The needs of individuals with severe mental illness in accessing primary healthcare

Abstract

Background: Patients with severe mental illness often suffer from somatic diseases and have a higher mortality rate due to natural causes than the general population. A 10-to-25-year life expectancy reduction in these individuals has been recorded. The study explores Primary Healthcare factors that locally contribute to this phenomenon. Aim: To explore SMI individuals’ awareness of physical comorbidities, their knowledge of available local Primary services and their experiences within these services. To find out needs and preferences of SMI individuals, to enhance the care for their physical health, and to explore the feasibility of carrying out physical health checks at a PHC level. Design: A qualitative approach following the principles of Bradshaw’s Taxonomy of Social Need. The study was conducted in the participants’ homes, or within Health Centres depending on the participants’ preferences. Four male and four female, Maltese SMI individuals between ages 35 and 60 on antipsychotic treatment for the past four years. Methods: Purposeful sampling was used to recruit. Semi-structured interviews were audiorecorded and transcribed verbatim. Bradshaw’s conceptual framework guided the analysis in this study. Results: Four superordinate themes emerged: ‘Scarcity of Physical Healthcare and Advice’, ‘Patient Related Barriers to Physical Healthcare’, ‘Barriers and Motivators When Accessing PHC Services’ and ‘Need for Better Physical Health’. Conclusion: There is a fragmentation of care between MHC, PHC and private physicians which has contributed to discrepancies in SMI individuals’ healthcare and health education. Health professionals should be notified that this population is receiving insufficient healthcare. SMI individuals are willing to look after their physical health. They find no challenges with service providers’ responses at the PHC centres and are in favour of attending routine check-ups within these premises. PHC and MHC nurses can play a crucial role in the preventive and promotive care of these individuals through integration.