Improving Health Care for Individuals with Serious Mental Illness Across the Lifespan

Abstract

OBJECTIVES: Individuals with severe persistent mental illness (SPMI), also referred to as serious mental illness (SMI), experience significant inequities in health care access and outcomes. These inequities may span the lifetime of an individual living with SPMI, and include poorer cancer outcomes, shorter lifespans, barriers to having their needs met in long-term care, and a decreased likelihood of receiving hospice care when indicated. The purpose of this dissertation was to explore the causes of the disproportionately poor health outcomes for individuals living with SPMI and describe current facilitators and barriers to providing care to this vulnerable population. METHODS: A qualitative descriptive study was carried out to explore health care professionals’ perception of the needs of long-term care residents with SPMI and chronic medical conditions. and barriers and facilitators to meeting the needs of this population. A narrative review was performed to identify what is currently known about cancer symptom clusters in individuals with schizophrenia. Lastly, an integrated review was conducted to identity factors associated with hospice use by individuals with SPMI and potential barriers to use of hospice services. RESULTS: Ten health care professionals were interviewed for the qualitative study. The themes that emerged were: coming to know the individual and their unique needs takes time; being flexible and adapting approaches facilitates trust; respecting the inherent worth of each person contributes to caring. Participants described the importance of a person-centered approach when caring for long-term care residents with SPMI and chronic medical conditions. The narrative review of current literature pertaining to cancer symptom clusters in individuals with schizophrenia revealed that this phenomenon has been sparsely represented in research. No data directly pertaining to cancer symptom clusters in this population were identified. Data describing the related phenomena of health conditions that may influence cancer risk and outcomes, physical experiences of cancer, and emotional and behavioral symptoms which may impact ability to tolerate cancer treatments were identified. The integrated review of literature describing factors associated with hospice use among individuals with SPMI found that hospice and palliative care services may not be utilized by individuals with SPMI due to system-level barriers such as inadequate patient-provider communication, fragmented care, and absence of discussions around end-of-life care. CONCLUSIONS: Systemic problems such as miscommunication, fragmentation of care, and stigma contribute to the health inequities experienced by individuals living with SPMI. Nurses and other health care providers can work to ameliorate these systemic problems by promoting and participating in collaborative care models and utilizing assessment techniques appropriate to individuals who may have difficulty communicating about their health-related symptoms. Individuals with SPMI should be offered opportunities to participate in research when appropriate so that they may benefit from newer treatments for disease, and health care providers may improve their understanding of how to address the medical needs of this population.