Promoting physical health among people with enduring mental illness: a qualitative study of healthcare providers’ perspectives

Abstract

BackgroundPeople with enduring mental illness (EMI) have higher morbidity and mortality from chronic diseases than the general population, and this results in a significantly reduced relative life expectancy—accounted for primarily by physical illness. This gap may be partly influenced by the reduced likelihood of access to and uptake of regular physical health screening.AimTo establish Irish service providers’ perspectives regarding the care of the physical health of people with EMI in an effort to inform future service developments aimed at improving the physical health of people with EMI.Design and settingQualitative study of healthcare providers—general practitioners (GPs) and members of the community mental health teams—in Ireland.ParticipantsGPs and mental health service providers.MethodsQualitative semi-structured interviews were conducted with 34 service providers. Thematic analysis was undertaken.ResultsParticipants considered that the physical health of people with EMI is not currently regularly addressed by the patient’s GP or the mental health team. Factors associated with this include patient compliance with attendance, time constraints in consultations to adequately support patient self-management, communication difficulties with the patient and between primary and secondary care, and lack of clarity as to whose responsibility it is to ensure physical health is monitored. In participants’ view, a barrier to improvement is the present funding approach.ConclusionThe evidence from this study has the potential to form the basis for innovation and change in service delivery for people with an EMI in Ireland and internationally, specifically in countries where it is not clear who has the overall responsibility to monitor the physical health of patients with EMI. This role requires time and regular contact, and both the organisation and the funding of the health system need to support it.

Perspectives of patients and healthcare professionals on metabolic monitoring of adult prescribed second-generation antipsychotics for severe mental illness: A meta-synthesis

“…Key respondents believed that mental health patients’ levels of comprehension and attitudes concerning their cardiovascular risk varied [ 4 ], due to various factors such as their condition, lifestyle, or sociodemographics [ 25 ]. Some patients visited the GP only when they had some serious health conditions as they attribute most of their physical symptoms to mental illness [ 17 , 18 , 25 ]. However, GPs and mental health experts also believed that their patients’ physical health knowledge was generally inadequate as they generally focused more on their mental health than physical health [ 18 , 24 ].…”

“…Some patients visited the GP only when they had some serious health conditions as they attribute most of their physical symptoms to mental illness [ 17 , 18 , 25 ]. However, GPs and mental health experts also believed that their patients’ physical health knowledge was generally inadequate as they generally focused more on their mental health than physical health [ 18 , 24 ]. One healthcare professional stated that he was unaware of the metabolic risk profile of different antipsychotics [ 24 ].…”

“…Short consultations with GP had a negative influence on communication which was acknowledged by the patient group [ 17 , 21 ]. When trying to educate and encourage patients to pay attention to their physical health, time restrictions in consultations were the most common challenge for GPs and psychiatrists [ 13 , 14 , 18 , 24 , 25 ]. Similar time constraints were also told by nurses [ 20 ].…”

“…Along with the difficulty in navigating the intranet system, caseloads exceeded prescribed limits, according to the care coordinators, and meeting durations were cut short due to the more number of clients to see [ 19 ]. Lack of resources for monitoring was also reported by the community mental health team clinicians and psychiatrists [ 4 , 13 , 18 , 25 ]. As a result, the amount of work that could be accomplished during meetings was hampered and physical health monitoring and interventions were frequently pushed aside in favour of other priorities [ 19 ].…”

“…Lack of interest on metabolic monitoring . The patients’ disinterest to undergo physical health monitoring was described by healthcare professionals and patients [ 13 , 15 , 18 ]. The mental health staff and GPs described patients refusing to give blood samples and also factors like forgetting to attend the follow-up [ 15 , 18 ].…”