Severe Mental Illness Experience Research Articles

Digital Mental Health for Schizophrenia and Other Severe Mental Illnesses: An International Consensus on Current Challenges and Potential Solutions.

Digital approaches may be helpful in augmenting care to address unmet mental health needs, particularly for schizophrenia and severe mental illness (SMI). An international multidisciplinary group was convened to reach a consensus on the challenges and potential solutions regarding collecting data, delivering treatment, and the ethical challenges in digital mental health approaches for schizophrenia and SMI. The consensus development panel method was used, with an in-person meeting of 2 groups: the expert group and the panel. Membership was multidisciplinary including those with lived experience, with equal participation at all stages and coproduction of the consensus outputs and summary. Relevant literature was shared in advance of the meeting, and a systematic search of the recent literature on digital mental health interventions for schizophrenia and psychosis was completed to ensure that the panel was informed before the meeting with the expert group. Four broad areas of challenge and proposed solutions were identified: (1) user involvement for real coproduction; (2) new approaches to methodology in digital mental health, including agreed standards, data sharing, measuring harms, prevention strategies, and mechanistic research; (3) regulation and funding issues; and (4) implementation in real-world settings (including multidisciplinary collaboration, training, augmenting existing service provision, and social and population-focused approaches). Examples are provided with more detail on human-centered research design, lived experience perspectives, and biomedical ethics in digital mental health approaches for SMI. The group agreed by consensus on a number of recommendations: (1) a new and improved approach to digital mental health research (with agreed reporting standards, data sharing, and shared protocols), (2) equal emphasis on social and population research as well as biological and psychological approaches, (3) meaningful collaborations across varied disciplines that have previously not worked closely together, (4) increased focus on the business model and product with planning and new funding structures across the whole development pathway, (5) increased focus and reporting on ethical issues and potential harms, and (6) organizational changes to allow for true communication and coproduction with those with lived experience of SMI. This study approach, combining an international expert meeting with patient and public involvement and engagement throughout the process, consensus methodology, discussion, and publication, is a helpful way to identify directions for future research and clinical implementation in rapidly evolving areas and can be combined with measurements of real-world clinical impact over time. Similar initiatives will be helpful in other areas of digital mental health and similarly fast-evolving fields to focus research and organizational change and effect improved real-world clinical implementation.

Understanding social and clinical associations with unemployment for people with schizophrenia and bipolar disorders: large-scale health records study.

People with severe mental illness (SMI) experience high levels of unemployment. We aimed to better understand the associations between clinical, social, and demographic inequality indicators and unemployment. Data were extracted from de-identified health records of people with SMI in contact with secondary mental health services in south London, UK. A Natural Language Processing text-mining application was applied to extract information on unemployment in the health records. Multivariable logistic regression was used to assess associations with unemployment, in people with SMI. Records from 19,768 service users were used for analysis, 84.9% (n = 16,778) had experienced unemployment. In fully adjusted models, Black Caribbean and Black African service users were more likely to experience unemployment compared with White British service users (Black Caribbean: aOR 1.62, 95% CI 1.45-1.80; Black African: 1.32, 1.15-1.51). Although men were more likely to have experienced unemployment relative to women in unadjusted models (OR 1.36, 95% CI 1.26-1.47), differences were no longer apparent in the fully adjusted models (aOR 1.05, 95% CI 0.97-1.15). The presence of a non-affective (compared to affective) diagnosis (1.24, 1.13-1.35), comorbid substance use (2.02, 1.76-2.33), previous inpatient admissions (4.18, 3.71-4.70), longer inpatient stays (78 + days: 7.78, 6.34-9.54), and compulsory admissions (3.45, 3.04-3.92) were associated with unemployment, in fully adjusted models. People with SMI experience high levels of unemployment, and we found that unemployment was associated with several clinical and social factors. Interventions to address low employment may need to also address these broader inequalities.

Access to general practice for preventive health care for people who experience severe mental illness in Sydney, Australia: a qualitative study.

People with lived experience of severe mental illness (PWLE) live around 20years less than the general population. Most deaths are due to preventable health conditions. Improved access to high-quality preventive health care could help reduce this health inequity. This study aimed to answer the question: What helps PWLE access preventive care from their GP to prevent long-term physical conditions? Qualitative interviews (n=10) and a focus group (n=10 participants) were conducted with PWLE who accessed a community mental health service and their carers (n=5). An asset-based framework was used to explore what helps participants access and engage with a GP. A conceptual framework of access to care guided data collection and analysis. Member checking was conducted with PWLE, service providers and other stakeholders. A lived experience researcher was involved in all stages of the study. PWLE and their carers identified multiple challenges to accessing high-quality preventive care, including the impacts of their mental illness, cognitive capacity, experiences of discrimination and low income. Some GPs facilitated access and communication. Key facilitators to access were support people and affordable preventive care. GPs can play an important role in facilitating access and communication with PWLE but need support to do so, particularly in the context of current demands in the Australian health system. Support workers, carers and mental health services are key assets in supporting PWLE and facilitating communication between PWLE and GPs. GP capacity building and system changes are needed to strengthen primary care's responsiveness to PWLE and ability to engage in collaborative/shared care.

Determination of attitudes and practices of nurses working in the psychiatry clinic towards physical health care of individuals with severe mental illness

Introduction and aim. Individuals with severe mental illness experience more physical health problems than the general population and their life expectancy may be shorter. Therefore, the physical care provided to these patients is very important.This study aims to examine the attitudes, practices, and training needs of nurses working in psychiatry clinics towards physical health care of individuals with severe mental illness. Material and methods. This descriptive, cross-sectional study collected data from 139 nurses in psychiatry clinics using the Personal Information Form and Physical Health Attitude Scale. Results. This study found that nurses often provide physical healthcare as part of their routine care for individuals with severe mental illness. However, the study also revealed that nurses require additional education to better provide this type of care. Despite this, the nurses generally displayed a positive attitude towards physical health. The average total score on the physical health attitude scale was 80.33±10.14. Conclusion. The study concluded that nurses have a positive attitude towards physical health in general. The role of nurses working in psychiatry clinics is crucial in evaluating and caring for physical health of individuals with severe mental illness, as it is an important aspect of holistic nursing care. It is necessary to make nurses aware of their shortcomings in providing physical health care and support them in improving in this area.

Use of co-production to explore food insecurity in adults with severe mental illness living in Northern England: a mixed-methods study

BackgroundPeople living with severe mental illness experience premature mortality from diet-related preventable illnesses. Yet, little research focuses on food insecurity with adults with severe mental illness. This coproduced study aimed to understand the experiences of adults with severe mental illness and food insecurity and strategies to help. MethodsFollowing a pragmatism philosophical foundation, we undertook a mixed-methods study involving a survey (online and paper versions) and one-to-one semi-structured interviews (online and telephone) during March 7 to Dec 16, 2022. We recruited participants via existing severe mental illness service user groups and social media in Northern England. Eligible participants were adults (≥18 years) self-reporting a diagnosis of severe mental illness. Ethics approval was obtained from Teesside University and the Health Research Authority (Reference: 22/NR/0010; IRAS ID: 306281), with informed consent given. The target sample size, accounting for a typical survey response rate for people with severe mental illness of 10–20%, was 135. A target sample of 20 interviews was agreed to capture a range of views. Food insecurity was defined as the lack of financial resources needed to ensure someone has reliable access to enough food to meet their dietary, nutritional, and social needs. It is sometimes called food poverty. Quantitative data were analysed using descriptive statistics and binary logistic regression and qualitative data using thematic analysis. Findings135 participants completed the survey (mean age 44·67 years [SD 14·1]). Participants were predominantly male (53%, n=72), white (87%, n=117), and from the Yorkshire region (50%, n=68). Overall, prevalence of food insecurity was 50·4% (n=68). Discussion across 13 interviews found food insecurity being a long-rooted experience, including familial and intergenerational experiences of food insecurity: “I grew up… with this insecurity around food” (P002). Recommendations for tackling food insecurity centred on food banks, increasing accessibility, and reducing stigma: “I would like to get more information on where the centres are...” (P006) and “I was referred to, erm, a foodbank … but it's still the stigma that's attached to it.” (P002). InterpretationWe found a higher prevalence of food insecurity in this study than in the general population (being 15%), yet limited research with adults with severe mental illness perpetuates food insecurity intergenerational injustices. Food insecurity should be eliminated. However, in the meanwhile, there should be widespread easy access to food banks offering nutritional foods. Limitations of this research include not reaching target sample size and a lack of ethnic diversity. FundingNational Institute of Health and Care Research (NIHR) Research for Patient Benefit.

A two-arm, randomised feasibility trial using link workers to improve dental visiting in people with severe mental illness: a protocol paper

BackgroundPeople with severe mental illness (e.g. psychosis, bipolar disorder) experience poor oral health compared to the general population as shown by more decayed, missing and filled teeth and a higher prevalence of periodontal disease. Attending dental services allows treatment of oral health problems and support for prevention. However, people with severe mental illness face multiple barriers to attending routine dental appointments and often struggle to access care. Link work interventions use non-clinical support staff to afford vulnerable populations the capacity, opportunity, and motivation to navigate use of services. The authors have co-developed with service users a link work intervention for supporting people with severe mental illness to access routine dental appointments. The Mouth Matters in Mental Health Study aims to explore the feasibility and acceptability of this intervention within the context of a feasibility randomised controlled trial (RCT) measuring outcomes related to the recruitment of participants, completion of assessments, and adherence to the intervention. The trial will closely monitor the safety of the intervention and trial procedures.MethodsA feasibility RCT with 1:1 allocation to two arms: treatment as usual (control) or treatment as usual plus a link work intervention (treatment). The intervention consists of six sessions with a link worker over 9 months. Participants will be adults with severe mental illness receiving clinical input from secondary care mental health service and who have not attended a planned dental appointment in the past 3 years. Assessments will take place at baseline and after 9 months. The target recruitment total is 84 participants from across three NHS Trusts. A subset of participants and key stakeholders will complete qualitative interviews to explore the acceptability of the intervention and trial procedures.DiscussionThe link work intervention aims to improve dental access and reduce oral health inequalities in people with severe mental illness. There is a dearth of research relating to interventions that attempt to improve oral health outcomes in people with mental illness and the collected feasibility data will offer insights into this important area.Trial registrationThe trial was preregistered on ISRCTN (ISRCTN13650779) and ClinicalTrials.gov (NCT05545228).

Creative activities as intervention: experiences of well-being and satisfaction with daily living in a mental health context

There is increasing recognition in research of the role of creative activities in mental health recovery empowering the management of daily living and enhancing well-being and personal growth. Creative activities can generate psychological, physiological, and social responses that are themselves causally linked with health outcomes. Purpose This study aimed to explore to what extent and in which way people with severe mental illness experience well-being, performance, and satisfaction with daily living when participating in creative activities as intervention. Materials and methods A sequential mixed-methods design was applied. Data was obtained at two measurement points two-three weeks apart using the WHO-5 questionnaire and COPM questionnaire from a sample of 33 participants participating in interventions with creative activities. In addition, eight of the participants took part in qualitative semi-structured interviews, and data was analysed using content analysis on a manifest level. The quantitative data was processed using descriptive statistics, paired t-tests and Kendall’s tau-b for correlations. Result Participation resulted in improved self-rated well-being (17. 70. p < 0.0001), self-perceived occupational performance of daily living (1.40, p = 0.001), and satisfaction with occupational performance (2.05, p < 0.0001). The changes in well-being and daily living were explained by a work-like content and structure, positive intrapersonal and social acceptability experiences, and greater self-esteem due to the experience of being an artist. Conclusion This study contributes with knowledge about participation in creative activities as intervention even for a short period enables well-being, and performance and satisfaction with daily living for people experiencing severe mental illness.

Protecting the Autonomy of Patients with Severe Mental Illness Through Psychiatric Advance Directive Peer-Facilitation

Protecting the Autonomy of Patients with Severe Mental Illness Through Psychiatric Advance Directive Peer-Facilitation

How patients with severe mental illness experience care provided by psychiatric mental health nurse practitioners.

Previous studies in somatic health care revealed that patients find nurse practitioners reliable, helpful, and empathic and feel empowered, at peace, and in control when cared for by nurse practitioners (NPs). Only one study so far considered what value people with severe mental illness (SMI) attached to treatment by a psychiatric mental health nurse practitioner (PMHNP). To explore what meaning people with SMI associate with the care provided by a PMHNP. A qualitative study from a phenomenological perspective was conducted, in which 32 people with SMI were interviewed. Data were analyzed using Colaizzi's seven-step method and the metaphor identification procedure (MIP). Eight fundamental themes emerged: (1) impact of the PMHNP on well-being, (2) feeling connected with, and (3) acknowledged by the PMHNP; (4) the PMHNP's care (not) needed; (5) perception of the PMHNP as a person; (6) shared decision-making; (7) PMHNP's expertise; and (8) flexibility of contact with the PMHNP. MIP analysis revealed six metaphors: PMHNP is a travel aid, means trust, is a combat unit, means hope, is an exhaust valve, and a helpdesk/encyclopedia. The interviewees highly appreciated the treatment and support by the PMHNP for the impact on their well-being. Thanks to the connection with and recognition by the PMHNP, they felt empowered, human, and understood. Challenged by the PMHNP, they focused on possibilities to strengthen self-confidence and self-acceptance. For further positioning of and education for PMHNPs, it is recommended to consider the meaning people with SMI associate with treatment and support by a PMHNP.

Examining Place-Based Neighborhood Factors in a Multisite Peer-Led Healthy Lifestyle Effectiveness Trial for People with Serious Mental Illness.

People with severe mental illness (SMI) experience significantly higher obesity-related comorbidities and premature mortality rates than healthy populations. The physical and social characteristics of neighborhoods where people with SMI reside can play an important role in promoting or hindering healthy eating and physical activity. However, this is seldom considered when designing and testing health behavior interventions for these populations. This study used baseline data from an obesity control trial for low-income, minority people with SMI to demonstrate the utility of assessing neighborhood- and city-level place-based factors within the context of lifestyle interventions. GIS was used to create a zip-code-level social and built environment geodatabase in New York City and Philadelphia, where the trial occurred. Chi-square and t-tests were used to assess differences in the spatial distribution of health-related built and social environment characteristics between and within cities and diet and physical activity outcomes. All types of neighborhood characteristics showed significant environmental differences between and within cities. Several neighborhood characteristics were associated with participants' baseline healthy eating and physical activity behaviors, emphasizing that place-based factors may moderate lifestyle interventions for SMI patients. Future behavioral interventions targeting place-dependent behaviors should be powered and designed to assess potential moderation by place-based factors.

How African Americans With Severe Mental Illness and Trauma Experience Diet and Exercise.

African Americans have a higher prevalence of obesity and obesity-related diseases than other racial/ethnic groups; among persons with serious mental illness (SMI), African Americans fare worse as well. This qualitative study focused on the perceptions of African Americans with SMI in regard to 1) their experiences with diet and exercise behaviors post trauma and 2) how diet and exercise programming can address trauma. A community-based participatory research (CBPR) team developed the interview guide, research protocols, and conducted three focus groups. The team used thematic analysis to analyze the data. Participant (N = 27) responses on the experience of trauma were coded into the following themes: 1) emotional eating, 2) appetite loss, 3) hesitancy to exercise due to community violence, 4) staying home due to mental health symptoms, and 5) substance use. Themes around how programming can address trauma included: 1) support, 2) communication, 3) strategies to avoid trauma, and 4) engagement in programming. Findings suggest the need for human service professionals to infuse trauma-informed communications and practices throughout programming, incorporate peer-led services and address concerns related to community violence.

Chronic kidney disease and severe mental illness: a scoping review.

People who have severe mental illness experience higher rates of long-term conditions and die on average 15-20years earlier than people who do not have severe mental illness, a phenomenon known as the mortality gap. Long-term conditions, such as diabetes, impact health outcomes for people who have severe mental illness, however there is limited recognition of the relationship between chronic kidney disease and severe mental illness. Therefore, the aim of this scoping review was to explore the available evidence on the relationship between chronic kidney disease and severe mental illness. Electronic databases, including MEDLINE, Embase, CINAHL, and PsycINFO were searched. The database searches were limited to articles published between January 2000-January 2022, due to significantprogress that has been madein the detection, diagnosis and treatment of both SMI and CKD.Articles were eligible for inclusion if they explored the relationship between SMI and CKD (Stages 1-5) in terms of prevalence, risk factors, clinical outcomes, and access to treatment and services. Severe mental illness was defined as conditions that can present with psychosis, including schizophrenia, schizoaffective disorder, bipolar disorder, and other psychotic disorders.Thirty articles were included in the review. The included studies illustrated that there is an increased risk of chronic kidney disease amongst people who have severe mental illness, compared to those who do not. However, people who have severe mental illness and chronic kidney disease are less likely to receive specialist nephrology care, are less likely to be evaluated for a transplant, and have higher rates of mortality. In conclusion, there is a dearth of literature in this area, but the available literature suggests there are significant health inequalities in kidney care amongst people who have severe mental illness. Further research is needed to understand the factors that contribute to this relationship, and to develop strategies to improve both clinical outcomes and access to kidney care.

Mental Health of Asian American Caregivers of Family Members With Severe Mental Illness.

Within the general population, caregivers of individuals with severe mental illness experience considerable mental health burdens. Less is known about these burdens among Asian Americans, who frequently serve as primary caregivers of family members in accordance with cultural values of familism and interdependence. Asian American caregivers experience severe stigma regarding mental health issues as well as other barriers to care, often resulting in decreased help-seeking behaviors and poorer mental health. Given a paucity of research, the authors systematically reviewed the literature on mental health outcomes among Asian American caregivers. This column offers policy and practice suggestions for supporting the mental health of Asian American families affected by severe mental illness.

Behandlungsvereinbarungen in der Psychiatrie – reale Praxis in einem Verbund psychiatrischer Kliniken

Joint crisis plans (JCPs) are offered in many psychiatric hospitals, but patients only rarely make use of them. To assess the rates of JCPs among inpatients of mental health hospitals and to analyze the clinical characteristics of patients who make use of aJCP. We carried out aretrospective analysis of routine data from the statistical database/basis documentation of the LVR hospital association, which consists of nine psychiatric hospitals. The basis documentation is consistent in the nine hospitals. All admissions between 2016 and 2020 were considered. We recorded the existence of aJCP, age, gender and main diagnosis at release, as well as previous hospital stays, detention under the Mental Health Act of the Federal State of NRW and experiences with compulsory measures (seclusion/restraint) in the previous 24months before index admission. Out of atotal of 117,662 inpatients 467 (0.4%) had completed aJCP. Patients with JCP were more likely to be diagnosed with schizophrenia, bipolar disorder, or emotionally unstable personality disorder. Patients with aJCP had more previous inpatient stays and they had more frequently experienced detentions and compulsory measures. However, 50% of the patients with aJCP had other diagnoses and the vast majority of them had experienced no detention or compulsory measure in the 24months preceding the first documentation of aJCP. Overall, the use of JCPs is limited. The targeted group of patients with severe mental illness and previous experience with involuntary placements and compulsory measures make use of the offer of aJCP but so do other patients as well. Additional qualitative analyses are required in order to analyze the content and objectives of JCPs in more detail.

Neuropsychiatric dimensions of COVID-19 - literature review

SARS-CoV-2 infection leads to severe multiple organ failure. The immune system is stimulated by activating the inflammatory mechanism and by releasing inflammatory cytokines. COVID-19 is able to penetrate the central nervous system, inducing neuritis and neurodegeneration. In our study, we analyzed the latest available articles. We focused on the subject of COVID-19 infection and consequences of neuroinflammation. For this study, we searched the literature available in Pubmed and Google Scholar databases using keywords. There is evidence of a common background of COVID-19 complications and neurological diseases such as Parkinson's or Alzheimer's disease. This type of complication is more frequently observed in serious cases of COVID-19, with a more intense immune response, with higher levels of CRP, ferritin and D-dimers. Organic changes in conjunction with environmental stress caused by the experience of severe illness, fear of becoming ill and social limitations, lead to neuropsychiatric pathologies, including major depressive disorders and post-traumatic stress. The neuropsychiatric implications of COVID-19 represent a severe clinical problem that deserves special attention in the treatment of COVID-19 infection. There is a need to monitor the neuropsychiatric consequences of COVID-19, in order to completely understand the impact of SARS-CoV-2 infection. This knowledge is necessary to be able to confront the public health crisis created by the COVID-19 pandemic.

Muva physical activity intervention to improve social functioning in people with a severe mental illness: study protocol of a pragmatic stepped wedge cluster randomized trial

BackgroundPeople with severe mental illness (SMI) often suffer from long-lasting symptoms that negatively influence their social functioning, their ability to live a meaningful life, and participation in society. Interventions aimed at increasing physical activity can improve social functioning, but people with SMI experience multiple barriers to becoming physically active. Besides, the implementation of physical activity interventions in day-to-day practice is difficult. In this study, we aim to evaluate the effectiveness and implementation of a physical activity intervention to improve social functioning, mental and physical health.MethodsIn this pragmatic stepped wedge cluster randomized controlled trial we aim to include 100 people with SMI and their mental health workers from a supported housing organization. The intervention focuses on increasing physical activity by implementing group sports activities, active guidance meetings, and a serious game to set physical activity goals. We aim to decrease barriers to physical activity through active involvement of the mental health workers, lifestyle courses, and a medication review. Participating locations will be divided into four clusters and randomization will decide the start of the intervention. The primary outcome is social functioning. Secondary outcomes are quality of life, symptom severity, physical activity, cardiometabolic risk factors, cardiorespiratory fitness, and movement disturbances with specific attention to postural adjustment and movement sequencing in gait. In addition, we will assess the implementation by conducting semi-structured interviews with location managers and mental health workers and analyze them by direct content analysis.DiscussionThis trial is innovative since it aims to improve social functioning in people with SMI through a physical activity intervention which aims to lower barriers to becoming physically active in a real-life setting. The strength of this trial is that we will also evaluate the implementation of the intervention. Limitations of this study are the risk of poor implementation of the intervention, and bias due to the inclusion of a medication review in the intervention that might impact outcomes.Trial registrationThis trial was registered prospectively in The Netherlands Trial Register (NTR) as NTR NL9163 on December 20, 2020. As the The Netherlands Trial Register is no longer available, the trial can now be found in the International Clinical Trial Registry Platform via: https://trialsearch.who.int/Trial2.aspx?TrialID=NL9163.

Comparing suicide and vascular mortality associated with mental illness

People with severe mental illness experience increased mortality from unnatural causes, most notably suicide, and natural causes, particularly vascular disease. In the last 5 years there has been an increase in attention in suicide prevention for people with mental illness alongside a growing recognition of the importance to meet their physical health-care needs. Although mental illness is strongly associated with suicide, the single biggest contributor to the dramatic gap in life expectancy associated with severe mental illness is not suicide but vascular disease.

Addressing victimization to enable societal participation in flexible assertive community treatment: A process evaluation of the implementation of a new intervention.

BackgroundIndividuals with severe mental illness experience more victimization and discrimination than other persons in the community. Effective rehabilitation and recovery-oriented care interventions aimed at addressing this issue are lacking. We therefore developed a victimization-informed intervention (accompanied by a training module for professionals) called the Victoria intervention. The purpose of the present study was to understand the trial effects by examining the implementation process and the factors that influenced it.Materials and methodsA process evaluation was conducted using a mixed-methods design. During the professionals’ intervision sessions, we used observations to understand the learning processes (n = 25). Subsequently, we studied the use of the intervention in practice through structured questionnaires (n = 215) and semi-structured interviews (n = 34) with clients and professionals. We used descriptive and inferential statistics for the quantitative data and the framework method for the analyses of the qualitative data.ResultsThe observations showed that the trainings were well received. The professionals shared the urgency of paying attention to victimization and discrimination and its harmful effects on participation. They also found the intervention steps to be logical and the intervention protocol easy to use. Nevertheless, they mentioned in the interviews that they had experienced difficulties initiating a conversation about victimization, and if they started one, they did not always follow the steps of the intervention as intended. Few clients said that victimization was placed on the agenda, though those who had discussed victimization with their caregivers expressed their appreciation in the interviews; they felt acknowledged and supported.DiscussionThe findings indicate that the intervention was considered helpful in raising awareness and the acknowledgment of victimization. However, professionals remain reluctant to talk about the subject, and the results show they need more practical training in this regard. This process evaluation has an important added value in that it helps us to understand the results of the effect evaluation of the intervention. The findings will facilitate the development and implementation of interventions that address clients’ victimization experiences in community mental healthcare settings and subsequently enable their participation in society.

The lived experience of severe mental illness and long-term conditions: a qualitative exploration of service user, carer, and healthcare professional perspectives on self-managing co-existing mental and physical conditions

BackgroundPeople with severe mental illness (SMI), such as schizophrenia, have higher rates of physical long-term conditions (LTCs), poorer health outcomes, and shorter life expectancy compared with the general population. Previous research exploring SMI and diabetes highlights that people with SMI experience barriers to self-management, a key component of care in long-term conditions; however, this has not been investigated in the context of other LTCs. The aim of this study was to explore the lived experience of co-existing SMI and LTCs for service users, carers, and healthcare professionals.MethodsA qualitative study with people with SMI and LTCs, their carers, and healthcare professionals, using semi-structured interviews, focused observations, and focus groups across the UK. Forty-one interviews and five focus groups were conducted between December 2018 and April 2019. Transcripts were coded by two authors and analysed thematically.ResultsThree themes were identified, 1) the precarious nature of living with SMI, 2) the circularity of life with SMI and LTCs, and 3) the constellation of support for self-management. People with co-existing SMI and LTCs often experience substantial difficulties with self-management of their health due to the competing demands of their psychiatric symptoms and treatment, social circumstances, and access to support. Multiple long-term conditions add to the burden of self-management. Social support, alongside person-centred professional care, is a key facilitator for managing health. An integrated approach to both mental and physical healthcare was suggested to meet service user and carer needs.ConclusionThe demands of living with SMI present a substantial barrier to self-management for multiple co-existing LTCs. It is important that people with SMI can access person-centred, tailored support for their LTCs that takes into consideration individual circumstances and priorities.

Caregiver or care receiver: Adolescents' experience of caregiving to a parent with severe mental illness: A qualitative study

AbstractExploring the experiences of adolescent caregivers of mentally ill parents is essential to understand their challenges and identify their care needs. Using a qualitative research design, 18 caregiving adolescents shared their experiences of living with and providing care to a parent with a severe mental illness. The analysis of the interviews resulted in the emergence of three main categories: (1) emotional exhaustion with associated subthemes of ‘ongoing worries’, ‘fear of loneliness’, ‘feeling of shame and guilt’ and ‘fear of discrimination and stigma’; (2) being trapped in a difficult situation with subthemes of ‘living a compromised life’, ‘alienating from peers’ and ‘caregiver rather than care receiver; and (3) adapting to the situation with subthemes of developing new skills and growing accountability. The study findings suggest that adolescent caregivers of parents with severe mental illness experience significant challenges and psychological distress associated with their caregiving role. They need to be supported by health care providers to develop strategies to adjust to their situation and maintain health and well‐being.