Literature Collection

Individuals with severe mental illness (SMI) face significantly reduced life expectancy, mainly driven by natural causes such as cardiovascular disease, pulmonary disease, cancer, and stroke. Although medical care has advanced, the mortality gap between individuals with SMI and the general population has continued to expand in many countries over recent decades. This disparity is exacerbated by systemic healthcare inequities, fragmented healthcare, insufficient use of preventive measures, and the burden of multimorbidity. This paper proposes six actionable strategies to reduce the excess mortality associated with SMI by integrating physical healthcare into psychiatric services. Across all recommendations, we explicitly embed lifestyle interventions, especially structured physical activity given its comparatively stronger evidence base in SMI, alongside sleep and nutrition support delivered through pragmatic, accessible programs. First, psychoeducation should be expanded to include physical health literacy. Second, structured smoking cessation programs must be implemented. Third, early identification and management of obesity, including pharmacological interventions, should be prioritized. Fourth, hypertension should be routinely screened and treated within psychiatric settings. Fifth, dyslipidaemia and diabetes require systematic monitoring and timely initiation of statins, metformin and GLP-1 receptor agonists. Sixth, these interventions must be delivered through integrated care models that ensure continuity, optimal self-management, and long-term outcome monitoring. Together, these six approaches offer a framework to narrow the mortality gap between people with SMI and the general population, as well as support a shift toward holistic, person-centered care. We synthesise the evidence on physical health disparities in SMI and provide practical, evidence-based recommendations for psychiatric settings. Together, these strategies offer a feasible, person-centered framework to improve health outcomes and reduce premature mortality in individuals with SMI.

Our initiation of a reverse-integration practice model revealed numerous advantages and rewards, as well as many challenges, for which we found solutions.

OBJECTIVE: This program evaluation examined integration of primary care nurse practitioners into assertive community treatment (ACT). METHODS: From January to June 2019, primary care nurse practitioners in a postgraduate fellowship program were assigned to five ACT teams (N=305 participants). Focus groups explored staff members' and participants' experiences. Screening rates for hemoglobin A1c and cholesterol for ACT participants were compared over time. RESULTS: Staff and participants in ACT described improved engagement in primary care, citing benefit from colocation and consultation. Field visits were not found to be an efficient use of the primary care nurse practitioners' time to serve most ACT participants. A significant increase in screening was observed after 6 months for the ACT teams with integrated primary care. CONCLUSIONS: An integrated primary care nurse practitioner readily available for participant engagement and consultation with the ACT team, using a cardiometabolic registry to guide care, may offer a sustainable model of integration.

INTRODUCTION: Chronic pain (CP) is a prevalent condition that significantly affects quality of life, making its optimal management essential in primary care. However, nurses are often not involved, highlighting the need to better understand the conditions necessary for integrating their expertise before deploying implementation strategies. OBJECTIVE: This qualitative study aimed to identify barriers and facilitators to implementing nursing activities in CP management and to explore primary care nurses' perceptions of their role in this regard. METHODOLOGY: Twenty-one nurses from primary care practices in Quebec, Canada, participated in four online focus groups. The Integrated Promoting Action on Research Implementation in Health Services framework in implementation science was used to explore the challenges and opportunities in CP nursing management. Data analysis followed both inductive and deductive approaches, guided by this framework. RESULTS: While nurses were interested in integrating pain assessment into their practice, they faced challenges due to a lack of training about CP. A gap was identified in their understanding of the chronic nature of pain and their ability to provide appropriate follow-up and support. Nurses also expressed concerns about addressing the mental health aspects associated with CP. Additionally, they often relied on primary care managers, whose leadership is pivotal in driving change, even within nursing practices. CONCLUSIONS: This study highlights several challenges while suggesting essential implementation strategies to strengthen nurses' capacities, including additional training and tailored tools. Promoting interdisciplinary collaboration, clarifying nursing roles, and increasing manager awareness are crucial for enhancing primary care nurses' involvement in CP management.