Inequalities in Healthcare Provision for People with Severe Mental Illness

Centre for Developmental Health, Curtin Health Innovation Research Institute, Telethon Institute for Child Health Research, Perth, Western Australia, Australia.
Journal of Psychopharmacology (Impact Factor: 3.59). 11/2010; 24(4 Suppl):61-8. DOI: 10.1177/1359786810382058
Source: PubMed


There are many factors that contribute to the poor physical health of people with severe mental illness (SMI), including lifestyle factors and medication side effects. However, there is increasing evidence that disparities in healthcare provision contribute to poor physical health outcomes. These inequalities have been attributed to a combination of factors including systemic issues, such as the separation of mental health services from other medical services, healthcare provider issues including the pervasive stigma associated with mental illness, and consequences of mental illness and side effects of its treatment. A number of solutions have been proposed. To tackle systemic barriers to healthcare provision integrated care models could be employed including co-location of physical and mental health services or the use of case managers or other staff to undertake a co-ordination or liaison role between services. The health care sector could be targeted for programmes aimed at reducing the stigma of mental illness. The cognitive deficits and other consequences of SMI could be addressed through the provision of healthcare skills training to people with SMI or by the use of peer supporters. Population health and health promotion approaches could be developed and targeted at this population, by integrating health promotion activities across domains of interest. To date there have only been small-scale trials to evaluate these ideas suggesting that a range of models may have benefit. More work is needed to build the evidence base in this area.

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Available from: Steve Kisely, Oct 09, 2015
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    • "Elevated rates of disease among individuals with SMI can occur as a result of physical inactivity (Osborn et al. 2010) or lack of help seeking (Robson & Gray 2007). Additionally, antipsychotic drug use has been associated with increased cardiometabolic risks (Foley & Morley 2011) Furthermore, the separation of primary care and mental health presents significant obstacles to the multiple care needs of people with SMI (Happell et al. 2012b; Lawrence & Kisely 2010). Since 2005, there has been increased attention to policy development concerning the treatment of co-occurrence of SMI and physical illness (e.g. "
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    ABSTRACT: The physical health of people with serious mental illness (SMI) has become a focal area of research. The aim of the present study was to ascertain the attention and distribution of research from within Australia on physical illness and SMI co-occurrence, and to identify gaps. A scoping review of peer-reviewed research literature from Australia, published between January 2000 and March 2014, was undertaken through an electronic literature search and coding of papers to chart trends. Four trends are highlighted: (i) an almost threefold increase in publications per year from 2000-2006 to 2007-2013; (ii) a steady release of literature reviews, especially from 2010; (iii) health-related behaviours, smoking, integrated-care programmes, and antipsychotic side-effects as the most common topics presented; and (iv) paucity of randomized, controlled trials on integrated-care models. Despite a marked increase in research attention to poorer physical health, there remains a large gap between research and the scale of the problem previously identified. More papers were descriptive or reviews, rather than evaluations of interventions. To foster more research, 12 research gaps are outlined. Addressing these gaps will facilitate the reduction of inequalities in physical health for people with SMI. Mental health nurses are well placed to lead multidisciplinary, consumer-informed research in this area. © 2015 Australian College of Mental Health Nurses Inc.
    International journal of mental health nursing 07/2015; 24(5). DOI:10.1111/inm.12142 · 1.95 Impact Factor
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    • "Although there have been great strides in defining patient centered care, its components, and outcomes (Morgan & Yoder, 2012), it also is acknowledged that patient-provider communication patterns exist that impede the development of patient-centered care (Chang et al., 2014). There also is recognition that, in behavioral health, stigma often creates a status differential that silences the patient's voice (Lawrence & Kisely, 2011). The literature documents that individuals hospitalized on inpatient psychiatric units seek relationships that are contingent on support, trust, and mutual respect (Walsh & Boyle, 2009), yet often experience less than the ideal and instead report experiencing stigma, de-humanization, and humiliation (Lilja & Hellzen, 2008; Shattell, Andes, & Thomas, 2008; Thibeault, Trudeau, d'Entremont, & Brown, 2010). "
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    ABSTRACT: Currently the United States health care system is responding to the Patient Protection and Affordable Care Act (PPACA) and the vision it contains for health care transformation. Along with sweeping changes in service delivery and payment structures, health care reform has championed concepts such as patient-centered care, integrated care, and wellness. Although these are not new ideas, their adaptation, in both ideology and service design has been accelerated in the context for reform. Indeed they are reaching a tipping point; the point where ideas gain wide acceptance and become influential trends. Although psychiatric mental health (PMH) nurses have been active in wellness, patient-centered care, and integrated care, at the current time they seem to be situated peripheral to these national trends. Increased presence of PMH nurses will facilitate their contribution to the development of these concepts within service structures and interventions. To increase knowledge and appreciation of PMH nurses’ practice and unique perspective on these issues, leaders are needed who will connect and effectively communicate PMH nursing efforts to the broader health care arena. This article outlines the events that created a context for these three concepts (patient-centered care, wellness, and integrated care), and I suggest why they have reached a tipping point and discuss the need for greater PMH nursing presence in the American national dialog and the role of nursing leaders in facilitating these connections.
    Issues in Mental Health Nursing 06/2015; 36(5). DOI:10.3109/01612840.2014.994688
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    • "En outre, plusieurs auteurs rapportent que les établissements de santé mentale dans de nombreux pays sont moins financés que les autres établissements de soins [23] [24]. Ce problème a été aggravé par une longue tradition de séparation des établissements de santé mentale des établissements de santé générale, tant à l'emplacement des installations et dans l'affectation des ressources et des modèles de gestion des employés [25]. "
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    ABSTRACT: Background Mortality in patients in psychiatric hospitals is reported to be two to three times as high as in the general population. In Tunisia, we do not have any figures on mortality and causes of death in psychiatric inpatients. Aim The aim of our study was to assess the mortality rate in a psychiatric hospital in comparison to the mortality rate in the general population, to determine the patients’ profile, and to identify the causes and risk factors for these deaths. Methods We performed a retrospective, descriptive and comparative study. We examined the records of all patients who died during their stay in the different wards of psychiatry at the Razi Hospital in Tunis. We also scrutinized reports of autopsies in the Forensic Medicine unit at Charles-Nicolle Hospital in Tunis over a period of eleven years from January 1st, 2000 to December 31st, 2010. We conducted a descriptive study to calculate the standardized mortality ratio (SMR) aiming to highlight any existing excess mortality among the psychiatric inpatients compared to the general population. This ratio was obtained by dividing the observed number of deaths by the expected number of deaths. In the analytical study, our sample was compared to a control population made-up of randomly selected living patients among those admitted to the Razi hospital in 2010. This study allowed us to investigate the risk factors for premature mortality in psychiatric inpatients. Results The average rate of mortality was two deaths per 1000 inpatients per year. Twenty-four percent (24 %) of deaths involved institutionalized patients. Compared to the general population, premature mortality was noted among patients aged less than 40 (SMR = 1.9). The older the patients were, the closer to 1 the SMR was. The average age at death was 51.38 years; 65 % of patients were male, 60 % had a low socio-economic level, 54 % had a comorbid medical condition. Forty-two percent (42 %) of deceased patients were diagnosed with schizophrenia with the paranoid form being the most prevalent (44 %), 13 % had bipolar disorder, 22 % had psycho-organic disorders (mental retardation, dementia, delirium). Antipsychotics were the most prescribed psychotropic drugs. High doses were used. Forty percent of cases (40 %) consisted of sudden deaths. A cause for death was identified in 80 % of cases. In 92 % of cases, the death was classified as being “natural”. Main causes were respiratory (26 %) and cardiovascular (9 %). Accidental causes accounted for 8 % of deaths. In 20 % of cases, the cause remained undetermined. Three factors were identified as independent predictors of mortality among mental patients: age at death (OR = 3.9 among patients older than 40), psychiatric diagnosis (OR = 2.9 among patients with psychotic or mood disorders compared to other diagnoses) and combination of antipsychotic drugs (OR = 6.09 in patients receiving more than two antipsychotics). Discussion Young psychiatric inpatients seem to be at high risk of premature death: the SMR in our study was 1.9. It ranged between 2.15 and 6.55 in other similar studies. This increased risk mainly concerns non-natural deaths. The leading natural cause of death in our population was represented by thromboembolic accidents. Such a high thromboembolic risk may be explained by the mental illness itself, by physical restraint as well as by antipsychotic treatment. Diagnosing medical conditions in psychiatric patients is often a daunting task: history of the patient is sometimes unreliable and clinical features might be modified by psychotropic agents. Patient-related risk factors for premature death include poor socio-economic level, access-to-care difficulties, positive family and personal history of mental and/or medical disorders, smoking, substance abuse, unhealthy diet and lack of physical activity. Moreover, iatrogenic effects of psychotropic drugs (combination of antipsychotics was more common in deceased patients than in controls) and inadequate medical care in psychiatric hospitals (lack of ECG devices, in particular) partly account for such a high mortality. Conclusion Identifying risk factors for deaths in psychiatric hospitals highlights needed changes in psychiatric management strategies taking into account the patient's characteristics as well as the drugs’ safety profile. Further studies with larger samples are needed to better highlight risk factors for premature death in psychiatric inpatients. Identifying such risk factors is necessary to develop efficient preventive strategies.
    L Encéphale 10/2014; 40(5). DOI:10.1016/j.encep.2014.07.007 · 0.70 Impact Factor
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