Making sense of self‐care practices at the intersection of severe mental illness and physical health—An Australian study

Ehrlich, Carolyn; Chester, Polly; Kisely, Steve; Crompton, David; Kendall, Elizabeth

doi:10.1111/hsc.12473

Cited by 16 publications

(10 citation statements)

References 42 publications

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“…While shared decision-making is recommended in mental health settings, this does not always translate into practice, as patients with schizophrenia frequently report that they do not feel involved in their treatment decisions [ 65 ]. People with SMI commonly report being excluded from decision making, particularly in relation to psychiatric medication [ 66 ]. Whilst the literature suggests healthcare professionals hold positive attitudes towards supportive self-management to improve patient outcomes, this does not always translate into intention and practice.…”

Section: Discussionmentioning

confidence: 99%

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

Balogun-Katung¹,

Carswell²,

Brown³

et al. 2021

PLoS ONE

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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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Section: Discussionmentioning

confidence: 99%

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

Balogun-Katung¹,

Carswell²,

Brown³

et al. 2021

PLoS ONE

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“…26 Second, these issues are often overlooked and/or dismissed by healthcare professionals and policy makers. 27 For example, physical health concerns of people on antipsychotics were not addressed by prescribing psychiatrists in a UK study. 28 Finally, the lifespan of persons with serious mental illness has been consistently reported as shortened compared with those without serious mental illness.…”

Section: Discussionmentioning

confidence: 99%

Assessing the physical healthcare gap among patients with severe mental illness: large real-world investigation from Italy

et al. 2021

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Background One critical barrier to the uptake of mental health programmes is the so-called physical healthcare gap, a concern raised by the unattended physical comorbidity and early mortality of persons with severe mental illness. Aims To evaluate the extension of physical healthcare gap among persons with severe mental illness under chronic drug therapies. Method A population-based cohort study was carried out, using Lombardy healthcare utilisation databases. Prevalent patients treated with blood pressure-, lipid- or glucose-lowering agents were identified in January 2017. Among these, those who were receiving care for depression, schizophrenia, bipolar disorder or personality disorder formed the study cohort. A reference cohort was randomly selected from prevalent patients treated with chronic therapies without signs of severe mental disorders, to be matched with study cohort members for gender, age and number of previous contacts with the National Health System. One-year adherence to healthcare was measured through the proportion of days covered (drug adherence), and exposure to selected recommendations (clinical control adherence). Results The 55 162 patients with severe mental illness were less likely to have high adherence to blood pressure-lowering, lipid-lowering or antidiabetic agents than the reference cohort by −24% (95% CI −26 to −22%), −10% (95% CI −14 to −6%) and −25% (95% CI −29 to −21%), respectively. The 9250 patients with diabetes and severe mental illness had −18% (95% CI −22% to −13%) reduced likelihood to meet recommendations for the clinical management of diabetes, compared with the reference cohort. Conclusions Adherence to chronic drug therapies was sensibly worse among patients living with mental illness than those without signs of mental disorders.

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“…The data demonstrate that partners and family members respond to the expectation and impetus for non‐medical management of chronic illness (Ehrlich et al . 2018, May et al . 2014) and that this may be particularly pronounced in conditions such as endometriosis, where uncertainty and incurability makes non‐medical management a central feature of the experience (Seear 2009).…”

Section: Discussionmentioning

confidence: 99%

Men, chronic illness and healthwork: accounts from male partners of women with endometriosis

Hudson

Law

Culley

et al. 2020

Sociology Health & Illness

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Currently dominant in medical discourse, the concept of self-management sees the responsibility for health and illness shift from the state to the individual. However, while this emphasis on individual responsibility and management has burgeoned, the role and status of partners and other family members in the management of chronic illness remains under-theorised. While self-management privileges individual responsibility for the management of chronic illness, the role of partners remains unclear. This paper utilises data from a study of heterosexual couples' experiences of living with the chronic gynaecological condition endometriosis to explore how male partners engage in its day-today management. In all, 22 couples participated in in-depth, semi-structured interviews with each partner interviewed separately (n = 44). Data were analysed thematically and dyadically, informed by an interpretivist relational approach. The paper utilises the concept of healthwork to describe the illness work, everyday life work, biographical work and emotion work men engaged in. The paper demonstrates how the conceptual value of healthwork is enhanced by incorporating an analysis of the emotional effort required in managing chronic illness. The paper illustrates the value of investigating the role of partners in managing chronic illness to provide a fuller account of the distributed and relational nature of healthwork.

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Making sense of self‐care practices at the intersection of severe mental illness and physical health—An Australian study

Cited by 16 publications

References 42 publications

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

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

Assessing the physical healthcare gap among patients with severe mental illness: large real-world investigation from Italy

Men, chronic illness and healthwork: accounts from male partners of women with endometriosis

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