The Being Equally Well policy roadmap aims to end neglect of the physical health of people living with serious mental illness
PEOPLE living with serious mental illness die prematurely up to the age of 20 due to chronic physical health problems. Most of these early deaths are due to preventable health conditions, including cardiovascular disease, smoking-related respiratory disease, diabetes and cancer. Primary care is not organized to provide this group with screening for cardiometabolic risk factors.
Current policies aimed at addressing this disparity in Australia and comparable countries have been ineffective. They are largely failing on the front lines of care because they ignore the way front line staff work. The Being Equally Well National Policy Roadmap proposes the changes needed in both specialist mental health care and primary health care and how to achieve them.
The accompanying supplement this question of SERVANT includes evidence reviews and discussions that fill knowledge gaps about effective physical health care for people living with serious mental illness.
Clinical microsystems are the small teams where patients and their families meet the health care system. Here, the foundations for safe and quality healthcare are laid. We have established expert working groups to examine how each layer of the health system hinders or assists the clinical microsystem in providing equitable mental and physical health care to people with serious mental illness. The mesosystem (primary health networks and acute mental health services) supports the clinical microsystem, while the macrosystem (federal and state governments) supports both the micro and meso systems.
Being Equally Well included five working groups. Four clinical groups examined the three levels of the system and system-wide quality improvement. The fifth group – consumers and caregivers – mapped the frustrations and health impacts of barriers within and between each layer of the system and developed core measures of success. The groups worked iteratively for 6 months. A constant exchange of information has been achieved through regular meetings of the chairs of the working groups. Recordings of group meetings were analyzed by theme to provide regular summaries to all groups.
Recommendations and critical evidence are summarized here and presented in detail in the supplement.
First, the lack of coordination between primary, secondary and tertiary care services was a central problem. The collaboration of the Royal Australian College of General Practitioners and the Royal Australian and New Zealand College of Psychiatrists to integrate their guidelines and develop shared care protocols is a key recommendation.
Second, consumers and caregivers identified as priorities the barriers of fragmented care and the complex difficulties of navigating the healthcare system, as well as the importance of community and peer group support. Investment in a nurse navigator workforce is proposed to actively support consumers and integrate the care they need from primary and specialist mental health services. Expanded roles for community pharmacists would provide medication management for people with high needs and facilitate shared care with allied health professionals. Developing peer helper roles is a high priority for consumers, as evidence points to the benefits of improved comprehensive care.
Third, the health effects of medications were a major concern, particularly the prevalence of metabolic syndrome. Although some countries use anti-diabetic drugs as a preventative treatment, this is not approved in Australia. The case for early use of anti-diabetic drugs is discussed in the supplement. The lessons learned from the use of clozapine are revealing. Despite the metabolic impacts, people receiving clozapine treatment have longer life expectancies. Monitoring is mandatory, which may explain this result.
Fourth, the benefits of nutritional interventions to improve the mental and physical health of people with severe mental illness were considered. Evidence indicates that they are particularly effective when directed by dietitians.
Finally, the lack of shared and consistent information between mental health services and primary care services underpins inadequate service delivery and exacerbates weak capacity to monitor and evaluate both health care and outcomes. health. A systematic national approach to quality improvement is proposed by establishing a national clinical quality register and annual reporting to the Australian Council of Health Ministers.
The findings and recommendations of the Being Equally Well project are set out in the national policy roadmap launched in August 2021. The Being Equally Well roadmap is a resource for primary care, mental health services, primary health networks and local hospitals and health districts and networks. It’s also a map for governments and health system administrators – without supporting system improvements, frontline health professionals cannot bring about lasting change.
Similar improvements in health care have been successful in reducing death and disability from conditions such as stroke. Bespoke shared health and support services have been put in place to improve the physical and mental health care of cancer patients. People with serious mental illness need the same commitment and attention to reduce preventable deaths and serious physical illness.
Professor Rosemary Calder is Professor of Health Policy at the Mitchell Institute at Victoria University.
Professor James Dunbar is from Deakin University.
Professor Maxmilian de Courtan is Professor of Global Health and Director of the Mitchell Institute at Victoria University.
This article is co-published at Australian medical journal. Read the original here.
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