Integrated care for people living with long term mental health conditions

The Lancet Psychiatry Commission wrote in 2019 that “the poor physical health of people with mental illness is a multifaceted, transdiagnostic, and global problem”. The Commission noted that life-expectancy for people living with long term severe mental illness (SMI) is lower than those without, due in part to “poor clinical management” and the gap may be widening. The Commission proposed integrating physical and mental healthcare to address this largely unmet need.

The incidence of obesity, diabetes and cardiovascular diseases is up to two times higher in this group than the wider population 1

Whilst not widely researched, this pattern also appears for people living with common mental health conditions such as depression2. Similarly, people living with SMI have much poorer outcomes reflected by higher numbers of planned and avoidable admissions to hospital3. The ”poor clinical management” referred to in the Commission’s report can be caused by a range of factors including a lack of access by people living with SMI to timely preventative care and treatment of physical health conditions. This lack of access can have origins in the way that services are organized, for example lack of colocation of physical and mental health services, and psycho-social factors that limit an individual’s ability to access services. A study in Belgium found that healthcare professionals’ capability and capacity to meet the needs of this group and an absence of multi-disciplinary guidelines were other barriers to high quality clinical management4.