Integrated care to address the physical health needs of people with severe mental illness: a rapid review

Abstract

BackgroundPeople with mental health conditions have a lower life expectancy and poorer physical health outcomes than the general population. Evidence suggests that this discrepancy is driven by a combination of clinical risk factors, socioeconomic factors and health system factors.Objective(s)To explore current service provision and map the recent evidence on models of integrated care addressing the physical health needs of people with severe mental illness (SMI) primarily within the mental health service setting. The research was designed as a rapid review of published evidence from 2013–15, including an update of a comprehensive 2013 review, together with further grey literature and insights from an expert advisory group.SynthesisWe conducted a narrative synthesis, using a guiding framework based on nine previously identified factors considered to be facilitators of good integrated care for people with mental health problems, supplemented by additional issues emerging from the evidence. Descriptive data were used to identify existing models, perceived facilitators and barriers to their implementation, and any areas for further research.Findings and discussionThe synthesis incorporated 45 publications describing 36 separate approaches to integrated care, along with further information from the advisory group. Most service models were multicomponent programmes incorporating two or more of the nine factors: (1) information sharing systems; (2) shared protocols; (3) joint funding/commissioning; (4) colocated services; (5) multidisciplinary teams; (6) liaison services; (7) navigators; (8) research; and (9) reduction of stigma. Few of the identified examples were described in detail and fewer still were evaluated, raising questions about the replicability and generalisability of much of the existing evidence. However, some common themes did emerge from the evidence. Efforts to improve the physical health care of people with SMI should empower people (staff and service users) and help remove everyday barriers to delivering and accessing integrated care. In particular, there is a need for improved communication between professionals and better information technology to support them, greater clarity about who is responsible and accountable for physical health care, and awareness of the effects of stigmatisation on the wider culture and environment in which services are delivered.Limitations and future workThe literature identified in the rapid review was limited in volume and often lacked the depth of description necessary to acquire new insights. All members of our advisory group were based in England, so this report has limited information on the NHS contexts specific to Scotland, Wales and Northern Ireland. A conventional systematic review of this topic would not appear to be appropriate in the immediate future, although a more interpretivist approach to exploring this literature might be feasible. Wherever possible, future evaluations should involve service users and be clear about which outcomes, facilitators and barriers are likely to be context-specific and which might be generalisable.FundingThe research reported here was commissioned and funded by the Health Services and Delivery Research programme as part of a series of evidence syntheses under project number 13/05/11. For more information visitwww.nets.nihr.ac.uk/projects/hsdr/130511.

Hyperarousal in the hospital and what to do about it

“…Data are presented for all 124 participants who completed the baseline questionnaires and received MPC treatment or MPC advice for treatment in their own region of living. Data analyses were carried out and calculated using SPSS 21.0 (SPSS Inc., Chicago, Illinois, USA) 21 . Linear mixed models were used to assess the overall longitudinal trends and to compare these trends for gastrointestinal and psychiatric complaints, as well as quality Chapter 4 66 of life, between the local group of patients living in the Maastricht catchment area and the external group of patients living outside the Maastricht catchment area.…”

“…Moreover, the prevalence of affective disorders in patients with overactive bladder is considerable 7 . In the UK, HADS anxiety scores of 8 and higher were found in 30% and 47% of men with OAB without and with bothersome complaints respectively, and in women this was 44% for OAB without bother, up to almost 60% in OAB with bother 21 . Prevalence rates in Sweden were similar to our results with aberrant scores of 8% 19% in men and 18% 32% in women for OAB without and with bother, respectively 21 .…”

“…In the UK, HADS anxiety scores of 8 and higher were found in 30% and 47% of men with OAB without and with bothersome complaints respectively, and in women this was 44% for OAB without bother, up to almost 60% in OAB with bother 21 . Prevalence rates in Sweden were similar to our results with aberrant scores of 8% 19% in men and 18% 32% in women for OAB without and with bother, respectively 21 . Depression scores in our cohort are similar to scores reported by Swedish men and women with OAB, but lower compared to UK men and women 21 .…”

“…A focus on integrated care at the primary level in psychiatric and somatic comorbidity makes sense for every industrialized country with exploding health care budgets. The fact is, more patients receive treatment for mental disorders by general practitioners (GPs) than in the mental health specialty setting 21 . This is also the case in the Netherlands (NL); at the level of primary care, a 'general module for somatic and psychiatric comorbidity' was initiated in co operation with the Dutch associations of Internal Medicine, Psychiatry and General Practitioners, an initiative that has recently been finalized 22 .…”

“…However, almost two thirds of all patients with abnormal scores were not identified by the attending physician as suffering from psychiatric problems 19,20 . Similarly, physicians detect only one third of all cases in somatoform disorders 21 . Numerous investigations have demonstrated that patients with medical conditions and comorbid psychiatric disorders have greater morbidity associated with medical illness, increased health care use and worse functional outcome 22 24 .…”