Literature Collection

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.

Individuals living with serious mental illness (SMI) face significant barriers to accessing appropriate physical health care, poorer associated health outcomes and premature mortality compared to the general population. This scoping review examines service delivery models and clinical practices supporting the integration of physical health care for adults with SMI within mental health settings, and their outcomes. Searches of four academic databases yielded 65 academic articles. Most integrated service delivery models were implemented in community mental health settings in the United States and incorporated elements of Wagner's Chronic Care Model, emphasizing delivery-system redesign, patient self-management support and use of clinical information systems. In most outcome studies, integrated care models were associated with improvements in primary care access and preventative screening rates, while other physical health indicators and emergency and inpatient service use demonstrated promising but mixed results. Implementation challenges of integrated service delivery models included securing financial resources and maintaining effective use of clinical information systems, among others. Successful implementation was facilitated by effective teamwork, care coordination, and administrative and leadership support. Study findings highlight the complexity of integrating physical health care in mental health settings, and the longer timeframes needed to observe changes in some outcomes. The review further underscores the need for ongoing efforts to advance integrated care delivery in mental health settings and the importance of longitudinal data collection to fully assess and optimize the implementation and outcomes of these interventions. Systematic Review Registration: https://doi.org/10.17605/OSF.IO/3T9VK.

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.

OBJECTIVE/BACKGROUND: Although perinatal substance use disorders (PSUDs) are increasingly prevalent among pregnant and postpartum (PPP) individuals, there is limited understanding of physicians’ perspectives on training needs and gaps in PSUD treatment. To reduce the negative impact of SUD on PPPs, identifying critical areas of intervention related to education and awareness for screening and treating PSUDs is critical. This study explored reproductive healthcare professionals’ (RHPs) perspectives on the necessary training to improve care for PPPs with PSUDs. METHODS: This study is an analysis of a cross-sectional survey of RHPs (n = 117). Inductive thematic analysis was conducted on free-text survey responses to identify RHP perspectives on training needs and strategies for improving care for PPP with SUD. Analyses were performed using Atlas.ti V 24.1. RESULTS: Participants were mostly White (77.8%) and female (93.2%) and included a broad sample of RHPs across multiple disciplines. Three primary themes were generated: (1) improving equitable access to evidence-based training, (2) prioritization of an integrated care network, and (3) addressing stigma in how care is delivered. DISCUSSION: The themes elicited from provider responses offer a framework for understanding opportunities to enhance care for PSUDs. Providers emphasized the need for more equitable access to evidence-based training to better equip clinicians to deliver high-quality care. They also described the importance of strengthening integrated care networks through collaboration among multidisciplinary professionals to improve care coordination and patient experiences. Addressing stigma in care delivery was identified as essential for fostering a more supportive treatment environment. These insights reflect provider perspectives and perceived priorities for system-level improvement rather than evaluated outcomes of specific interventions. Future research should examine the effectiveness of existing training and care models and identify strategies to enhance their accessibility and impact.

BACKGROUND: Rural and underserved communities face persistent shortages of Family Nurse Practitioners (FNPs), limiting access to high-quality care. Academic-Practice Partnerships (APPs) offer a strategy to build workforce readiness. PURPOSE: This study evaluated the effects of an enhanced APP model on FNP learners' practice confidence and employment outcomes in underserved settings. METHODS: Using a longitudinal, repeated-measures design, 33 FNP learners completed assessments at baseline, program completion, and 1-year post-graduation. Surveys measured confidence across 6 domains. RESULTS: Practice confidence significantly increased across all domains post-program (P < .001), with sustained gains at one year. Behavioral health and pharmacology showed initial surges followed by slight declines. One year after graduation, 63.6% remained at APP partner sites and 48.5% worked in rural areas. CONCLUSIONS: Enhanced APP models effectively build and sustain FNP practice confidence and retention in high-need settings, though continued post-graduation support is warranted.

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.