The online version of this article (https://doi.org/10.1186/s12875-017-0687-0) contains supplementary material, which is available to authorized users.
Persons with severe mental illness (e.g. schizophrenia, bipolar disorder) have a high prevalence of somatic conditions compared to the general population. Mortality data in the Nordic countries reveal that these persons die 15–20 years earlier than the general population. Some factors explaining this high prevalence may be related to the individuals in question; others arise from the health care system’s difficulty in offering somatic health care to these patient groups. The aim of the present study was therefore to explore the experiences and views of patients, relatives and clinicians regarding individual and organizational factors which facilitate or hinder access to somatic health care for persons with severe mental illness.
Flexible qualitative design. Data was collected by means of semi-structured individual interviews with patients with severe mental illness, relatives and clinicians representing primary and specialized health care. In all, 50 participants participated.
The main barrier to accessing somatic care is the gap between the organization of the health care system and the patients’ individual health care needs. This is observed at both individual and organizational level. The health care system seems unable to support patients with severe mental illness and their psychiatric-somatic comorbidity. The main facilitators are the links between severe mental illness patients and medical departments. These links take the form of functions (i.e. systems which ensure that patients receive regular reminders), or persons (i.e. professional contacts who facilitate patients’ access the health care).
Health care services for patients with severe mental illness need reorganization. Organizational structures and systems that facilitate cooperation between different departments must be put in place, along with training for health care professionals about somatic disease among psychiatric patients. The links between individual and organizational levels could be strengthened by introducing professional contacts, such as liaison physicians and case managers. This is also important to reduce stress and responsibility among relatives.
Additional file 1: Interview guides for semi-structured interviews with patients, relatives and clinicians. (DOCX 19 kb)12875_2017_687_MOESM1_ESM.docx
Vancampfort D, Wampers M, Mitchell AJ, Correll CU, De Herdt A, Probst M, De Hert M. A meta-analysis of cardio-metabolic abnormalities in drug naive, first-episode and multi-episode patients with schizophrenia versus general population controls. World Psychiatry. 2013;12:240–50. CrossRefPubMedPubMedCentral
Vancampfort D, Stubbs B, Mitchell AJ, De Hert M, Wampers M, Ward PB, Rosenbaum S, Correll CU. Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis. World Psychiatry. 2015;14:339–47. CrossRefPubMedPubMedCentral
Smith DJ, Langan J, McLean G, et al. Schizophrenia is associated with excess multiple physical-health comorbidities but low levels of recorded cardiovascular disease in primary care: cross-sectional study. BMJ Open. 2013;3:e002808. doi: https://doi.org/10.1136/bmjopen-2013-002808.
Torgerson J, Kjellström A, Overgaard K, Dimberg Jonson H: Vårdbehov i Västra Götaland. Somatisk vård och hälsoutfall vid samtidig psykisk sjukdom (In Swedish with a summary in English) http://analys.vgregion.se/contentassets/4ecc73f2879543bbb2b258b04836c292/somatisk-vard-och-halsoutfall-vid-samtidig-psykisk-sjukdom.pdf. 2016.
Groenkjaer M, de Crespigny C, Liu D, Moss J, Cairney I, Lee D, Procter N, Galletly C. "The chicken or the egg": barriers and facilitators to collaborative Care for People with Comorbidity in a metropolitan region of South Australia. Issues Ment Health Nurs. 2016;38(1):18–24.
De Hert M, Cohen D, Bobes J, Cetkovich-Bakmas M, Leucht S, Ndetei DM, Newcomer JW, Uwakwe R, Asai I, Moller HJ, et al. Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, plus recommendations at the system and individual level. World Psychiatry. 2011;10:138–51. CrossRefPubMedPubMedCentral
Kvale S. Interviews. Thousand Oaks: Sage; 1996.
Health care in Sweden [ https://sweden.se/society/health-care-in-sweden/]. Accessed 3 Aug 2017.
Coventry P, Lovell K, Dickens C, Bower P, Chew-Graham C, McElvenny D, Hann M, Cherrington A, Garrett C, Gibbons CJ, et al. Integrated primary care for patients with mental and physical multimorbidity: cluster randomised controlled trial of collaborative care for patients with depression comorbid with diabetes or cardiovascular disease. BMJ. 2015;350:h638. CrossRefPubMedPubMedCentral
Royal College of Psychiatrists: Improving the physical health of adults with severe mental illness: essential actions Working Group for Improving the Physical Health of People with SMI; 2016.
Rusner M, Carlsson G, Brunt D, Nystrom M. A dependence that empowers: the meaning of the conditions that enable a good life with bipolar disorder. Int J Qual Stud Health Well-being. 2010;5
Creswell JW. Research design: qualitative, quantitative, and mixed methods approaches. Sage cop: Thousand Oaks; 2009.
- Access to primary and specialized somatic health care for persons with severe mental illness: a qualitative study of perceived barriers and facilitators in Swedish health care
Elisabeth Björk Brämberg
Anna Norman Kjellström
- BioMed Central
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