Exploring the physical health of patients with severe or long-term mental illness using routinely collected general practice data from MedicineInsight

BackgroundAlthough GPs provide care to many patients with severe and persistent mental illness, the role and skillset of the GP in this space are contested. Patients are less satisfied with GP care of mental health than physical health issues.AimTo explore patient expectations and experiences of GP roles in their mental health, and identify opportunities for improving mental health care in general practice.Design & settingPatient participants were recruited from community mental health clinics in Brisbane, Australia.MethodIndividual semi-structured interviews were conducted with a convenience sample of patients. Interviews were audio-recorded and transcribed professionally. The authors conducted an inductive thematic analysis, attending to participant vulnerability and reflexivity.Results16 interviews were conducted by one author (RW), average duration 29 minutes. Three overarching themes were identified: being heard; being known; and being safe. Participants greatly valued ‘good GPs’ who were able to detect early signs of relapse, and with whom they came to feel heard, known and safe over time. Experiences of perfunctory, hurried care and avoidance of mental health issues were also reported. Many participants were uncertain whether GP training in mental health was sufficient to keep them safe. Patients may suspect negative attitudes to mental illness in GPs who actively engage predominantly with their physical health.ConclusionSome GPs play central roles in patients’ mental healthcare. Barriers for others need further exploration, and may include time, confidence and/or expertise. Findings challenge GPs to engage more actively and effectively with these patients in theirgeneral practice consultations.

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Exploring the facilitators, barriers, and strategies for self-management in adults living with severe mental illness, with and without long-term conditions: A qualitative evidence synthesis

PLoS ONE ◽

10.1371/journal.pone.0258937 ◽

2021 ◽

Vol 16 (10) ◽

pp. e0258937

Author(s):

Abisola Balogun-Katung ◽

Claire Carswell ◽

Jennifer V. E. Brown ◽

Peter Coventry ◽

Ramzi Ajjan ◽

...

Keyword(s):

Mental Illness ◽

Physical Health ◽

Severe Mental Illness ◽

Evidence Synthesis ◽

Barriers And Facilitators ◽

Self Management ◽

Qualitative Evidence Synthesis ◽

Long Term Conditions ◽

Qualitative Evidence

Background People living with severe mental illness (SMI) have a reduced life expectancy by around 15–20 years, in part due to higher rates of long-term conditions (LTCs) such as diabetes and heart disease. Evidence suggests that people with SMI experience difficulties managing their physical health. Little is known, however, about the barriers, facilitators and strategies for self-management of LTCs for people with SMI. Aim To systematically review and synthesise the qualitative evidence exploring facilitators, barriers and strategies for self-management of physical health in adults with SMI, both with and without long-term conditions. Methods CINAHL, Conference Proceedings Citation Index- Science, HMIC, Medline, NICE Evidence and PsycInfo were searched to identify qualitative studies that explored barriers, facilitators and strategies for self-management in adults with SMI (with or without co-morbid LTCs). Articles were screened independently by two independent reviewers. Eligible studies were purposively sampled for synthesis according to the richness and relevance of data, and thematically synthesised. Results Seventy-four articles met the inclusion criteria for the review; 25 articles, reporting findings from 21 studies, were included in the synthesis. Seven studies focused on co-morbid LTC self-management for people with SMI, with the remaining articles exploring self-management in general. Six analytic themes and 28 sub-themes were identified from the synthesis. The themes included: the burden of SMI; living with co-morbidities; beliefs and attitudes about self-management; support from others for self-management; social and environmental factors; and routine, structure and planning. Conclusions The synthesis identified a range of barriers and facilitators to self-management, including the burden of living with SMI, social support, attitudes towards self-management and access to resources. To adequately support people with SMI with co-morbid LTCs, healthcare professionals need to account for how barriers and facilitators to self-management are influenced by SMI, and meet the unique needs of this population.

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Influence of chronic diseases on long-term change in physical health: a consultation–survey linkage cohort study in general practice

Quality of Life Research ◽

10.1007/s11136-011-9974-8 ◽

2011 ◽

Vol 21 (4) ◽

pp. 581-591 ◽

Cited By ~ 4

Author(s):

J. A. Prior ◽

K. P. Jordan ◽

U. T. Kadam

Keyword(s):

General Practice ◽

Cohort Study ◽

Physical Health ◽

Chronic Diseases ◽

Term Change

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Severe and enduring mental illness

Oxford Textbook of Old Age Psychiatry ◽

10.1093/med/9780198807292.003.0045 ◽

2020 ◽

pp. 701-712

Author(s):

Catherine Hatfield ◽

Tom Dening

Keyword(s):

Mental Health ◽

Mental Illness ◽

Older People ◽

Physical Health ◽

Social Services ◽

Psychiatric Hospitals ◽

Functional Disorders ◽

Recovery Approach ◽

Long Term Experience

Severe and enduring mental illness refers mainly to the long-term experience of schizophrenia and psychosis but also to other chronic functional disorders. The prevalence of psychoses in older people is hard to measure but estimates are around 0.5% of the population. Historically many people with long term illness resided in psychiatric hospitals but now most are in the community, receiving variable amounts of support from mental health, primary care, and social services. The physical health of this population is often poor and they receive less treatment and support than other older people with comparable physical health needs. Problems with psychiatric comorbidity (e.g. depression and substance misuse), cognitive impairment and social exclusion are also common. Treatment includes the judicious use of medication, nonpharmacological approaches, and social support—especially appropriate accommodation. Positive outcomes can be achieved by a recovery approach that attends to all aspects of the person’s health.

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Severe and enduring mental illness

10.1093/med/9780199644957.003.0048 ◽

2013 ◽

Author(s):

Catherine Hatfield ◽

Tom Dening

Keyword(s):

Mental Illness ◽

Older People ◽

Physical Health ◽

Social Services ◽

Psychiatric Comorbidity ◽

Psychiatric Hospitals ◽

Positive Outcomes ◽

Recovery Approach ◽

Long Term Experience

Severe and enduring mental illness refers mainly to the long term experience of schizophrenia and psychosis but also to other chronic functional disorders. The prevalence of psychoses in older people is hard to measure but estimates are around 0.5% of the population. Historically many people with long term illness resided in psychiatric hospitals but now most are in the community, receiving variable amounts of support from mental health, primary care, and social services. The physical health of this population is often poor and they receive less treatment and support than other older people with comparable physical health needs. Problems with psychiatric comorbidity (e.g. depression and substance misuse), cognitive impairment and social exclusion are also common. Treatment includes the judicious use of medication, non pharmacological approaches, and social support – especially appropriate accommodation. Positive outcomes can be achieved by a recovery approach that attends to all aspects of the person’s health.

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