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The lived experience of severe mental illness and long-term conditions: a qualitative exploration of service user, carer, and healthcare professional perspectives on self-managing co-existing mental and physical conditions

The lived experience of severe mental illness and long-term conditions: a qualitative exploration of service user, carer, and healthcare professional perspectives on self-managing co-existing mental and physical conditions
The lived experience of severe mental illness and long-term conditions: a qualitative exploration of service user, carer, and healthcare professional perspectives on self-managing co-existing mental and physical conditions

Background: People with severe mental illness (SMI), such as schizophrenia, have higher rates of physical long-term conditions (LTCs), poorer health outcomes, and shorter life expectancy compared with the general population. Previous research exploring SMI and diabetes highlights that people with SMI experience barriers to self-management, a key component of care in long-term conditions; however, this has not been investigated in the context of other LTCs. The aim of this study was to explore the lived experience of co-existing SMI and LTCs for service users, carers, and healthcare professionals. Methods: A qualitative study with people with SMI and LTCs, their carers, and healthcare professionals, using semi-structured interviews, focused observations, and focus groups across the UK. Forty-one interviews and five focus groups were conducted between December 2018 and April 2019. Transcripts were coded by two authors and analysed thematically. Results: Three themes were identified, 1) the precarious nature of living with SMI, 2) the circularity of life with SMI and LTCs, and 3) the constellation of support for self-management. People with co-existing SMI and LTCs often experience substantial difficulties with self-management of their health due to the competing demands of their psychiatric symptoms and treatment, social circumstances, and access to support. Multiple long-term conditions add to the burden of self-management. Social support, alongside person-centred professional care, is a key facilitator for managing health. An integrated approach to both mental and physical healthcare was suggested to meet service user and carer needs. Conclusion: The demands of living with SMI present a substantial barrier to self-management for multiple co-existing LTCs. It is important that people with SMI can access person-centred, tailored support for their LTCs that takes into consideration individual circumstances and priorities.

Long-term conditions, Mental health, Multimorbidity, Qualitative research, Self-management, Severe mental illness
1471-244X
C., Carswell
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J.V.E., Brown
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R.A., Ajjan
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S.L., Alderson
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A., Balogun-Katung
796e8da3-20ca-4a69-a69b-1048c7d3bee6
S., Bellass
f5ca4fe7-aea8-49dc-a1a6-d3c151c45fd6
K., Double
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S., Gilbody
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C.E., Hewitt
912ce5cc-90b0-4788-b33e-cdc9a2fe8262
R., Jacobs
866d8f3e-c1e0-46b7-888a-35d6000e78a5
Holt, Richard
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I., Kellar
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E., Peckham
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D., Shiers
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J., Taylor
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N., Siddiqi
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P., Coventry
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DIAMONDS Research Team
C., Carswell
d6b65238-ebc0-40dd-b297-05aea78c7289
J.V.E., Brown
62f77248-f330-49f2-b55f-9c736b08b789
R.A., Ajjan
2b92e62b-fb4d-475f-8df5-3cfaa8b876f2
S.L., Alderson
627b4814-337c-4f6a-9e8d-040d982fd156
A., Balogun-Katung
796e8da3-20ca-4a69-a69b-1048c7d3bee6
S., Bellass
f5ca4fe7-aea8-49dc-a1a6-d3c151c45fd6
K., Double
187a9d83-e397-4dbc-bbdf-6c8d46148865
S., Gilbody
51192a31-3174-4450-8755-50098409b008
C.E., Hewitt
912ce5cc-90b0-4788-b33e-cdc9a2fe8262
R., Jacobs
866d8f3e-c1e0-46b7-888a-35d6000e78a5
Holt, Richard
d54202e1-fcf6-4a17-a320-9f32d7024393
I., Kellar
24e26393-8783-40d3-ab44-119af97dce62
E., Peckham
c4843e9a-4fe0-46c9-bbf2-a016e5f1581f
D., Shiers
cda9a572-de4d-4be6-82cb-491d3e8bca6c
J., Taylor
89d4e33a-fe0a-4e17-9662-7dc69c43b619
N., Siddiqi
b6951748-13a0-4edf-a9ed-27ba08f7e44d
P., Coventry
5b5dfee8-ad0a-4f19-a4cc-4058328f98ec

C., Carswell, J.V.E., Brown and R.A., Ajjan , DIAMONDS Research Team (2022) The lived experience of severe mental illness and long-term conditions: a qualitative exploration of service user, carer, and healthcare professional perspectives on self-managing co-existing mental and physical conditions. BMC Psychiatry, 22 (1), [479]. (doi:10.1186/s12888-022-04117-5).

Record type: Article

Abstract

Background: People with severe mental illness (SMI), such as schizophrenia, have higher rates of physical long-term conditions (LTCs), poorer health outcomes, and shorter life expectancy compared with the general population. Previous research exploring SMI and diabetes highlights that people with SMI experience barriers to self-management, a key component of care in long-term conditions; however, this has not been investigated in the context of other LTCs. The aim of this study was to explore the lived experience of co-existing SMI and LTCs for service users, carers, and healthcare professionals. Methods: A qualitative study with people with SMI and LTCs, their carers, and healthcare professionals, using semi-structured interviews, focused observations, and focus groups across the UK. Forty-one interviews and five focus groups were conducted between December 2018 and April 2019. Transcripts were coded by two authors and analysed thematically. Results: Three themes were identified, 1) the precarious nature of living with SMI, 2) the circularity of life with SMI and LTCs, and 3) the constellation of support for self-management. People with co-existing SMI and LTCs often experience substantial difficulties with self-management of their health due to the competing demands of their psychiatric symptoms and treatment, social circumstances, and access to support. Multiple long-term conditions add to the burden of self-management. Social support, alongside person-centred professional care, is a key facilitator for managing health. An integrated approach to both mental and physical healthcare was suggested to meet service user and carer needs. Conclusion: The demands of living with SMI present a substantial barrier to self-management for multiple co-existing LTCs. It is important that people with SMI can access person-centred, tailored support for their LTCs that takes into consideration individual circumstances and priorities.

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e-pub ahead of print date: 19 July 2022
Published date: 19 July 2022
Additional Information: Funding Information: DS is an expert advisor to the NICE Centre for Guidelines; the views expressed are the authors’ and not those of NICE. RIGH has received honoraria for speaker engagement, conference attendance or advisory boards from: Abbott, AstraZeneca, Boehringer-Ingelheim, European Association for the Study of Diabetes, Eli Lilly, Encore, Janssen, Menarini, NAPP, Novo Nordisk and Omniamed, Roche and Sanofi. PC and SG are part funded by the UK Research and Innovation Closing the Gap Network+ [ES/S004459/1] and the NIHR Applied Research Collaboration Yorkshire and Humber. Funding Information: This paper reports work undertaken as part of the DIAMONDS programme, which is funded by the National Institute for Health Research under its Programme Grants for Applied Research (project number RP-PG-1016-20003). PC and SG are part funded by the UK Research and Innovation Closing the Gap Network+ [ES/S004459/1] and the NIHR Applied Research Collaboration Yorkshire and Humber. Publisher Copyright: © 2022, The Author(s).
Keywords: Long-term conditions, Mental health, Multimorbidity, Qualitative research, Self-management, Severe mental illness

Identifiers

Local EPrints ID: 468283
URI: http://eprints.soton.ac.uk/id/eprint/468283
ISSN: 1471-244X
PURE UUID: f3c9dd86-bf53-4eba-9762-cbe41c358d2a
ORCID for Richard Holt: ORCID iD orcid.org/0000-0001-8911-6744

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Date deposited: 09 Aug 2022 16:46
Last modified: 17 Mar 2024 02:52

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Contributors

Author: Carswell C.
Author: Brown J.V.E.
Author: Ajjan R.A.
Author: Alderson S.L.
Author: Balogun-Katung A.
Author: Bellass S.
Author: Double K.
Author: Gilbody S.
Author: Hewitt C.E.
Author: Jacobs R.
Author: Richard Holt ORCID iD
Author: Kellar I.
Author: Peckham E.
Author: Shiers D.
Author: Taylor J.
Author: Siddiqi N.
Author: Coventry P.
Corporate Author: DIAMONDS Research Team

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