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RESEARCH ARTICLE (Open Access)
Contents Vol 30(1)

Access to general practice for preventive health care for people who experience severe mental illness in Sydney, Australia: a qualitative study

Catherine Spooner https://orcid.org/0000-0002-6741-5644 A * , Peri O’Shea https://orcid.org/0009-0008-1393-2516 A , Karen R. Fisher https://orcid.org/0000-0002-0828-6395 B , Ben Harris-Roxas https://orcid.org/0000-0003-1716-2009 C , Jane Taggart https://orcid.org/0000-0001-7283-6710 A , Patrick Bolton https://orcid.org/0000-0002-3401-553X A D and Mark F. Harris https://orcid.org/0000-0002-0705-8913 A
+ Author Affiliations
- Author Affiliations

A Centre for Primary Health Care and Equity, UNSW Sydney, Sydney, NSW 2052, Australia.

B Social Policy Research Centre, UNSW Sydney, Sydney, NSW 2052, Australia.

C School of Population Health, UNSW Sydney, Sydney, NSW 2052, Australia.

D South Eastern Local Health District, Sydney, NSW 2022, Australia.

* Correspondence to: c.spooner@unsw.edu.au

Australian Journal of Primary Health 30, PY23195 https://doi.org/10.1071/PY23195
Submitted: 24 October 2023  Accepted: 3 December 2023  Published: 4 January 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background

People with lived experience of severe mental illness (PWLE) live around 20 years less than the general population. Most deaths are due to preventable health conditions. Improved access to high-quality preventive health care could help reduce this health inequity. This study aimed to answer the question: What helps PWLE access preventive care from their GP to prevent long-term physical conditions?

Methods

Qualitative interviews (n = 10) and a focus group (n = 10 participants) were conducted with PWLE who accessed a community mental health service and their carers (n = 5). An asset-based framework was used to explore what helps participants access and engage with a GP. A conceptual framework of access to care guided data collection and analysis. Member checking was conducted with PWLE, service providers and other stakeholders. A lived experience researcher was involved in all stages of the study.

Results

PWLE and their carers identified multiple challenges to accessing high-quality preventive care, including the impacts of their mental illness, cognitive capacity, experiences of discrimination and low income. Some GPs facilitated access and communication. Key facilitators to access were support people and affordable preventive care.

Conclusion

GPs can play an important role in facilitating access and communication with PWLE but need support to do so, particularly in the context of current demands in the Australian health system. Support workers, carers and mental health services are key assets in supporting PWLE and facilitating communication between PWLE and GPs. GP capacity building and system changes are needed to strengthen primary care’s responsiveness to PWLE and ability to engage in collaborative/shared care.

Keywords: community mental health: services, delivery of health care: integrated, health services: accessibility, health services: needs and demands, patient care: team, preventive health services, preventive medicine, primary health care.

References

Bartlem K, Fehily C, Wynne O, Gibson L, Lodge S, Clinton-McHarg T, Dray J, Bowman J, Wolfenden L, Wiggers J (2020) Initiatives to improve physical health for people in community-based mental health programs. The Sax Institute, Sydney. doi:10.57022/conj2912

Brophy L, Minshall C, Fossey E, Whittles N, Jacques M (2022) The Future Horizon: Good Practice in Recovery-Oriented Psychosocial Disability Support. Stage Two Report. La Trobe, report. doi:10.26181/17131973.v1

Cabassa LJ, Camacho D, Vélez-Grau CM, Stefancic A (2017) Peer-based health interventions for people with serious mental illness: a systematic literature review. Journal of Psychiatric Research 84, 80-89.
| Crossref | Google Scholar | PubMed |

Calder RV, Dunbar JA, de Courten MP (2022) The Being Equally Well national policy roadmap: providing better physical health care and supporting longer lives for people living with serious mental illness. Medical Journal of Australia 217, S3-S6.
| Crossref | Google Scholar | PubMed |

Cooperrider DL, Whitney D (1999) Appreciative inquiry: a positive revolution in change. In ‘The change handbook: group methods for shaping the future’. (Eds P Holman, T Devane) pp. 245–261. (Berrett-Koehler: San Francisco)

Curtis J, Watkins A, Rosenbaum S, Teasdale S, Kalucy M, Samaras K, Ward PB (2016) Evaluating an individualized lifestyle and life skills intervention to prevent antipsychotic-induced weight gain in first-episode psychosis. Early Intervention in Psychiatry 10, 267-276.
| Crossref | Google Scholar | PubMed |

Devine A, Dickinson H, Rangi M, Huska M, Disney G, Yang Y, Barney J, Kavanagh A, Bonyhady B, Deane K, McAllister A (2022) ‘Nearly gave up on it to be honest’: utilisation of individualised budgets by people with psychosocial disability within Australia’s National Disability Insurance Scheme. Social Policy & Administration 56, 1056-1073.
| Crossref | Google Scholar |

Ewart SB, Bocking J, Happell B, Platania-Phung C, Stanton R (2016) Mental health consumer experiences and strategies when seeking physical health care: a focus group study. Global Qualitative Nursing Research 3, 233339361663167.
| Crossref | Google Scholar |

Firth J, Siddiqi N, Koyanagi A, Siskind D, Rosenbaum S, Galletly C, Allan S, Constanza C, Carney R, Carvalho AF, Chatterton ML, Correll CU, Curtis J, Gaughran F, Heald A, Hoare E, Jackson SE, Kisely S, Lovell K, Maj M, McGorry PD, Mihalopoulos C, Myles H, O’Donoghue B, Pillinger T, Sarris J, Schuch FB, Shiers D, Smith L, Solmi M, Suetani S, Taylor J, Teasdale SB, Thornicroft G, Torous J, Usherwood T, Vancampfort D, Veronese N, Ward PB, Yung AR, Killackey E, Stubbs B (2019) The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness. Lancet Psychiatry 6(8), 675-712.
| Crossref | Google Scholar |

Happell B, Wilson K, Platania-Phung C, Stanton R (2017) Filling the gaps and finding our way: family carers navigating the healthcare system to access physical health services for the people they care for. Journal of Clinical Nursing 26, 1917-1926.
| Crossref | Google Scholar | PubMed |

Happell B, Platania-Phung C, Bocking J, Ewart SB, Scholz B, Stanton R (2019) Consumers at the centre: interprofessional solutions for meeting mental health consumers’ physical health needs. Journal of Interprofessional Care 33, 226-234.
| Crossref | Google Scholar | PubMed |

Harris E, Harris MF (2023) An exploration of the inverse care law and market forces in Australian primary health care. Australian Journal of Primary Health 29, 137-141.
| Crossref | Google Scholar | PubMed |

Harris M, Lloyd J (2012) The role of Australian primary health care in the prevention of chronic disease. Report prepared for ANPHA. CPHCE, Sydney. Available at https://adma.org.au/download/the-role-of-australian-primary-health-care-in-prevention-of-chronic-disease/

Levesque J-F, Harris MF, Russell G (2013) Patient-centred access to health care: conceptualising access at the interface of health systems and populations. International Journal for Equity in Health 12, 18.
| Crossref | Google Scholar | PubMed |

Liu NH, Daumit GL, Dua T, Aquila R, Charlson F, Cuijpers P, Druss B, Dudek K, Freeman M, Fujii C, Gaebel W, Hegerl U, Levav I, Munk Laursen T, Ma H, Maj M, Elena Medina-Mora M, Nordentoft M, Prabhakaran D, Pratt K, Prince M, Rangaswamy T, Shiers D, Susser E, Thornicroft G, Wahlbeck K, Fekadu Wassie A, Whiteford H, Saxena S (2017) Excess mortality in persons with severe mental disorders: a multilevel intervention framework and priorities for clinical practice, policy and research agendas. World Psychiatry 16, 30-40.
| Crossref | Google Scholar | PubMed |

Melamed OC, Fernando I, Soklaridis S, Hahn MK, LeMessurier KW, Taylor VH (2019) Understanding engagement with a physical health service: a qualitative study of patients with severe mental illness. The Canadian Journal of Psychiatry 64, 872-880.
| Crossref | Google Scholar | PubMed |

Parker SM, Paine K, Spooner C, Harris M (2023) Barriers and facilitators to the participation and engagement of primary care in shared-care arrangements with community mental health services for preventive care of people with serious mental illness: a scoping review. BMC Health Services Research 23, 977.
| Crossref | Google Scholar | PubMed |

Primary Mental Health Care Services for People With Severe Mental Illness (2019) Australian Government Department of Health, PHN Primary Mental Health Care Flexible Funding Pool Programme Guidance, Canberra. Available at https://view.officeapps.live.com/op/view.aspx?src=https%3A%2F%2Fwww.health.gov.au%2Fsites%2Fdefault%2Ffiles%2Fdocuments%2F2021%2F04%2Fprimary-health-networks-phn-primary-mental-health-care-guidance-services-for-people-with-severe-mental-illness-primary-health-networks-phn-primary-mental-health-care-guidance-primary-mental-health-care-services-for-people.docx&wdOrigin=BROWSELINK. [Accessed 4 July 2023]

RACGP (2023) Shared Care Model between GP and non-GP specialists for complex chronic conditions. Available at https://www.racgp.org.au/advocacy/position-statements/view-all-position-statements/clinical-and-practice-management/shared-care-model-between-gp-and-non-gp-specialist. [Accessed 13 October 2023]

Royal Australian College of General Practitioners (2018) ‘Guidelines for Preventive Activities in General Practice (The Red Book),’ 9th edn. (RACGP: Melbourne). Available at https://www.racgp.org.au/FSDEDEV/media/documents/Clinical%20Resources/Guidelines/Red%20Book/Guidelines-for-preventive-activities-in-general-practice.pdf

Stumbo SP, Yarborough BJH, Yarborough MT, Green CA (2018) Perspectives on providing and receiving preventive health care from primary care providers and their patients with mental illnesses. American Journal of Health Promotion : AJHP 32, 1730-1739.
| Crossref | Google Scholar | PubMed |

Thomas H, Best M, Mitchell G (2020) Whole-person care in general practice: ‘Factors affecting the provision of whole-person care’. Australian Journal of General Practice 49, 215-220.
| Crossref | Google Scholar | PubMed |

Thornicroft G, Sunkel C, Aliev AA, Baker S, Brohan E, el Chammay R, Davies K, Demissie M, Duncan J, Fekadu W, Gronholm PC, Guerrero Z, Gurung D, Habtamu K, Hanlon C, Heim E, Henderson C, Hijazi Z, Hoffman C, Hosny N, Huang F-X, Kline S, Kohrt BA, Lempp H, Li J, London E, Ma N, Mak WWS, Makhmud A, Maulik PK, Milenova M, Cano GM, Ouali U, Parry S, Rangaswamy T, Rüsch N, Sabri T, Sartorius N, Schulze M, Stuart H, Salisbury TT, Juan NVS, Votruba N, Winkler P (2022) The Lancet Commission on ending stigma and discrimination in mental health. The Lancet 400(10361), 1438-1480.
| Crossref | Google Scholar | PubMed |

Vereeken S, Peckham E, Gilbody S (2023) Can we better understand severe mental illness through the lens of Syndemics? Frontiers in Psychiatry 13, 1092964.
| Crossref | Google Scholar | PubMed |

Whiteford H, Buckingham B, Harris M, Diminic S, Stockings E, Degenhardt L (2017) Estimating the number of adults with severe and persistent mental illness who have complex, multi-agency needs. Australian and New Zealand Journal of Psychiatry 51, 799-809.
| Crossref | Google Scholar | PubMed |