‘It Is Like a Cross-Stitch … All Joined Together But Not Making a Very Nice Pattern’: A Qualitative Study of Patient Perspectives on Physical Health Inequalities in Severe Mental Illness

Background

People with severe mental illness (SMI) have worse physical health than the general population and face a range of challenges with their healthcare. This study aimed to explore the interplay of issues across system, service, social and individual levels that impact healthcare experiences and outcomes from the perspective of people with comorbid SMI and physical health needs.

Methods

A qualitative study was conducted. Fifteen individuals participated through focus groups and interviews (mean age = 55 years; range = 39–74 years). Participants were secondary mental health service users living with comorbid SMI and physical health condition(s) in South East London, the United Kingdom. Data were analysed through a process of inductive thematic analysis with reflexive elements.

Results

Seven themes were generated, demonstrating the interplay of system, service, social and individual-level issues. The first two focused on prevailing issues described by participants, including ‘systemic barriers to effective and equitable social and health care’ and ‘interpersonal stigma exacerbating inequalities’. The third and fourth themes described the consequences of these issues: ‘services turning to medication in response to multiple constraints’ and ‘inequities limiting individual actions’. Themes 5 and 6 centred on creating equitable conditions for people with SMI and physical healthcare needs, including ‘the role of informal and formal social supports’ and ‘patient perspectives on what works in health services’. The seventh cross-cutting theme described the ‘intertwined nature of mental and physical health’.

Implications

This study highlights systemic barriers and interpersonal stigma as sources of inequality for people with comorbid SMI and physical health needs. The findings highlight the need for investment in social and healthcare roles, services and systems which can be responsive to compounding risks experienced by these individuals. Both physical and mental health needs, and their interactions, should be considered, along with the cumulative impact of poor socio-economic conditions and stressors.

Patient or Public Contribution

A service user steering group, comprising five people with lived experience of SMI, was convened to support the study. The group met to inform the development of research questions, topic guides and participant materials, support the interpretation of findings, and provide input on the paper.