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

Abstract

Background: People 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.

Aim: To 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 setting: Qualitative study of healthcare providers-general practitioners (GPs) and members of the community mental health teams-in Ireland.

Participants: GPs and mental health service providers.

Methods: Qualitative semi-structured interviews were conducted with 34 service providers. Thematic analysis was undertaken.

Results: Participants 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.

Conclusion: The 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.

Keywords: health services administration & management; mental health; preventive medicine; primary care; psychiatry; qualitative research.