Attitudes to physical healthcare in severe mental illness; a patient and mental health clinician qualitative interview s
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RESEARCH ARTICLE
Open Access
Attitudes to physical healthcare in severe mental illness; a patient and mental health clinician qualitative interview study Joseph Butler1*† , Simone de Cassan2†, Phil Turner3, Belinda Lennox2,4, Gail Hayward3 and Margaret Glogowska5
Abstract Background: People with severe mental illness experience physical health significantly worse than the general population. Physical health monitoring is shared between primary care and secondary mental healthcare services, though there is debate whether mental health teams should provide more physical healthcare. The views of mental health clinicians and patients with mental illness towards physical healthcare provision are unclear. Aims: To explore the attitudes of Community Mental Health Team (CMHT) clinicians and patients experiencing severe mental illness towards physical healthcare and its provision. Design and setting: Qualitative study in a CMHT setting. Methods: Interviews were carried out with CMHT clinicians and patients with severe mental illness. Data were collected using semi-structured interviews and analysed using thematic analysis. Results: There were 14 patients and 15 clinicians recruited. Patients varied in their awareness of the association between physical and mental health, but were engaged in physical health monitoring. Clinicians were aware of the importance of physical healthcare but reported barriers to provision, including lack of training, resource constraints and uncertainty in their role. There was no consensus in either group regarding how physical healthcare should be provided, with diverse attitudes expressed for why CMHTs should and shouldn’t provide more physical healthcare. Conclusions: Increasing physical healthcare provision from mental health teams requires healthcare-related barriers be addressed, but it remains unclear whether CMHT clinicians or patients believe this to be a solution. Keywords: Mental health, Qualitative research, Health promotion and prevention
Introduction The mainstay of psychiatric care in the UK is delivered by Community Mental Health Teams (CMHTs). CMHTs operate alongside General Practitioners (GPs) in the community and as a result, have joint responsibility for certain aspects of patient care, in particular the physical health of patients with severe mental illness * Correspondence: Joseph.Butler@psych.ox.ac.uk Joseph Butler and Simone de Cassan are joint first Authors. 1 Foundation Year 3 Physical Health Care, Department of Psychiatry, University of Oxford, Oxford, UK Full list of author information is available at the end of the article
(defined as schizophrenia, bipolar affective disorder and other psychoses) [1]. Psychotic Disorders are associated with a 15–20 year mortality gap [2–4] mediated primarily by cardiovascular comorbidity [5]. Against a background of increasing multi-morbidity, the numbers of people living with both physical and mental health conditions is rising [6, 7], which is associated with disproportionate increases in healthcare utilisation [8]. The National
