Article

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

ABSTRACT

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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    • "Professional role revision in health care occurs in response to factors including, but not limited to, demands of the public and changing expectations, challenges with accessibility, advances in technologies and treatments, shortages of health care professionals, and increased health care costs[1]. In mental illness and addictions care, many of these factors co-occur alongside broader changes in the funding and delivery of health care such as shorter hospitalizations, fewer inpatient beds, and increasing demands on physicians and other primary care providers to care for people with serious mental illnesses and addictions2345. Ensuring that all disciplines are practicing to their full potential and scope in mental illness and addictions care is one of many mechanisms to facilitate overcoming these, and various other challenges, such as enduring issues with timeliness, accessibility , appropriateness of care, and continuity of care567. Pharmacists can impact various outcomes (e.g., improve adherence rates, decrease prescribing of potentially inappropriate psychotropics) in mental illness and addictions care[8,9]. "
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    ABSTRACT: Background Community pharmacists are accessible health care professionals who encounter people with lived experience of mental illness and addictions in daily practice. Although some existing research supports that community pharmacists’ interventions result in improved patient mental health outcomes, gaps in knowledge regarding the pharmacists’ experiences with service provision to this population remain. Improving knowledge regarding the pharmacists’ experiences with mental illness and addictions service provision can facilitate a better understanding of their perspectives and be used to inform the development and implementation of interventions delivered by community pharmacists for people with lived experience of mental illness and addictions in communities. Methods We conducted a qualitative study using a directed content analysis and the Theoretical Domains Framework as part of our underlying theory of behaviour change and our analytic framework for theme development. The Theoretical Domains Framework facilitates understanding of behaviours of health care professionals and implementation challenges and opportunities for interventions in health care. Thematic analysis co-occurred throughout the process of the directed content analysis. We recruited community pharmacists, with experience dispensing psychotropics, at a minimum, through multiple mechanisms (e.g., professional associations) in a convenience sampling approach. Potential participants were offered the option of focus groups or interviews. Results Data were collected from one focus group and two interviews involving six pharmacists. Theoretical Domains Framework coding was primarily weighted in two domains: social/professional role and identity and environmental context and resources. We identified five main themes in the experiences of pharmacists in mental illness and addictions care: competing interests, demands, and time; relationships, rapport, and trust; stigma; collaboration and triage; and role expectations and clarity. Conclusions Pharmacists are not practicing to their full scope of practice in mental illness and addictions care for several reasons including limitations within the work environment and lack of structures and processes in place to be fully engaged as health care professionals. More research and policy work are needed to examine better integration of pharmacists as members of the mental health care team in communities. Electronic supplementary material The online version of this article (doi:10.1186/s13011-016-0050-9) contains supplementary material, which is available to authorized users.
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    • "Significant and pervasive inequalities exist in the provision of healthcare for people with serious mental illness (Lawrence & Kisely, 2010), as exemplified in the enduring neglect of their physical health needs. As far back as the late 19th century , the healthcare inequalities that people with serious mental illness experience were highlighted. "
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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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