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.

Mark Rodgers,Gillian Parker,Jane Dalton,Melissa Harden,Alison Eastwood,Andrew Street

doi:10.5334/ijic.2605

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.

Highlights

People with severe mental illness (SMI; such as schizophrenia, schizotypal and delusional disorders; bipolar affective disorder; severe depressive episode(s) with or without psychotic episodes) [1] have a lower life expectancy and poorer physical health outcomes than the general population [2]. Evidence suggests this discrepancy is driven by a combination of clinical risk factors, socioeconomic factors, and health system factors, notably a lack of integration when care is required across service settings [3]
While our mapping review was focused on integrated care initiatives addressing the physical health needs of people with SMI when they enter mental health services, the themes emerging from the literature and advisory group consultations touched on concerns about continuity of care more broadly [70]
There is broad agreement about what needs to be done to improve the physical health of people with SMI, but not about who should be responsible, within multidisciplinary teams involved in the co-ordination and provision of mental health services

Summary

Introduction

People with severe mental illness (SMI; such as schizophrenia, schizotypal and delusional disorders; bipolar affective disorder; severe depressive episode(s) with or without psychotic episodes) [1] have a lower life expectancy and poorer physical health outcomes than the general population [2]. Evidence suggests this discrepancy is driven by a combination of clinical risk factors (e.g., comorbid diabetes, cardiovascular disease), socioeconomic factors, and health system factors, notably a lack of integration when care is required across service settings [3]. While our work was intended to inform the English National Health Service, and our discussion of current policy draws on English examples, the issues identified are ones that are being grappled with internationally [6]

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