Equally Healthy Policy Roadmap aims to end disregard for physical health for people with serious mental illness
People with severe mental illness die up to 20 years prematurely from chronic physical health conditions. Most of these premature deaths are due to preventable health conditions such as cardiovascular disease, smoking-related respiratory disease, diabetes and cancer. Primary care is not organized to provide cardiometabolic risk factor screening for this group.
Current policies to address this disparity in Australia and similar countries have been ineffective. They fail mostly on the front line of care because they do not consider how frontline staff are working. It proposes necessary changes for both healthcare and how to achieve these.
Attached supplement this problem of MJAMore It consists of a review and discussion of the evidence that fills knowledge gaps in effective physical health management for people with severe mental illness.
A clinical microsystem is a small team where patients and their families meet the healthcare system. Here the foundations of healthcare safety and quality are built. To examine how each layer of the health system hinders or helps the clinical microsystem to provide equitable mental and physical health care to people with serious mental illness, we A working group of experts was set up. Mesosystems (primary health networks and acute mental health services) support clinical microsystems, while macrosystems (federal and state governments) support both microsystems and mesosystems.
Equally Healthy is made up of five working groups. Four clinical groups noted his three levels of the system and the improvement in overall system quality. A fifth group (consumers and caregivers) charted the frustration and health impact of barriers within and between each layer of the system and developed a central measure of success. The group he worked iteratively over a period of six months. A constant exchange of information took place through regular meetings of the Working Group Chairs. Recordings of group meetings were thematically analyzed to provide regular summaries for all groups.
Key recommendations and evidence are summarized here and presented in detail in the Supplement.
First, the lack of coordination between primary, secondary and tertiary health services was a central issue. The collaboration of the Royal Australian College of General Practitioners and the Royal Australian and New Zealand College of Psychiatricists to consolidate guidelines and develop shared care protocols is an important recommendation.
Second, consumers and caregivers identified as priorities the complex difficulties of navigating fragmented care barriers and healthcare systems, and the importance of support from communities and peer groups. Investments in a nurse-navigator workforce are proposed to actively support consumers and integrate the care they need from primary and specialized mental health services. Expanding the role of community pharmacists to provide medication administration to individuals in high need and facilitate shared care with relevant health professionals. Developing the role of peer workers is a top priority for consumers. This is because enhanced evidence points to benefits of comprehensive care.
Third, the health effects of drugs, especially the prevalence of metabolic syndrome, were of great concern. Some countries use antidiabetic drugs as preventive therapy, but they are not approved in Australia. A case of early use of antidiabetic drugs is described in the Supplement. Despite the metabolic effects, those on clozapine therapy have a longer life expectancy. Monitoring is mandatory, which may explain this result.
Fourth, the benefits of nutritional interventions to improve the mental and physical health of people with serious mental illness were considered. .
Finally, the lack of consistent information shared between mental health and primary care services underlies poor service delivery and exacerbates the poor ability to monitor and assess both health care and health outcomes. A systematic national approach to quality improvement is proposed by establishing a National Clinical Quality Registry and an annual report to the Australian Council of Health Ministers.
The results and recommendations of the Staying Equally Healthy project can be found in the National Policy Roadmap launched in August 2021. The Equally Healthy Roadmap is a resource for primary care, mental health services, primary health networks, and local hospitals and health districts. network. It is also a map for government and health system administrators. Frontline medical professionals cannot bring about sustainable change if they do not support system improvement.
Similar health care enhancements have been successful in reducing death and disability from stroke and other causes. Coordinated shared health services and supports are in place to improve physical and mental health care for cancer patients. People with serious mental illness must take the same commitment and care to reduce preventable deaths and serious physical illness.
Professor Rosemary Calder is Professor of Health Policy at the University of Victoria’s Mitchell Institute.
Professor James Dunbar is from Deakin University.
Professor Maximilian de Courtan is Professor of Global Health and Director of the Mitchell Institute at the University of Victoria.
This article Australian Medical Journal. read original here.
