Literature Collection

In a deinstitutionalised mental health care system, those with mental illness require complex, multidisciplinary and intersectoral care at the primary or community service setting. This paper describes an Evidence Map of different strategies to strengthen the provision of mental health care at the primary health care (PHC) setting, the quality of the evidence, and knowledge gaps. Electronic and reference searching yielded 2666 articles of which 306 qualified for data extraction. A systematic review methodology identified nine different strategies that strengthen the provision of mental healthcare and these strategies are mapped in line with the outcomes they affect. The top three strategies that were reported the most, included strategies to empower families, carers and patients; integration of care or collaborative interventions; and e-health interventions. The least reported strategy was task shifting. The Evidence Map further shows the amount and quality of evidence supporting each of the listed strategies, and this helps to inform policy design and research priorities around mental health. This is the first systematic Evidence Map to show the different strategies that strengthen the provision of mental healthcare at PHC setting and the impact these strategies have on patient, hospital and societal level indicators.

BACKGROUND: Individuals experiencing serious mental illness (SMI) have higher rates of comorbid physical health conditions, poorer associated health outcomes, and die on average 10-20 years earlier than the general population. They encounter multiple barriers to accessing appropriate physical health care in many countries, including Canada, where policies and practices to promote integrated care delivery to this population remain scant. This qualitative study aimed to explore health provider perspectives and experiences with integrated physical and mental health care within mental health settings in Canada, in efforts to address the health needs of this population. METHODS: This qualitative descriptive study involved conducting individual semi-structured interviews with 13 health administrators and four focus groups with 15 clinicians between July 2023 and April 2024. The data analysis team, inclusive of individuals with SMI, used thematic analysis to identify overarching themes that capture participants' perspectives on and experiences with delivering integrated physical and mental health care within mental health settings in Canada, including their clinical practices and organizational contexts. RESULTS: We identified four themes in participant narratives: (1) the need for integrated care delivery within mental health settings; (2) organizational readiness for integrated care; (3) moving integration forward: addressing challenges; and (4) leveraging opportunities to advance integrated care. Both participant groups highlighted challenges with fragmented healthcare services, emphasized the urgent need for policies, practices and guidelines that support person-centered, comprehensive care within mental health settings, and called for engaging people with living/lived experience and family members in service redesign. CONCLUSION: Findings underscore the importance of accelerating efforts to promote integrated health care delivery for adults with SMI within mental health settings, and of implementing policies that address health disparities for this population in the Canadian context. CLINICAL TRIAL NUMBER: Not Applicable.

BACKGROUND: Individuals with serious mental illness (SMI) have higher rates of comorbid physical health conditions, poorer associated health outcomes, and die on average 10-20 years earlier than the general population. This qualitative study aimed to explore the perspectives and experiences of adults living with SMI and family members with accessing physical healthcare within primary and mental health settings in Canada. METHODS: We conducted a qualitative descriptive study using semi-structured interviews with 20 adults living with SMI and five focus groups with 18 family members between July 2023 and April 2024. After coding by two authors, thematic analysis was completed with the support of a data analysis team to identify overarching themes capturing participant experiences with accessing physical healthcare, care needs and preferences. RESULTS: Four main themes emerged from participant narratives: (1) The centrality of mental health problems in the lives of people with SMI; (2) Challenges in accessing physical healthcare; (3) The role of families in supporting access to care; (4) Perceived health priorities and preferences. There was a high degree of congruence between the perspectives of individuals living with SMI and family members. Both participant groups described challenges accessing primary care settings, fragmented health services, and a desire for person-centred, whole-person health within mental health settings, with family member support where available. CONCLUSIONS: Findings from this study highlight the need for advancing the integration of physical healthcare within mental health settings for adults living with SMI, who are less likely to engage with community-based primary care services. Enhanced access to physical healthcare could leverage multidisciplinary resources in these settings and partnerships with families. These findings can inform efforts to provide whole-person healthcare for individuals experiencing SMI. PATIENT OR PUBLIC CONTRIBUTION: The study team collaborated closely with community organizations and individuals with lived experience at every stage of this research. This included contributions to the funding proposal, the study protocol, participant recruitment, study materials, data analysis and preparing the manuscript. Individuals with lived experience and family members actively participated in management and project meetings for the duration of the study.

Initiatives that support and incentivize the integration of behavioral health and general medical care have become a focus of government strategies to achieve the triple aim of improved health, better patient experience, and reduced costs. The authors describe the components of four large-scale national initiatives aimed at integrating care for a wide range of behavioral health needs. Commonalities across these national initiatives highlight health care and social services needs that must be addressed to improve care for people with co-occurring behavioral health and general medical conditions. These findings can inform how to design, test, select, and align the most promising strategies for integrated care in a variety of settings.