify and treat somatic health problems in people with SMI (for psychiatrists and psychiatric nurses) and lack of psychiatric knowledge and feeling or sensitivity for psychiatric patients (for non-psychiatric healthcare professionals) further complicated adequate somatic health care. Finally, optimal somatic follow-up of patients with SMI was hampered by organisational problems (unavailability of equipment, unadapted infrastructure, understaffing, hospital pharmacy issues, and insufficient health promotion/lifestyle interventions), patient-related issues (unawareness of physical problems, non-adherence, need for accompaniment) and financial barriers.ConclusionThere is an urgent need for integrated somatic and mental healthcare systems and a cultural change. Psychiatrists and primary care providers continue to consider the mental and physical health of their patients as mutually exclusive responsibilities due to a lack of sufficient training and experience, poor or absent liaison links, time constraints and organisational and financial barriers. Modifying these aspects will improve the quality of somatic health care for these vulnerable patients.

Highlights

A huge and still growing mortality gap between people with severe mental illness (SMI) and the general population exists
Lack of Sufficient Training and Experience Psychiatric Staff Interviewed psychiatrists referred to their lack of training and experience in addressing somatic health care issues
Healthcare professionals should take a holistic approach to health care for the benefit of the patient [26, 27], and all of the above mentioned barriers to somatic health care should be tackled with this basic idea in mind

Summary

Introduction

A huge and still growing mortality gap between people with severe mental illness (SMI) and the general population exists. People with severe mental illness (SMI), usually defined as a psychiatric illness that causes serious functional impairment (i.e., schizophrenia, bipolar disorder, or major depressive disorder), have a two to three times higher mortality rate than the general population [1, 2]. This increased mortality rate is observed in both high- and low-income countries [1]. Disparities in somatic health care access, utilisation, and provision may be another cause of the excess mortality due to somatic comorbidities in this vulnerable population. It even seems that the mortality gap between people with SMI and the general population is widening [14]

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